In recent years, deep vein thrombosis (DVT) has increased year by year trend, incidence of thrombosis sequelae seriously affect the patient's ability to work, and even cause damage, especially in patients after surgery is associated with venous thrombosis due to various reasons. Knowledge of deep venous thrombosis can help prevent deep venous thrombosis and reduce hospital stay, medical costs and mortality.
Risk factors for deep venous thrombosis
(1) slow venous blood flow
(2) injury to the venous wall. Congenital immunodeficiency disease of scarlet; Theta mechanical damage; Computerized vein surgery; Bilateral infectious lesions.
(3) hypercoagulation: it is one of the basic factors causing venous thrombosis.
(4) other factors: postoperative deep vein thrombosis is generally closely related to the type of surgery, degree of trauma, duration of surgery and postoperative bed time.
Assess the possibility of deep venous thrombosis in patients: patients were classified into four grades according to the score of total risk factors:
Low risk 1 score, including: obesity, age 41-60, history of major surgery, varicose veins, minor surgery <45min;
Circulating medium danger 2 points, including: age over 60, >45min in major surgery, >72h in bed, lower extremity gypsum fixation, malignant tumor;
(3) risk, 3 ~ 4 points, including: a history of DVT/PE, lack of protein C or S, Leiden factor V/activated protein C resistance, coagulation factors Ⅲ lack of protein, blood cellulose raw anomaly, heparin caused by thrombocytopenia, for antiphospholipid antibodies, hemagglutinin 20210 a.
In addition, patients with severe acute spinal cord injury (paralysis) are more likely to have lower extremity major surgery, hip, pelvis or leg fractures, or acute spinal cord injury (paralysis).
Prevention of deep venous thrombosis
(1) psychological nursing: patients often show a constant frown and worry. Therefore, psychological nursing is especially important. Patients should be patient to listen to the patient's speech, targeted guidance and interpretation, so that patients maintain an optimistic mood, correct understanding of the disease. To introduce necessary medical knowledge and help patients to understand the nature of the disease, so as to find out early and treat with Chinese and western medicine timely.
(2) food: food should be light, using the low fat diet, eating fresh vegetables and fruit, avoiding spicy, greasy food, drink water more, maintain defecate unobstructed, constipation give laxative, when it is necessary to give enema.
(3) raise the lower extremities, early activity, promote venous blood backflow: for the patients with DVT symptoms, thrombosis 1 week should stay in bed, push up limb 20 ° to 30 °, in order to promote blood circulation. Pay attention to the affected limbs to keep warm, do not massage or do strenuous exercise, so as not to fall off the suppository, strictly prohibited cold and hot compress.
(4) mechanical prevention: arteriovenous foot pump. Inflating and releasing air into the foot cover through the foot stimulates blood flow and deep vein blood flow to the heart.
(5) to carry out health education for high-risk groups: to avoid limb compression or trauma; Substances elevates the limbs when seated to promote venous reflux; Never massage or scratch a sore area; Gradually increase the activity level, and stop immediately when feeling physical pain; Avoid crossing your legs while standing or sitting for too long. Run out of bed at least 3 times a day. To avoid long-term bed rest or inactivity during the day; For long distance car or airplane travel, move your body in the middle; Symptoms and signs of clots, including shortness of breath, chest pain, dyspnea, back pain, and swelling in the extremities, were observed.
(6) drug prevention: mainly anticoagulation and thrombolysis. Monitoring laboratory indicators: APTT, INR, hemoglobin, reticular erythrocytes, platelets and hepatase, especially before medication. Thrombolytic drugs should be prepared at present, and should be kept at low temperature after preparation. After the application of thrombolytic drugs, patients should be closely observed pupil change, headache, nausea, numbness, signs of sudden high blood pressure, intracranial hemorrhage, and other abnormal bleeding phenomenon, such as gum bleeding, nose bleeding, subcutaneous ecchymosis, injection site bleeding, urinary tract bleeding, gastrointestinal bleeding and incision hematoma and bleeding. High alert for pulmonary embolism.
(7) protection of veins: thrombolytic drugs are injected intravenously, and drug infiltration is strictly prohibited.
(8) local skin care: prevent the skin from breaking down, use neutral and gentle lotion to clean the affected limb, keep the skin clean and dry. Apply towel to wet and hot compress 4 times /d.
DVT patient discharge guidance
(1) inform patients of the relationship between their mental states and diseases, guide them to correctly understand diseases, maintain a comfortable mood and build confidence to overcome diseases.
(2) instruct the patient to elevate the affected limb, 20 ~ 30cm above the lung plane, change position regularly during bed, often squeeze the calf's gastrocnemius muscle, and perform deep flexural exercises on the back of the foot. Step by step when getting out of bed. Don't stand too long.
(3) exercise moderately every day to avoid staying in the same position for a long time, to avoid standing for a long time, sitting for a long time and walking for a long time. According to climate change, pay attention to increase or decrease clothing, avoid cold, cold. Smoking should be strictly prohibited.
(4) have medicine at home should be observed during the body without haemorrhage, bleeding gums, black, blood in urine, etc., have difficulty breathing, chest pain, cough, palpitation, hemoptysis, purple purple, etc., found that these symptoms should contact a doctor immediately, in time to see a doctor. If you are taking warfarin, avoid foods rich in Vit K. Introduce effective, inexpensive drugs for patients and how to take them. Blood coagulation indicators should be monitored during medication, adverse reactions of drugs should be observed, and abnormal and timely medical treatment should be found.
(5) ensure adequate rest for patients, avoid drinking coffee, strong tea and other beverages before sleep, and drink milk and music, so as to relax the brain and promote sleep.
(6) observe the skin temperature, skin color and foot dorsal artery pulsation of the affected limb, find the abnormality, and seek medical treatment timely. Should not be cold compress, because cold compress can make blood vessel contractile, reduce blood supply; Heat should not be applied, because heat can increase tissue metabolism resulting in increased hypoxia. Temperature should be hot, temperature in 38 ~ 40 ℃.
(7) guide the correct medication method, do not stop the medicine by yourself, and regularly review the blood vessel color ultrasound in the hospital to avoid the aggravation or recurrence of thrombus caused by the irregular medication and re-diagnosis.
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