脊柱外科术后患者深静脉血栓预防及管理的最佳证据总结
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摘要
目的检索并获取脊柱外科术后患者深静脉血栓预防及管理的相关证据,为临床提供参考,以降低脊柱外科术后患者深静脉血栓的发生率。方法应用循证护理的方法,针对脊柱外科术后患者深静脉血栓预防及管理提出问题,检索相关文献,采用澳大利亚JBI循证卫生保健中心的文献评价标准和证据分级系统,对各类研究进行文献质量评价及证据级别评定。结果结合专业人员的判断,总结出27条脊柱外科术后患者深静脉血栓预防及管理的证据,包括深静脉血栓评估、诊断与筛查、干预策略、预防时机及方法、健康指导等。结论本研究总结了目前关于脊柱外科术后患者深静脉血栓预防及管理的最佳证据,可为护士及护理管理者提供循证依据。通过应用最佳证据,以科学的方法管理和预防脊柱外科术后深静脉血栓,可提升护理质量。
Objective To select and obtain the best evidence for deep venous thrombosis(DVT) prophylaxis in spinal surgery patients after operation so as to provide reference for clinical practice to decrease the rate of DVT.Methods Using the method of evidence-based nursing,clinical question of DVT prevention in spinal surgery patients was raised. Relevant research was retrieved by computer search. JBI evidence appraisal and recommendation system were used to evaluate quality of studies and level of evidence. Results Combined with judgment of clinical professionals,totally 27 evidences selected,including DVT assessment,diagnosis and screening,intervention strategies,prevention time and methods,health guidance,etc. Conclusion This study summarized the best evidence for prevention and management of deep venous thrombosis after spinal surgery,and help clinical nurses and nursing administrators decision-making,ultimately through adapting the best evidence and using scientific nursing methods to solve the clinical problems and improve nursing quality.
Objective To select and obtain the best evidence for deep venous thrombosis(DVT) prophylaxis in spinal surgery patients after operation so as to provide reference for clinical practice to decrease the rate of DVT.Methods Using the method of evidence-based nursing,clinical question of DVT prevention in spinal surgery patients was raised. Relevant research was retrieved by computer search. JBI evidence appraisal and recommendation system were used to evaluate quality of studies and level of evidence. Results Combined with judgment of clinical professionals,totally 27 evidences selected,including DVT assessment,diagnosis and screening,intervention strategies,prevention time and methods,health guidance,etc. Conclusion This study summarized the best evidence for prevention and management of deep venous thrombosis after spinal surgery,and help clinical nurses and nursing administrators decision-making,ultimately through adapting the best evidence and using scientific nursing methods to solve the clinical problems and improve nursing quality.
引文
[1]谢煜,包倪荣,刘云,等.骨科大手术患者围手术期深静脉血栓预防策略研究[J].中华护理杂志,2017,52(7):773-779
[2]山慈明,尹慧珍,杜书明,等.围手术期深静脉血栓形成的物理预防研究进展[J].中华护理杂志,2014,49(3):349-354.
[3]Pierce J,Kositratna G,Attiah M,et al.Efficiency of spinal anesthesia versus general anesthesia for lumbar spinal surgery:a retrospective analysis of 544 patients[J].Local Reg Anesth,2017,10:91-98.
[4]Rojas-Tomba F,Gormaz-Talavera I,Menendez-Quintanilla IE,et al.Incidence and risk factors of venous thromboembolism in major spinal surgery with no chemical or mechanical prophylaxis[J].Rev Esp Cir Ortop Traumatol,2016,60(2):133-140.
[5]Glotzbecker MP,Bono CM,Wood KB,et al.Thromboembolic disease in spinal surgery:a systematic review[J].Spine,2009,34(3):291-303.
[6]Yamaguchi T,Hasegawa M,Niimi R,et al.Incidence and time course of asymptomatic deep vein thrombosis with fondaparinux in patients undergoing total joint arthroplasty[J].Thromb Res,2010,126(4):323-326.
[7]Smith JS,Fu KM,Polly DJ,et al.Complication rates of three common spine procedures and rates of thromboembolism following spine surgery based on 108,419 procedures:a report from the Scoliosis Research Society Morbidity and Mortality Committee[J].Spine,2010,35(24):2140-2149.
[8]邱贵兴.中国骨科大手术静脉血栓栓塞症预防指南[J].中华关节外科杂志(电子版),2016,36(2):65-71.
[9]朱政,胡雁,邢唯杰,等.不同类型循证问题的构成[J].护士进修杂志,2017,32(21):1991-1994.
[10]Dicenso A,Bayley L,Haynes RB.Accessing pre-appraised evidence:fine-tuning the 5S model into a 6S model[J].Evid Based Nurs,2009,12(4):99-101.
[11]谢利民,王文岳.《临床指南研究与评价系统Ⅱ》简介[J].中西医结合学报,2012,10(2):160-165.
[12]米元元,沈月,郝彬,等.ICU患者肠内营养支持并发腹泻的循证护理实践[J].中华护理杂志,2017,53(11):1291-1298.
[13]Merli G,Galanis T,Eraso L,et al.Deep vein thrombosis[EB/OL].(2017-10-01)[2018-05-17].http://h-s.bestpractice.bmj.com/topics/en-gb/70.
[14]Hansebout R,Kachur E.Acute traumatic spinal cord injury[EB/OL].(2014-10-20)[2018-05-17].https://www.uptodate.com/contents/zh-Hans/acute-traumatic-spinal-cord-injury?search=Acute%20traumatic%20spinal%20cord%20injury&source=default&-display_rank=1.
[15]Pai M,Douketis JD.Prevention of venous thromboembolic disease in surgical patients[EB/OL].(2017-09-28)[2018-05-17].https://www.uptodate.com/contents/zh-Hans/prevention-of-venousthromboembolic-disease-in-adult-nonorthopedic-surgical-patients?search_result&selectedTitle=1~150&usage_type=default&display_rank=1.
[16]The Joanna Briggs Institute(JBI).Venous thromboembolism(longterm treatment):heparin[EB/OL].(2017-05-25)[2018-05-17].http://ovidsp.tx.ovid.com/sp-3.30.0b/ovidweb.cgi7csl_190.
[17]The Joanna Briggs Institute(JBI).Thromboembolism:low molecular weight heparin[EB/OL].(2017-01-04)[2018-05-17].http://ovidsp.tx.ovid.com/sp-3.30.0b/ovidweb.cgi=S.sh.21%7c6%7c1.
[18]The Joanna Briggs Institute(JBI).Graduated compression stockings:clinician information[EB/OL].(2016-01-11)[2018-05-17].http://ovidsp.tx.ovid.com/sp-3.30.0b/ovidweb.cgi=S.sh.21%7c6%7c1.
[19]The Joanna Briggs Institute(JBI).Orthopedic surgery:mechanical prophylaxis for venous thromboembolism[EB/OL].(2016-09-13)[2018-05-17].http://ovidsp.tx.ovid.com/sp-3.30.0b/ovidweb.cgi=S.sh.21%7c6%7c1.
[20]The Joanna Briggs Institute(JBI).Venous thromboembolism:prevention and prophylaxis[EB/OL].(2017-04-28)[2018-05-17].http://ovidsp.tx.ovid.com/sp-3.30.0b/ovidweb.cgi=S.sh.40%7c2%7c1.
[21]The Joanna Briggs Institute(JBI).Deep vein thrombosis:clinical information[EB/OL].(2016-03-07)[2018-05-17].http://ovidsp.tx.ovid.com/sp-3.30.0b/ovidweb.cgi=S.sh.21%7c5%7c1.
[22]The Joanna Briggs Institute(JBI).Deep vein thrombosis:treatments(thrombolysis and thrombectomy[EB/OL].(2016-04-03)[2018-05-17].http://ovidsp.tx.ovid.com/sp-3.30.0b/ovidweb.cgi=S.sh.21%7c6%7c1.
[23]The Joanna Briggs Institute(JBI).Deep vein thrombosis prophylaxis[EB/OL].(2017-04-10)[2018-05-17].http://ovidsp.tx.ovid.com/sp-3.30.0b/ovidweb.cgi=S.sh.21%7c6%7c1.
[24]The Joanna Briggs Institute(JBI).Venous thromboembolism(initial treatment):heparin[EB/OL].(2017-05-25)[2018-05-17].http://ovidsp.tx.ovid.com/sp-3.30.0b/ovidweb.cgi=S.sh.40%7c2%7csl_190.
[25]Court A,Lockwood C,O'Connell A,et al.Graduated compression stockings for the prevention of post operative venous thromboembolism[J].Aust Nurs J,2008,16(2):31-33.
[26]Dhall SS,Hadley MN,Aarabi B,et al.Deep venous thrombosis and thromboembolism in patients with cervical spinal cord injuries[J].Neurosurgery,2013,72(2):244-254.
[27]Desjardins B,Rybicki FJ,Kim HS,et al.ACR appropriateness Criteria(R)suspected upper extremity deep vein thrombosis[J].J Am Coll Radiol,2012,9(9):613-619.
[28]Ho VB,van Geertruyden PH,Yucel EK,et al.ACR Appropriateness Criteria(R)on suspected lower extremity deep vein thrombosis[J].J Am Coll Radiol,2011,8(6):383-387.
[29]Vedantham S,Thorpe PE,Cardella JF,et al.Quality improvement guidelines for the treatment of lower extremity deep vein thrombosis with use of endovascular thrombus removal[J].J Vasc Interv Radiol,2009,20(7):227-239.
[30]Stanton C,Writer C.Guideline for prevention of venous thromboembolism[J].Aorn J,2017,106(3):7-9.
[31]Ravikumar R,Williams KJ,Babber A,et al.Neuromuscular electrical stimulation for the prevention of venous thromboembolism[J].Cochrane Database Syst Rev,2017,11(2):1-12.
[32]Sansone JM,del Rio AM,Anderson PA.The prevalence of and specific risk factors for venous thromboembolic disease following elective spine surgery[J].J Bone Joint Surg Am,2010,92(2):304-313.
[33]Glotzbecker MP,Bono CM,Wood KB,et al.Thromboembolic disease in spinal surgery:a systematic review[J].Spine,2009,34(3):291-303.
[34]Hill J,Treasure T.Reducing the risk of venous thromboembolism(deep vein thrombosis and pulmonary embolism)in patients admitted to hospital:summary of the NICE guideline[J].Heart,2010,96(11):879-882.
[35]中华医学会骨科学分会创伤骨科学组.创伤骨科患者深静脉血栓形成筛查与治疗的专家共识[J].中华创伤骨科杂志,2013,15(12):1013-1017.
[36]Geerts WH,Bergqvist D,Pineo GF,et al.Prevention of venous thromboembolism:American College of Chest Physicians Evidence-Based Clinical Practice Guidelines(8th Edition)[J].Chest,2008,133(6):381-453.
[37]Geersing GJ,Janssen KJM,Oudega R,et al.Excluding venous thromboembolism using point of care D-dimer tests in outpatients:a diagnostic meta-analysis[J].BMJ,2009,339(7718):450-450.
[38]Kakkos SK,Caprini JA,Geroulakos G,et al.Combined intermittent pneumatic leg compression and pharmacological prophylaxis for prevention of venous thrombo-embolism in highrisk patients[J].Eur J Vasc Endovasc Surg,2009,37(3):364-365.
[39]Rajasekhar A,Lottenberg R,Lottenberg L,et al.Pulmonary embolism prophylaxis with inferior vena cava filters in trauma patients:a systematic review using the meta-analysis of observational studies in epidemiology(MOOSE)guidelines[J].JThromb Thrombolysis,2011,32(1):40-46.
[40]Amin AN,Girard F,Samama MM.Does ambulation modify venous thromboembolism risk in acutely ill medical patients?[J].Thromb Haemost,2010,104(5):955-961.
[41]Schellong SM,Beyer J,Kakkar AK,et al.Ultrasound screening for asymptomatic deep vein thrombosis after major orthopaedic surgery:the VENUS study[J].J Thromb Haemost,2007,5(7):1431-1437.
[42]Kim DY,Kobayashi L,Chang D,et al.Early pharmacological venous thromboembolism prophylaxis is safe after operative fixation of traumatic spine fractures[J].Spine,2015,40(5):299-304.
[43]Jia X,Kowalski RG,Sciubba DM,et al.Critical care of traumatic spinal cord injury[J].J Intensive Care Med,2013,28(1):12-23.
[44]Strom RG,Frempong-Boadu AK.Low-molecular-weight heparin prophylaxis 24 to 36 hours after degenerative spine surgery:risk of hemorrhage and venous thromboembolism[J].Spine,2013,38(23):1498-1502.
[45]王春青,胡雁.JBI证据预分级及证据推荐级别系统(2014版)[J].护士进修杂志,2015,30(11):964-967.
[46]Andras A,Sala TA,Crawford F.Vitamin K antagonists or lowmolecular-weight heparin for the long term treatment of symptomatic venous thromboembolism[J].Cochrane Database Syst Rev,2012,10:1-73.
[2]山慈明,尹慧珍,杜书明,等.围手术期深静脉血栓形成的物理预防研究进展[J].中华护理杂志,2014,49(3):349-354.
[3]Pierce J,Kositratna G,Attiah M,et al.Efficiency of spinal anesthesia versus general anesthesia for lumbar spinal surgery:a retrospective analysis of 544 patients[J].Local Reg Anesth,2017,10:91-98.
[4]Rojas-Tomba F,Gormaz-Talavera I,Menendez-Quintanilla IE,et al.Incidence and risk factors of venous thromboembolism in major spinal surgery with no chemical or mechanical prophylaxis[J].Rev Esp Cir Ortop Traumatol,2016,60(2):133-140.
[5]Glotzbecker MP,Bono CM,Wood KB,et al.Thromboembolic disease in spinal surgery:a systematic review[J].Spine,2009,34(3):291-303.
[6]Yamaguchi T,Hasegawa M,Niimi R,et al.Incidence and time course of asymptomatic deep vein thrombosis with fondaparinux in patients undergoing total joint arthroplasty[J].Thromb Res,2010,126(4):323-326.
[7]Smith JS,Fu KM,Polly DJ,et al.Complication rates of three common spine procedures and rates of thromboembolism following spine surgery based on 108,419 procedures:a report from the Scoliosis Research Society Morbidity and Mortality Committee[J].Spine,2010,35(24):2140-2149.
[8]邱贵兴.中国骨科大手术静脉血栓栓塞症预防指南[J].中华关节外科杂志(电子版),2016,36(2):65-71.
[9]朱政,胡雁,邢唯杰,等.不同类型循证问题的构成[J].护士进修杂志,2017,32(21):1991-1994.
[10]Dicenso A,Bayley L,Haynes RB.Accessing pre-appraised evidence:fine-tuning the 5S model into a 6S model[J].Evid Based Nurs,2009,12(4):99-101.
[11]谢利民,王文岳.《临床指南研究与评价系统Ⅱ》简介[J].中西医结合学报,2012,10(2):160-165.
[12]米元元,沈月,郝彬,等.ICU患者肠内营养支持并发腹泻的循证护理实践[J].中华护理杂志,2017,53(11):1291-1298.
[13]Merli G,Galanis T,Eraso L,et al.Deep vein thrombosis[EB/OL].(2017-10-01)[2018-05-17].http://h-s.bestpractice.bmj.com/topics/en-gb/70.
[14]Hansebout R,Kachur E.Acute traumatic spinal cord injury[EB/OL].(2014-10-20)[2018-05-17].https://www.uptodate.com/contents/zh-Hans/acute-traumatic-spinal-cord-injury?search=Acute%20traumatic%20spinal%20cord%20injury&source=default&-display_rank=1.
[15]Pai M,Douketis JD.Prevention of venous thromboembolic disease in surgical patients[EB/OL].(2017-09-28)[2018-05-17].https://www.uptodate.com/contents/zh-Hans/prevention-of-venousthromboembolic-disease-in-adult-nonorthopedic-surgical-patients?search_result&selectedTitle=1~150&usage_type=default&display_rank=1.
[16]The Joanna Briggs Institute(JBI).Venous thromboembolism(longterm treatment):heparin[EB/OL].(2017-05-25)[2018-05-17].http://ovidsp.tx.ovid.com/sp-3.30.0b/ovidweb.cgi7csl_190.
[17]The Joanna Briggs Institute(JBI).Thromboembolism:low molecular weight heparin[EB/OL].(2017-01-04)[2018-05-17].http://ovidsp.tx.ovid.com/sp-3.30.0b/ovidweb.cgi=S.sh.21%7c6%7c1.
[18]The Joanna Briggs Institute(JBI).Graduated compression stockings:clinician information[EB/OL].(2016-01-11)[2018-05-17].http://ovidsp.tx.ovid.com/sp-3.30.0b/ovidweb.cgi=S.sh.21%7c6%7c1.
[19]The Joanna Briggs Institute(JBI).Orthopedic surgery:mechanical prophylaxis for venous thromboembolism[EB/OL].(2016-09-13)[2018-05-17].http://ovidsp.tx.ovid.com/sp-3.30.0b/ovidweb.cgi=S.sh.21%7c6%7c1.
[20]The Joanna Briggs Institute(JBI).Venous thromboembolism:prevention and prophylaxis[EB/OL].(2017-04-28)[2018-05-17].http://ovidsp.tx.ovid.com/sp-3.30.0b/ovidweb.cgi=S.sh.40%7c2%7c1.
[21]The Joanna Briggs Institute(JBI).Deep vein thrombosis:clinical information[EB/OL].(2016-03-07)[2018-05-17].http://ovidsp.tx.ovid.com/sp-3.30.0b/ovidweb.cgi=S.sh.21%7c5%7c1.
[22]The Joanna Briggs Institute(JBI).Deep vein thrombosis:treatments(thrombolysis and thrombectomy[EB/OL].(2016-04-03)[2018-05-17].http://ovidsp.tx.ovid.com/sp-3.30.0b/ovidweb.cgi=S.sh.21%7c6%7c1.
[23]The Joanna Briggs Institute(JBI).Deep vein thrombosis prophylaxis[EB/OL].(2017-04-10)[2018-05-17].http://ovidsp.tx.ovid.com/sp-3.30.0b/ovidweb.cgi=S.sh.21%7c6%7c1.
[24]The Joanna Briggs Institute(JBI).Venous thromboembolism(initial treatment):heparin[EB/OL].(2017-05-25)[2018-05-17].http://ovidsp.tx.ovid.com/sp-3.30.0b/ovidweb.cgi=S.sh.40%7c2%7csl_190.
[25]Court A,Lockwood C,O'Connell A,et al.Graduated compression stockings for the prevention of post operative venous thromboembolism[J].Aust Nurs J,2008,16(2):31-33.
[26]Dhall SS,Hadley MN,Aarabi B,et al.Deep venous thrombosis and thromboembolism in patients with cervical spinal cord injuries[J].Neurosurgery,2013,72(2):244-254.
[27]Desjardins B,Rybicki FJ,Kim HS,et al.ACR appropriateness Criteria(R)suspected upper extremity deep vein thrombosis[J].J Am Coll Radiol,2012,9(9):613-619.
[28]Ho VB,van Geertruyden PH,Yucel EK,et al.ACR Appropriateness Criteria(R)on suspected lower extremity deep vein thrombosis[J].J Am Coll Radiol,2011,8(6):383-387.
[29]Vedantham S,Thorpe PE,Cardella JF,et al.Quality improvement guidelines for the treatment of lower extremity deep vein thrombosis with use of endovascular thrombus removal[J].J Vasc Interv Radiol,2009,20(7):227-239.
[30]Stanton C,Writer C.Guideline for prevention of venous thromboembolism[J].Aorn J,2017,106(3):7-9.
[31]Ravikumar R,Williams KJ,Babber A,et al.Neuromuscular electrical stimulation for the prevention of venous thromboembolism[J].Cochrane Database Syst Rev,2017,11(2):1-12.
[32]Sansone JM,del Rio AM,Anderson PA.The prevalence of and specific risk factors for venous thromboembolic disease following elective spine surgery[J].J Bone Joint Surg Am,2010,92(2):304-313.
[33]Glotzbecker MP,Bono CM,Wood KB,et al.Thromboembolic disease in spinal surgery:a systematic review[J].Spine,2009,34(3):291-303.
[34]Hill J,Treasure T.Reducing the risk of venous thromboembolism(deep vein thrombosis and pulmonary embolism)in patients admitted to hospital:summary of the NICE guideline[J].Heart,2010,96(11):879-882.
[35]中华医学会骨科学分会创伤骨科学组.创伤骨科患者深静脉血栓形成筛查与治疗的专家共识[J].中华创伤骨科杂志,2013,15(12):1013-1017.
[36]Geerts WH,Bergqvist D,Pineo GF,et al.Prevention of venous thromboembolism:American College of Chest Physicians Evidence-Based Clinical Practice Guidelines(8th Edition)[J].Chest,2008,133(6):381-453.
[37]Geersing GJ,Janssen KJM,Oudega R,et al.Excluding venous thromboembolism using point of care D-dimer tests in outpatients:a diagnostic meta-analysis[J].BMJ,2009,339(7718):450-450.
[38]Kakkos SK,Caprini JA,Geroulakos G,et al.Combined intermittent pneumatic leg compression and pharmacological prophylaxis for prevention of venous thrombo-embolism in highrisk patients[J].Eur J Vasc Endovasc Surg,2009,37(3):364-365.
[39]Rajasekhar A,Lottenberg R,Lottenberg L,et al.Pulmonary embolism prophylaxis with inferior vena cava filters in trauma patients:a systematic review using the meta-analysis of observational studies in epidemiology(MOOSE)guidelines[J].JThromb Thrombolysis,2011,32(1):40-46.
[40]Amin AN,Girard F,Samama MM.Does ambulation modify venous thromboembolism risk in acutely ill medical patients?[J].Thromb Haemost,2010,104(5):955-961.
[41]Schellong SM,Beyer J,Kakkar AK,et al.Ultrasound screening for asymptomatic deep vein thrombosis after major orthopaedic surgery:the VENUS study[J].J Thromb Haemost,2007,5(7):1431-1437.
[42]Kim DY,Kobayashi L,Chang D,et al.Early pharmacological venous thromboembolism prophylaxis is safe after operative fixation of traumatic spine fractures[J].Spine,2015,40(5):299-304.
[43]Jia X,Kowalski RG,Sciubba DM,et al.Critical care of traumatic spinal cord injury[J].J Intensive Care Med,2013,28(1):12-23.
[44]Strom RG,Frempong-Boadu AK.Low-molecular-weight heparin prophylaxis 24 to 36 hours after degenerative spine surgery:risk of hemorrhage and venous thromboembolism[J].Spine,2013,38(23):1498-1502.
[45]王春青,胡雁.JBI证据预分级及证据推荐级别系统(2014版)[J].护士进修杂志,2015,30(11):964-967.
[46]Andras A,Sala TA,Crawford F.Vitamin K antagonists or lowmolecular-weight heparin for the long term treatment of symptomatic venous thromboembolism[J].Cochrane Database Syst Rev,2012,10:1-73.