Perioperative nursing experience of intravascular interventional treatment of patients with acute lower extremity deep venous thrombosis complicated with pulmonary embolism / 中国中西医结合急救杂志

ABSTRACT

Objective To observe the impact of enhancing perioperative care on the clinical efficacy of the patients with intravascular intervention for treatment of patients with acute lower extremity deep venous thrombosis (LEDVT) complicated with pulmonary embolism (PE). Methods Twenty-nine patients with LEDVT complicated with PE admitted to the Tianjin First Center Hospital from May 2015 to February 2019 were enrolled, the pulmonary angiography + pulmonary thrombolysis was applied for all the patients, and 25 cases used inferior vena cava filter implantation, 1 patient underwent catheter-directed thrombolysis (CDT), 4 patients underwent mechanical endovascular aspiration of thromboembolism (PTM), etc intravascular interventional treatment, the peri-operative care was strengthened, including closely observation on the patient's condition, correct use of anticoagulant and thrombolytic drugs, in the mean time, after operation, the nursing care and observation on thrombolysis catheters, involved limbs, complications should be well performed, and health education and discharge guidance ought to be carried out. Before the patient was discharged from the hospital, the improvement of clinical symptoms and the changes of coagulation indexes D-dimer, fibrinogen (Fib), prothrombin time (PT), and activated partial thromboplastin time (APTT) were observed; the Bartel index evaluation quantitative scale was used to assess the patient's activity of daily living (ADL) score; WeChat was used to investigate patient's satisfaction. Results In this group of 29 patients, postoperative chest tightness, shortness of breath symptoms were improved significantly, no fatal PE etc complications occurred. The pulmonary artery computed tomographic angiography (CTA) showed that the pulmonary artery and its branches PE basically disappeared or the measured range or area was obviously decreased. Re-examination of blood gas analysis showed that the arterial oxygen partial pressure (PaO2) was increased. Echocardiography revealed the improvement in pulmonary hypertension. 12 patients with pulmonary infection were improved after anti-inflammatory treatment, the swelling of the affected limb was significantly relieved, and the patients had no distending pain after activities on the ground. After treatment, the coagulation indexes D-dimer and fibrinogen (Fib) were significantly lower than those before treatment [D-dimer (μg/L)2 389.45±2 061.02 vs. 6 093.45±2 586.99, Fib (g/L) 3.18±0.91 vs. 4.07±1.49, both P < 0.01], there were no significant differences in PT and APTT before and after treatment [PT (s) 13.12±2.27 vs. 12.33±2.06, APTT (s)34.51±11.79 vs. 31.84±3.05, both P > 0.05]. After treatment, the ADL score of patients was obviously higher than that before treatment (scores 79.66±6.26 vs. 17.24±8.30, P < 0.01). WeChat was used to investigate the patients' satisfaction, the nursing score was 95-100 points with an average of (97.38±1.37) points. Conclusion High quality nursing care can minimize the suffering to the largest extent in the patients with pulmonary thrombosis, elevate the quality of life, and reduce the disability and recurrence rates.