分级心理干预联合气压泵气压...肢深静脉血栓形成的预防效果_张丽娜.pdf

癌症进展2023 年 3 月第 21 卷第 6 期ONCOLOGY PROGRESS,Mar 2023 V ol.21,No.6*论著*分级心理干预联合气压泵气压治疗对宫颈癌术后患者下肢分级心理干预联合气压泵气压治疗对宫颈癌术后患者下肢深静脉血栓形成的预防效果深静脉血栓形成的预防效果张丽娜，王玉华#，罗穗豫，曹蕾河南省人民医院妇产科，河南省护理医学重点实验室，郑州大学人民医院，郑州 4500030 0摘要摘要：目的目的探讨分级心理干预联合气压泵气压治疗对宫颈癌术后患者下肢深静脉血栓形成的预防效果。方法方法采用随机数字表法将108例宫颈癌手术患者分为对照组（n=54）和观察组（n=54），对照组患者予以气压泵气压治疗，观察组患者在对照组的基础上予以分级心理干预。比较两组患者的凝血指标凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、凝血酶时间（TT）以及纤维蛋白原（FIB）水平、血流速度、下肢深静脉血栓发生率及满意度。结果结果干预后，两组患者PT、APTT、TT均短于本组干预前，FIB水平均低于本组干预前，观察组患者PT、APTT、TT均短于对照组，FIB水平低于对照组，差异均有统计学意义（P0.05）。干预后，两组患者下肢股静脉和足背静脉血流速度均高于本组干预前，且观察组患者下肢股静脉和足背静脉血流速度均高于对照组，差异均有统计学意义（P0.05）。观察组患者下肢深静脉血栓发生率低于对照组，满意度高于对照组，差异均有统计学意义（P0.05）。结论结论对宫颈癌术后患者应用分级心理干预联合气压泵气压治疗，能够改善患者的凝血指标，加快患者血流速度，预防下肢深静脉血栓形成，且患者满意度较高，值得临床推广应用。关键词关键词：分级心理干预；气压泵气压治疗；宫颈癌；术后；下肢深静脉血栓；满意度中图分类号中图分类号：R R737737.3333文献标志码文献标志码：AdoiAdoi：10.11877/j.issn.1672-1535.2023.21.06.17Preventive effect of graded psychological intervention combined with pneumaticPreventive effect of graded psychological intervention combined with pneumaticcompression therapy on lower extremity deep vein thrombosis in patients withcompression therapy on lower extremity deep vein thrombosis in patients withcervical cancer surgerycervical cancer surgeryZHANG Li na,WANG Yuhua#,LUO Suiyu,CAO LeiDepartment of Gynaecology and Obstetrics,He nan Provincial Key Medicine Laboratory of Nursing,He nan Provincial People s Hospital,Zhengzhou University People s Hospital,Zhengzhou 450003,He nan,ChinaAbstractAbstract:ObjectiveObjectiveTo investigate the preventive effect of graded psychological intervention combined with pneumatic compression therapy on lower extremity deep vein thrombosis in patients with cervical cancer surgery.MethodMethodAtotal of 108 patients undergoing cervical cancer surgery were randomly divided into the control group(n=54)and the observation group(n=54).The patients in the control group received pneumatic compression therapy,and the patients in theobservation group received graded psychological intervention based on the control group.The coagulation indexes prothrombin time(PT),activated partial thromboplastin time(APTT),thrombin time(TT),and fibrinogen(FIB)levels,blood flow velocity,incidence of lower extremity deep vein thrombosis,and satisfaction rate were compared between thetwo groups.ResultResultAfter the intervention,the PT,APTT,and TT of the two groups were shorter than those before the intervention,and the FIB levels were lower than those before the intervention,the PT,APTT,and TT in the observationgroup were shorter than those in the control group,and the FIB level was lower than that in the control group,and the differences were statistically significant(P0.05).After the intervention,the blood flow velocities of the femoral vein anddorsalis pedis of the two groups were higher than those before the intervention,and the blood flow velocities of the femoral vein and dorsalis pedis in the observation group were higher than those in the control group,and the differences werestatistically significant(P0.05).The incidence of lower extremity deep vein thrombosis in the observation group waslower than that in the control group,and the satisfaction rate was higher than that in the control group,and the differenceswere statistically significant(P0.05).ConclusionConclusionThe application of graded psychological intervention combined withpneumatic compression therapy to patients after cervical cancer surgery can improve the coagulation index,accelerate theblood flow velocity,prevent lower extremity deep vein thrombosis,and have high patient satisfaction,which is worthy ofclinical application.Key wordsKey words:graded psychological intervention;pneumatic compression therapy;cervical cancer;postoperative;lower extremity deep vein thrombosis;satisfactionOncol Prog,2023,21(6)#通信作者（corresponding author），邮箱：652ONCOLOGY PROGRESS,Mar 2023 V ol.21 No.6宫颈癌是女性常见的恶性肿瘤之一，近年来其发病群体逐渐趋于年轻化，严重威胁广大女性的生命健康1。临床治疗宫颈癌仍以手术为主，宫颈癌根治术虽然能在一定程度上延长患者的生存期，但手术面积和创口较大，手术过程中容易对输尿管、膀胱淋巴管以及神经等造成不同程度的损伤，从而引发一系列泌尿系统和神经系统并发症2-3。下肢深静脉血栓是宫颈癌术后最常见的并发症之一，其主要是由于下肢深静脉血液异常凝结引起静脉回流所致，主要表现为下肢肿胀、疼痛，同时伴有淤积性溃疡和静脉曲张，会对患者的术后恢复进程和生活质量产生严重不良影响，若未及时进行治疗，还容易引发肾脏疾病，甚至造成生命威胁4-5。因此，采取有效的干预措施预防下肢深静脉血栓对于宫颈癌手术患者术后恢复和生命健康意义重大。气压泵气压治疗是临床应用较多的干预方法，原理是通过对患者下肢间歇性加压，促进血液循环，缓解血液淤积情况，减少下肢深静脉血液的堆积量，从而对下肢深静脉血栓具有一定的预防效果6-7。临床实践表明，多数宫颈癌患者术后会出现严重的心理问题，常规干预已无法满足临床需求8-9。本研究探讨分级心理干预联合气压泵气压治疗对宫颈癌术后患者下肢深静脉血栓形成的预防效果，现报道如下。1 1对象与方法对象与方法1 1.1 1 研究对象研究对象选取 2017 年 1 月至 2019 年 1 月于河南省人民医院接受手术治疗的 108 例宫颈癌患者。纳入标准：符合 宫颈癌及癌前病变规范化诊疗指南（试行）10中宫颈癌的诊断标准，经影像学、病理学检查确诊为宫颈癌；年龄18岁；符合手术指征，接受相同方案的宫颈癌根治术。排除标准：凝血功能异常；心、肝、肾等重要脏器功能不全；精神异常或理解能力较差；合并视觉、听力、语言障碍；术前患有神经、血液系统疾病。采用随机数字表法将患者分为对照组（n=54）和观察组（n=54），对照组患者予以气压泵气压治疗，观察组患者在对照组的基础上予以分级心理干预。对照组患者年龄3355岁，平均（44.655.28）岁；受教育程度：高中以下 34 例，高中及以上 20 例；肿瘤分期：期 26 例，期 28 例；肿瘤分型：鳞状细胞癌26例，腺癌28例。观察组患者年龄3556岁，平均（45.525.35）岁；受教育程度：高中以下37例，高中及以上17例；肿瘤分期：期28例，期26例；肿瘤分型：鳞状细胞癌24例，腺癌30例。两组患者的年龄、受教育程度、肿瘤分期、肿瘤分型比较，差异均无统计学意义（P0.05），具有可比性。本研究经医院伦理委员会批准通过，所有患者均知情同意。1 1.2 2 干预方法干预方法对照组患者予以气压泵气压治疗。患者平卧后取舒适位，以压力护套套于患者下肢，套牢后打开仪器开关，设置患者可承受的合适压力，将时间设置为 60 min，