脊柱外科围手术期患者下肢深静脉血栓诊断流程的构建及应用

Construction and application of diagnostic model for lower extremity deep venous thrombosis in patients with spinal surgery

中文关键词:  脊柱外科  下肢深静脉血栓  诊断  检出率  效果分析

英文关键词:Spine surgery  Deep venous thrombosis  Diagnosis  Detection rate  Effect analysis

中文摘要:

  【摘要】 目的：将下肢深静脉血栓诊断的循证医学证据应用于脊柱外科围手术期患者下肢深静脉血栓诊断流程，以提高下肢深静脉血栓的早期检出率。方法：通过检索诊断下肢深静脉血栓的循证医学证据，结合临床情景和专业判断，最终纳入5条下肢深静脉血栓诊断的循证医学证据，并制定基于此5条循证医学证据的下肢深静脉血栓筛查诊断流程。选取2018年1~5月在中南大学湘雅二医院脊柱外科病房住院的443例围术期患者采取传统血栓诊断流程（传统方法组），即患者出现DVT临床表现或D-二聚体检测值明显高于其阳性临界值时再采取双下肢B超对患者DVT进行筛查诊断。于2018年7月1日～11月30日对同一病区住院的498例围术期患者行基于循证医学的DVT筛查诊断流程（新方法组）。比较两种方法应用前后，脊柱外科围术期患者DVT的发生率及患者确诊DVT时出现下肢肿胀、疼痛、皮肤颜色变紫变暗等DVT临床表现（症状性DVT）的发生情况；通过查看患者双下肢B超检查报告单统计患者DVT临床分型中周围型占比情况。结果：传统方法组与新方法组患者下肢深静脉血栓的发生率分别为2.93%、19.28%，两组比较差异有统计学意义（P＜0.05）；症状性DVT占比分别为100%、18.75%，两组比较差异有统计学意义（P＜0.05）；确诊为下肢深静脉血栓的患者中，周围型下肢深静脉血栓占比分别为7.69%、95.83%，两组比较差异有统计学意义（P＜0.05）。结论：开展基于循证医学的下肢深静脉血栓诊断实践，可提高脊柱外科围术期患者下肢深静脉血栓的早期检出率。

英文摘要:

  【Abstract】 Objectives: To apply the best evidence for the diagnosis of deep venous thrombosis in the diagnosis model among spinal surgery patients, in order to improve the early diagnosis of deep venous thrombosis. Methods: The diagnosis model of deep venous thrombosis based on best evidence was retrieved. Combined with clinical scenarios and professional judgment, the best evidence for the diagnosis of 5 deep venous thrombosis was finally included, and evidence-based thrombus diagnostic model screening based on best evidence was developed. A total of 443 patients in the perioperative period who were hospitalized in the spinal surgery ward of the Second Xiangya Hospital of Central South Unviersity from January to May 2018 were selected to adopt the traditional thrombosis diagnosis process(traditional method group), that was, when DVT clinical manifestations or D-dimer detection values were significantly higher than the positive threshold value, B-ultrasound of lower limbs was adopted to screen and diagnose DVT in patients. From July 1, 2018 to November 30, 2018, 498 perioperative patients hospitalized in the same ward underwent an evidence-based DVT screening diagnosis process(new method group). Before and after the application of evidence-based DVT screening and diagnosis procedures, the incidence of DVT in perioperative patients of spinal surgery and the occurrence of DVT clinical manifestations, such as lower limb swelling, pain, and purple and dark skin color, occurred in patients diagnosed with DVT were compared. The proportion of peripheral types in clinical classification of DVT of the patients was analyzed by checking the B-ultrasonic examination report sheet of both lower limbs. Results: The incidence of deep venous thrombosis in traditional method group and new method group was 2.93% and 19.28% respectively. The difference between the two groups was statistically significant(P<0.05). The incidence of symptomatic DVT in patients with deep venous thrombosis was respectively 100%, 18.75%, the difference between the two groups was statistically significant(P<0.05). Among those deep vein thrombosis of the lower extremity patients, the peripheral deep venous thrombosis was respectively 7.69% and 95.83%. The difference between the two groups was statistically significant(P<0.05). Conclusions: Evidence-based practice of the deep venous thrombosis diagnosis can improve the detection rate of deep venous thrombosis among the perioperative period of spinal surgery patients ,which can achieve early diagnosis of deep venous thrombosis.