| Objective: To investigate the current situation of prevention of VTE in surgical patients,by selecting the common risk assessment model recommended by the guidelines,and observe the implementation of risk assessment and prevention intervention of VTE in the period of operation outside urinary tract,general surgery and bone periphery.To explore the value of caprini risk assessment model in VTE prevention of postoperative patients,and to analyze the results of the prevention of VTE in three departments,so as to provide reference for further prevention of VTE in surgery and reduce the incidence of VTE in surgical patients.Methods: 1.From January 2018 to December 2018,retrospective investigation was made on postoperative patients,including 200 cases of Urology,784 cases of general surgery,224 cases of bone surgery,and analysis of the overall prevention of VTE in three departments.2.The electronic medical records of inpatients in urology surgery from January 2018 to December 2018 were selected retrospectively.According to whether the electronic medical records of caprini risk assessment scale were used,the risk assessment was carried out 24 hours after the operation,and they were divided into assessment group and non assessment group.The electronic medical records used 100 patients with complete risk assessment records as the assessment group;at the same time,the electronic medical records were not used 100 patients with risk assessment and no medical record were included in the non assessment group.Two groups of patients were excluded from the age of less than 18 years old,hospital stay less than 24 hours,admitted to the hospital has diagnosed VTE patients,the general data of the two groups are comparable.Taking the implementation of VTE preventive measures as the observation index,the comparative analysis was carried out.3.A retrospective survey was conducted on 784 patients after general surgery from January 2018 to December 2018.The risk assessment model of caprini was used to analyze the risk of VTE and the common risk factors during perioperative period.4.A retrospective study of 244 Cases of postoperative orthopedic patients from January 2018 to December 2018 was conducted to analyze the risk stratification of VTE and the implementation of preventive measures byusing the caprini risk assessment model.At the same time,60 cases of orthopedic surgery patients from January 2018 to June 2019 were selected to analyze the differences between VTE prevention and guidelines from VTE prevention measures,anticoagulation start time,drug prevention time limit and discharge doctor's orders.Results: 1.The total risk level of the three departments was 12.6% of low risk,22.3% of medium risk,46.5% of high risk and 18.6% of extremely high risk.The total implementation rate of preventive measures was 28.3%,including 8.2% of mechanical prevention,9.4% of drug prevention and 10.7% of joint prevention.2.Compared with the non evaluation group,the implementation rate of preventive measures in the evaluation group was statistically significant(P<0.05);the prevention rate of VTE was increased from 64% to 100%,the combined prevention rate was increased from 12% to 44%,and the mechanical prevention and drug prevention were basically the same.3.The risk of VTE in 784 patients in general surgery: 118 patients in low-risk accounted for 15.05%,160 patients in medium-risk accounted for 20.41%,399 patients in high-risk accounted for 50.89%,107 patients in extremely high-risk accounted for 13.64%;the common risk factors from high to low were age(702 / 784)89.54%,Celiac Operation(370 / 784)47.19%,body mass index BMI(204 / 784)was 26.02%,malignant tumor(102 / 784)was 13.01%,major operation(67 / 784)was 8.55%.4.Among 244 Cases of Orthopaedic Surgery,the risk of VTE was 14.75% in 36 cases of low risk,20.08% in 49 cases of medium risk,31.97% in 78 cases of high risk and 33.20% in 81 cases of very high risk;the implementation rate of VTE prevention measures was 0.82% in mechanical prevention,34.43% in drug prevention,28.69% in combination prevention and 36.36%in other(no prevention or simple basic prevention);including 37 cases of orthopaedic major surgery,all of them belong to the extremely high risk group and take the preventive measures of VTE.Among 60 cases of Orthopaedic Surgery,1 case was treated with mechanical prevention,18 cases with drug prevention and 40 cases with combined prevention,of which 2 cases had severe anticoagulation contraindications;54 cases were treated with drug prevention within 12 hours after operation;the anticoagulation time of drug prevention patients was 7-14 days,29 cases of tha patients were treated with out of hospital orders,which emphasized the anticoagulation to 35 days after operation;1 case was not excluded the possibility of pulmonary embolism.Conclusion: The risk of VTE in surgical inpatients is high,the risk assessment of VTE in departments is still insufficient,and the implementation of preventive measures needs to be strengthened.The standardized use of electronic risk assessment system can significantly improve the prevention and control of perioperative VTE,increase the implementation rate of VTE preventive measures,and reduce the risk of VTE. |
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