背景:静脉血栓栓塞症(VTE),包括深静脉血栓形成和肺栓塞,是一种常见且可能致命的术后并发症。研究表明,50%的VTE原因是术中,在手术期间和术后立即发生的风险最高。因此,应制定早期评估和预防战略。
目标:为了确定最佳的设备选择,压缩协议,术中间歇性充气压缩(IPC)期间并发症的预防和管理策略,这项研究旨在综合现有的最佳证据。目的是提供准确的风险评估,并促进早期机械预防静脉血栓形成。
方法:利用JoannaBriggs研究所提出的临床证据模型的实际应用。使用2023年1月至2023年10月的现有最佳证据确定了指标,并进行了基线审查。根据临床循证实践确定负面因素。不同指标在循证实践之前(n=372)和之后(n=405)的执行率,术中IPC相关不良事件和VTE的发生率,和静脉血栓形成前(n=50)和后(n=50)的风险进行识别和比较。此外,通过涉及109名手术室人员的干预前后调查,评估了医务人员对术中IPC最佳实践的了解.
结果:经循证实践后,所有复习指标均显著改善(P<0.01),9达到100%。两次术中静脉血栓事件发生前的循证实践,发生率为0.53%;经循证实践,未发生术中静脉血栓事件,差异无统计学意义(X2=2.171,P=0.141>0.05)。然而,术前、术后静脉血血流动力学差异有统计学意义(P<0.05)。此外,9IPC相关不良事件,包括4例皮肤压力,3例皮肤过敏,下肢循环障碍2例,是在循证实践之前报告的,发病率为2.4%。值得注意的是,在循证实践后,没有发生术中IPC相关的不良事件(X2=9.913,P<0.01)。同时,经过循证实践,手术室医务人员对IPC预防静脉血栓形成的标准使用理解得分为93.34±3.64,高于循证实践前的(67.55±5.45)。总的来说,临床实践显著改善了循证实践。
结论:在临床实践中应用基于最佳证据的术中IPC使用标准可有效降低术中IPC相关不良事件发生率和术中静脉血栓形成风险。它还提高了执行率和医务人员对手术室机械预防标准的遵守。未来的研究应优先制定和完善术中静脉血栓预防的最佳临床实践。特别强调机械预防策略的整合。
BACKGROUND: Venous thromboembolism (VTE), including deep venous thrombosis and pulmonary embolism, is a common and potentially fatal post-surgery complication. Research has shown that 50% of VTE causes are intraoperative, with the risk of occurrence highest during and immediately post-surgery. Therefore, strategies for early assessment and prevention should be established.
OBJECTIVE: To identify optimal equipment selection, compression protocols, and strategies for complication prevention and management during intraoperative intermittent pneumatic compression (IPC), this study aims to synthesize the best available evidence. The objective is to inform accurate risk assessment and facilitate early mechanical prophylaxis against venous thrombosis.
METHODS: The Practical Application to Clinical Evidence model proposed by the Joanna Briggs Institute was utilized. Indicators were identified using the available best evidence from January 2023 to October 2023, and a baseline review was conducted. Negative factors were identified based on clinical evidence-based practice. The implementation rates of different indicators before (n = 372) and after (n = 405) evidence-based practice, the incidence rates of intraoperative IPC-related adverse events and VTE, and the risk of venous thrombosis before (n = 50) and after (n = 50) practice were identified and compared. Furthermore, medical staff\'s knowledge of best practices for intraoperative IPC was assessed through pre- and post-intervention surveys involving 109 operating room personnel.
RESULTS: All review indicators significantly improved (P < 0.01) after the evidence-based practice, and 9 reached 100%. Two intraoperative venous thrombosis events occurred before the evidence-based practice, with an incidence rate of 0.53%; no intraoperative venous thrombosis event occurred after the evidence-based practice, with no significant difference (X2 = 2.171, P = 0.141 > 0.05). However, there were significant differences in intraoperative venous blood hemodynamics before and after the practice (P < 0.05). Moreover, 9 IPC-related adverse events, including 4 cases of skin pressure, 3 cases of skin allergy, and 2 cases of lower limb circulation disorders, were reported before the evidence-based practice, with an incidence rate of 2.4%. Notably, no intraoperative IPC-associated adverse events occurred after the evidence-based practice(X2 = 9.913, P < 0.01). Meanwhile, the score of comprehension of the standard utilization of IPC for preventing venous thrombosis by medical staff in the operating room was 93.34 ± 3.64 after the evidence-based practice, which was higher than that (67.55 ± 5.45) before the evidence-based practice. Overall, the clinical practice was significantly improved the evidence-based practice.
CONCLUSIONS: Applying intraoperative IPC utilization standards based on the best evidence in clinical practice effectively reduces the intraoperative IPC-associated adverse event rate and the risks of intraoperative venous thrombosis. It also improves the execution rates and compliance with mechanical prevention standards in the operating room by medical staff. Future research should prioritize the development and refinement of best clinical practices for intraoperative venous thrombosis prevention, with a particular emphasis on the integration of mechanical prophylaxis strategies.