| Objective The study aims to develop a simple,feasible,and early warning model of deep vein thrombosis in patients undergoing hip arthroplasty in accordance with China's national conditions,and to independently,scientifically and effectively carry out risk assessment and prevention of thrombosis in hip arthroplasty patients Provide references.Methods1.Literature review: Extensive review of relevant domestic and foreign literature on the occurrence of deep vein thrombosis in patients after hip replacement,combined with China's national conditions,analysis and summary of risk factors for deep vein thrombosis in patients after hip replacement in China,and preliminary formation of hip A pool of risk assessment indicators for patients with deep vein thrombosis after replacement.2.Qualitative interviews: Based on a literature review,this study selected experts in orthopaedics and vascular surgery from a tertiary Class A hospital in Inner Mongolia to conduct interviews to further improve the indicator system and prepare a Delphi expert letter inquiry questionnaire.3.Delphi expert inquiry: Send the revised early warning model of the risk of deep vein thrombosis in patients after hip replacement surgery to the experts,and select indicators based on expert opinions to finally establish the early warning model of risk of deep vein thrombosis in patients after hip replacement.The analytic hierarchy process is used to determine the weight of each index,and the judgment matrix is constructed with yaahp software and the consistency check is performed to obtain the weight value of each index.4.A total of 248 patients who underwent hip arthroplasty in three tertiary Class A hospitals in Inner Mongolia from June to December 2019 were selected and evaluated using a warning model of deep vein thrombosis after hip replacement.Verify the reliability and validity of the model,and draw the ROC curve to determine the threshold of the model.Results1.The effective recovery rates of the two rounds of expert letter enquiries are94.12% and 100%,respectively,and the authority of the experts is 0.88 and 0.89.In the first round,the average value of the importance of all indicators ranges from 3.5 to 4.88 and the coefficient of variation ranges from 0.07 ~ 0.23;in the second round,the mean value of all indicators is 4.0 ~ 4.88,the coefficient of variation is 0.07 ~ 0.18,and the Kendall coordination coefficients of the two rounds are 0.267 and 0.187.The 7first-level indicators and weights are respectively It is: the basic situation of the patient(0.2146),previous history(0.1205),comorbidities(0.0750),medication(0.0922),activity(0.1205),surgery-related conditions(0.2146),and laboratory tests(0.1625).An early warning model of 7 primary indicators and 45 secondary indicators was finally formed.2.The early warning model was applied to 248 patients who underwent hip arthroplasty.The results showed that the overall Cronbach coefficient of the model was0.702.The exploratory factor analysis extracted 3 common factors and the cumulative contribution rate reached 71.683%.The area under the ROC curve of the early warning model is 0.821,the standard error is 0.033,the 95% confidence interval is 0.757 to0.885,the maximum value of the Jordan index is 0.535,the sensitivity is 88%,and the specificity is 65.5%.The threshold is 17 points.Conclusion1.Based on literature review,qualitative interviews,expert consultation and hierarchical analysis,a risk early-warning model for lower extremity deep venous thrombosis in hip replacement patients was developed as a risk assessment tool.The model contains 7 first-level indicators and 45 second-level indicators.It has a certain scientific nature,can objectively and truthfully reflect the risk factors of venous thrombosis,and provides a reference for nursing evaluation.2.Through empirical tests,the reliability and validity of the early warning model are good,and the operability is strong,which can provide work guidance for the prevention and treatment of thrombosis in patients with hip replacement. |
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