Effects Of Preoperative Health Education Based On The Health Belief Mode For Prevention Of Deep Venous Thrombosis After Total Hip Arthroplasty

Background Lower extremity deep venous thrombosis is a common complication of total hip arthroplasty. If timely and reasonable intervention was not given, it can lead to deep vein valve insufficiency and pulmonary embolism, increase the pain of the patients and even threaten the life of them. Therefore to investigate prevention intervention to prevent DVT after THA has important clinical significance.Objective Explore the risk factors of the lower extremities DVT after THA and the value of preoperative health education based on the health belief model in reducing the incidence rate of DVT after THA.Methods Clinical data of 218 cases that have received THA surgery in our hospital from Jan.2005-Jan.2014 were analyzed retrospectively.29 cases that had DVT after operations were taken into DVT group.189 cases without DVT were taken into no DVT group. Single factor analysis used chi-square test and t-test and multiple factors analysis used multivariable Logistic regression analysis to screen the risk factors for DVT after THA.120 cases were selected from Jan.2010-Jan.2014,which were divided into experiment group and control group (both 60 cases) randomly. The control group was given THA routine nursing intervention, including health education, functional exercise, physical and drug prevention. The experiment group was given the preoperative health education based on the health belief model except the routine intervention of control group. First of all, let patients be afraid of results of their harmful behavior to health. Then teach them to believe if they give up harmful behavior and take the healthy behavior, they would get good outcome. At the same time clear understanding for difficulties to change during the process was essential. Finally, to make them be full of confidence to change. DVT basic knowledge scores, health belief level rating, postoperative function exercise start time and the treatment compliance, the incidence of DVT symptoms, blood coagulation function, D-dimer level, protein C and S and the ultrasonic examination of the two groups were observed before and after the intervention.Results1. The risk factors analysis of the DVT after THA1.1 Single factor analysis result showed the women constitute ratio, senior age (age≥70), obesity (BMI≥ 25 kg/m2), increased triglycerides (triglycerides≥117 mmol/L), large amount of blood transfusion (amount≥ 800ml), associated with diabetes, varicose veins and bone cement using of the DVT group was significantly higher than the no DVT group (P<0.05). Compliance of early functional exercise, using pressure instrument and drug in DVT group was lower than no DVT group (P=0.008). The extremity difference, smoking history, high blood pressure and coronary heart disease history, anesthesia method, blood coagulation function, operative time of the two groups had no statistically significant difference (P> 0.05).1.2 Multivariable Logistic regression analysis result showed that age≥70 (OR = 4.814,95% CI 2.284 to 6.468, P= 2.284), blood transfusion amount >800 ml (OR= 3.315,95% CI 1.306 to 8.411, P= 0.012), and triglycerides≥ 117moml/L (OR= 2.123,95% CI 1.036 to 5.238, P= 1.036) were the independent risk factors for the DVT after THA. Postoperative functional exercise (OR=0.771,95% CI 0.603 to 0.987, P= 0.039), anticoagulation drug (OR=0.579,95%CI 0.275～0.935, P=0.037) and intermittent pneumatic compression devices (OR=0.456,95%CI 0.176～0.890, P=0.022) were the protection factors for the DVT after THA.2. The effect of preoperative health education based on the health belief model in preventing DVT after THA2.1 The DVT basic knowledge score, health belief level rating, the incidence of DVT symptoms, blood coagulation function, D-dimer level, activity of protein C and protein S and ultrasound examination of experiment group and control group has no statistically difference before intervention (P> 0.05).2.2 The DVT basic knowledge score and health belief level rating of the experiment group after nursing intervention were significantly higher than control group. The average postoperative function exercise start time of experiment group (0.62±0.24d) was obviously earlier than control group (1.76±0.72d). The good rate of compliance of postoperative function exercise in experiment group (54/60,90.0%) was obviously better than control group(32/60,53.3%). The perimeter and surface temperature of the lower limbs and the incidence rates of Homan sign and Neuhof sign and D-dimer level in experiment group was significantly lower than the control group (P< 0.05). The activity of protein C and protein S, blood coagulation function of the two groups had no statistically significant difference (P> 0.05). One case was found blood stasis of deep vein throght ultrasound test in experiment group (1.67%) but no DVT. Seven cases in control group were found blood stasis (11.67%) and three cases were diagnosed DVT (5.0%). There were no pulmonary embolism found in both groups. The incidence rates of blood stasis and DVT in experiment group were significantly lower than the control group (P> 0.05).Conclusion:1. There are many risk factors of DVT after THA. Senior age, large amount of blood transfusion and high triglycerides level were the independent risk factors of DVT after THA. Early postoperative function exercise, using anticoagulation drug and intermittent pneumatic compression devices were the protection factors of the DVT after THA.2. Whole evaluation of all kinds of the risk factors for THA must be paid great attention in nursing. Preoperative health education based on the health belief model can increase the compliance of patients effectively. It can make patients easy to accept the early exercise, physical and medication prevention for DVT. Then rehabilitation after THA would be accelerated and the risk of DVT reduced.