| With the widespread use of total joint replacement, there are always increased concernabout postoperative complications. The incidence of deep vein thrombosis(DVT) is high,and it often occurs in the deep veins of lower limb, especially the left. If the patient can notget timely and effective treatment and care, DVT will develop into pulmonary embolismand further threaten the patient’s life.There are certain foundations on the study on DVT in patients undergoing total jointreplacement at the moment. But single-factor intervention or two-factor was often used,and two-factor intervention was better. Bundles of care(BC) consists of a set ofinterventions, each intervention can improve patient’s clinical outcome, and acomprehensive application is better. It is an effective method of implementingevidence-based practice guidelines. This study attempts to take the bundles of care toprevent deep venous thrombosis in mid-elderly patients undergoing total joint replacement.Objective: To develop bundles of care to the prevention of DVT in patientsundergoing total hip arthroplasty(THA) and total knee arthroplasty(TKA). In addition, toevaluate the effectiveness of the measures to the prevention of DVT in mid-elderly patientsundergoing THA and TKA.Methods: To develop the bundles of care to the prevention of DVT in patientsundergoing THA and TKA by literature reviewing and clinical trial.Patients who met ourinclusion criteria were randomized into control group(45cases) and intervention group(45cases).There was no statistic difference in age, gender, education level, operation method,comorbidity and patients’ mastery of DVT disease related knowledge. Control groupreceived usual care, while intervention group received usual care and bundles of care withhealth education based on health belief model, early exercises after total joint replacement,graduated compression stockings or intermittent pneumatic compression andpharmacological prophylaxis. The patients’ mastery of DVT disease related knowledge,symptoms of DVT, hemagglutination inspection, D-dimer and color doppler ultrasound were measured before and after the operation.Results:①At the7th day after surgery, we observed significant higher scores of DVTdisease related knowledge questionnaire and health belief Questionnaire in interventiongroup, compared with control group(P<0.05).②About the score of the health belief,perceived susceptibility, perceived severity, perceived benefits of action and self-efficacyin intervention group were significantly superior to those of control group(P<0.05), whilethere was no statistic difference in perceived barriers of action and healthy power betweenthese two groups(P>0.05).③Patients with Homan signs or Neuhof signs in interventiongroup were significantly more than in control group(P<0.05).④With-in comparisonshowed that in control group, the level of D-dimer was lower in interventiongroup(P<0.05), however, no statistic difference was evidenced on Protein C and Protein Sbetween these two groups(P>0.05).⑤In the hemagglutination inspection, only activatedpartial thromboplastin time(APTT) in intervention group was longer than in controlgroup(P<0.05). There was no statistic difference in the hemagglutination inspection exceptAPTT between these two groups(P>0.05).⑥7days after surgery,1patient appeared bloodstasis in intervention group. However, in control group, there were2patients with DVTand6patients with blood stasis. No patient developed clinical feathers of pulmonaryembolism(PE). The effect of preventive measures in intervention group was better thancontrol group(P<0.05).Conclusions:①Health education based on health belief model could effectivelyenhanced the patients’ DVT disease related knowledge, and the level of health belief,thereby reduce the risk of DVT and improve the patients’ quality of life.②BC decreasedsymptoms of DVT and can prevent DVT in patients undergoing total joint replacement. It isworthy of promotion and application. |
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