Application of nursing intervention based on DVT risk assessment nomogram in gynecologic laparoscopic patients

Abstract

Objective To investigate the effectiveness of the nursing intervention on deep vein thrombosis (DVT) predicting after gynecologic laparoscopic surgery based on the risk assessment nomogram. Methods From July 2015 to July 2017, the clinical data of 431 patients undergoing gynecologic laparoscopic surgery at Shengjing Hospital of China Medical University were collected. The independent risk factors affecting postoperative DVT were analyzed. The R software was used to establish a nomogram model of DVT risks after gynecologic laparoscopic surgery. A prospective enrollment of 100 patients undergoing gynecologic laparoscopic surgery was randomly divided into a study group of 50 patients and a control group of 50 patients by random number table. The control group received routine care after surgery. The study group implemented a care plan based on the DVT risk nomogram model beyond what was given the the control group. The plasma D-dimer levels and the incidence of DVT on the 3rd and 5th day after surgery were compared between the two groups before and after the intervention. Results The incidence of postoperative DVT in the 431 patients underwent laparoscopic surgery was 10.4% (45/143). Logistic regression analysis showed that age, D-dimer ≥0.5 mg/L, head position during operation, blood loss≥400 ml, operation time≥ 1 h, bed time> 5 d were independent risk factors of postoperative DVT. The nomogram model predicted a C-index of 0.857 for the risk of DVT after gynecologic laparoscopic surgery, and the discrimination was good. After the nursing intervention based on the nomogram, the plasma D-dimer level of the study group was (0.47±0.09) and (0.54±0.17) mg/L on the 3rd and 5th day after the operation, respectively, which were lower than the control group. The difference was statistically significant (P<0.05) . On the 5th day after surgery, the incidence of DVT in the study group was 2.0% (1/50) , and that in the control group was 14.0% (7/50) . The difference was statistically significant (P<0.05) . Conclusions Nursing interventions based on the nomogram model can reduce the incidence of DVT after gynecologic laparoscopic surgery. Key words: Venous thrombosis; Gynecologic diseases; Laparoscopic surgery; Nomogram model; Nursing intervention