The Study On Effect Of Risk Assessment And Graded Intervention In Deep Venous Thrombosis On Patients With The Thoracolumbar Fractures

Objective:To investigate the effect of risk assessment and graded intervention deep venous thrombosis on patients with the thoracolumbar fractures and provide more targeted and feasible suggestions for the prevention of deep venous in the period-perative period of thoracolumbar fracture.Methods:A total of 92 patients with thoracolumbar fracture were enrolled in the department of orthopedics of Wannan Medical College of our university from Aug.2017 to Dec.2018.92 patients were randomly divided into two groups according to the order of admission time: the intervention group(47cases)and control group(45cases).Patients in control group were given conventional treatment and general health guidance.Patients in intervention group were given graded interventions based on conventional treatment.Than compare and analyze indexes of the two groups before and after operation.First,register the patient's general information,including age,sex,educational level,anesthesia,payment methods,hospital stay,body mass index,internal medicine diseases.etc.Blood coagulation function,plasma D dimer and other biochemical tests were measured preoperatively and on the 3rd and 1 week postoperative day and the time of discharge.Routine examinations of deep vein thrombosis color doppler ultrasonography were carried out to calculate the incidence of deep vein thrombosis on the 6th postoperative day and the time of discharge.The diameters of the lower limbs(10cm above the patellar bone,10 cm below the patellar bone and 10 cm above the ankle bone)of the two groups were measured before the surgery,3 days after the surgery and1 week after the surgery,respectively.The age,hospital stay,body mass index and other measurement data were analyzed by test of two independent samples treatment.Sex,educational level,anesthesia,surgical site,payment methods and other counting data were used chi-square test for statistical treatment.Results:1.The differences of the two groups gender,preoperative Auter scale scores,educ ation level,anesthesia method,surgical method,whether and whether patients had in ternal diseases and other general data have no statistical significance(P>0.05),and the materials have good comparability;2.Comparison of coagulation function between the two groups: preoperativecom parison of coagulation function between the two groups had no statistical signific ance(P>0.05)On the 3th and 1 week after the operation,prothrombin time(PT),act ivated partial thrombin time(APTT)and thrombin time(TT)were prolonged,and fi brinogen(FIB)were increased,but the difference in indicators in the intervention gr oup was lower than that in the control group(P<0.05).However,at discharge,the c oagulation indexes of the two groups of patients were decreased in both groups.3.There was no statistical difference in the level of d-dimer before surgery(P>0.05).On the third day after surgery,the level of d-dimer in both groups incre ased significantly(P<0.05),but on the 1 week,the level of d-dimer in theinterventi on group decreased more than that in the control group.4.6.4% in the intervention group(2cases)and The incidence of DVT was17.8% in the control group(8cases),with statistically significant difference(t=0.037,p<0.05).Postoperative deep venous thrombosis in patients with thoracolumbar fract ure mostly occurred in the first week after surgery.Comprehensive preventive mea sures can effectively reduce the incidence of deep vein thrombosis(DVT)inpatients with thoracolumbar fractures,and improve the patient's satisfaction in hospital.5.Comparison of hospitalization days between the two groups:compared with the two groups,the length of hospitalization in the intervention group was shorter than that in the control group,and the difference was statistically significant(P<0.05).Conclusion:Graded interventions based on risk assessment can not only effectively reduce the incidence of peri-operative DVT in patients with thoracolumbar fractures;but also improve the blood circulation and coagulation function of patients.It shortens the length of hospital stay,increases the intimacy between nurses and patients,and improves the satisfaction of patients.At the same time,the patient's lumbar pain and postoperative blood loss were not aggravated.