Design And Application Of Perioperative VTE Prevention In Patients With Lumbar Spinal Stenosis Based On ERAS Concept

Objective1.Using the concept of Accelerated rehabilitation surgery(ERAS)as the framework,to summarize the evidence related to the tissue management,perioperative evaluation,health education,and prevention of venous thromboembolism(VTE)in patients with lumbar spinal stenosis(LSS),and to provide evidence-based evidence for the development of perioperative VTE prevention programs.2.The scheme was applied clinically to reduce the incidence of VTE,shorten postoperative bed rest time and catheter indwelling time,and reduce patients’ pain level,anxiety and depression scores.Methods:1.Literature review: Clinical nursing problems were established according to the PIPOST principle,based on the "6S" evidence pyramid model,top-down retrieval of computer decision systems,guide networks,databases,etc.at home and abroad,such as Up To Date.The Clinical Guidelines Research and Evaluation System(AGREE Ⅱ)is used to evaluate the quality of the guidelines,the expert consensus,the system evaluation tool(AMSTAR 2.0),the Australian JBI evidence-based health care center corresponding evaluation criteria for quality evaluation.2.Expert meeting method: The feasibility,suitability,clinical significance and effectiveness of the evidence contents were evaluated through the expert meeting to form the final draft of the Plan.3.Clinical empirical study: non-synchronous controlled experimental study.Convenience sampling method was used to select LSS patients admitted from 2022.03 to 2022.07 in the Spinal surgery department of a third-class A hospital in Chifeng City as the control group,and LSS patients admitted from 2022.08 to 2022.12 as the experimental group.The control group received routine nursing,and the experimental group received perioperative nursing based on ERAS concept.The incidence rate of VTE,scores of pain,anxiety and depression,postoperative bed time and catheter indent time were compared between the two groups.Results:1.Summary of evidence: Through the retrieval of perioperative VTE prevention,ERAS guidelines,systematic review,evidence summary and expert consensus in patients undergoing LSS surgery,5 clinical decisions,12 guidelines,5 evidence summaries,7 systematic reviews and 6 expert consensus were finally included.The 95 pieces of evidence were preliminarily summarized to form the first draft of the Plan.2.Expert meeting: The final draft of the Plan was formed after the contents of evidence were modified,deleted and added through the expert meeting.The final draft of the plan contains 89 pieces of evidence,including six aspects: organization and management,perioperative assessment,health education,basic prevention before,during and after surgery,physical prevention and chemical prevention.3.Empirical Research:(1)There was no difference in the general data between the two groups(P>0.05).(2)No pulmonary embolism occurred in both groups.The experimental group had 1 case of slow venous flow and no VTE,the control group had 1 case of deep vein thrombosis and 5cases of intermuscular vein thrombosis.The incidence of VTE in the experimental group was lower than that in the control group,and the difference was statistically significant(p<0.05).The number of cases with Homans sign and Neuhof sign in experimental group was significantly lower than that in control group,and the difference was statistically significant(p<0.05).(3)There was no difference in the indwelling time of postoperative drainage tube between experimental group and control group(P>0.05).Urinary catheter indwelling time and bed rest time of experimental group were shorter than those of control group,and the difference was significant(p<0.05).(4)There was no difference in VAS score between 2 groups at admission(p>0.05).The VAS scores of the experimental group were lower than those of the control group at 3 and 7days after surgery,and the difference was significant(P<0.05).(5)There was no significant difference in anxiety and depression scores between 2groups at admission(p>0.05).The anxiety and depression scores of test group were lower than those of control group 1 day before surgery and at discharge,and the difference was significant(P<0.05).Conclusions:1.According to the literature review,ERAS was developed late in the field of spinal surgery,and standardized clinical nursing workflow is lacking.There are no studies on perioperative VTE prevention in patients with LSS based on the concept of ERAS.2.Perioperative nursing practice based on ERAS concept reduced the incidence of VTE,perioperative anxiety,depression and pain scores of patients.It is feasible and effective in clinical application and can provide reference for clinical practice.