Study On Establishing Nursing Prevention Program For Pregnant And Lying-in Women With Deep Vein Thrombosis Based On Evidence And Delphi Method

Objectives:1.The relevant influencing factors of China’s pregnant and lying-in women with DVT were initially explored by meta-analysis.2.By searching the literature related to pregnant and lying-in women about prevention and management of DVT,to find the best evidence of DVT in pregnant and lying-in women,and initially construct a prevention plan for DVT in pregnant and lying-in women.Through the Delphi method,the prevention plan was revised to form nursing and prevention program of DVT for pregnant and lying-in women in line with my country’s conditions.Methods:1.Literatures were researched in databases such as Cochrane Library,PubMed,Web of Science,Embase,EBSCO,Ovid,Wanfang Database,CNKI,CBM,VIP and other databases.Case-control studies,cross-sectional studies and cohort studies published were researched from the establishment of the database to May 2020 at home and abroad to explore the influencing factors of DVT in pregnant and lying-in women in China.Then,the literatures were screened,extracted and evaluated.RevMan5.3 was used to conduct a Meta-analysis of the final included files.2.Guidelines and other documents related to the prevention and management of maternal venous thrombosis published from the establishment of the database to June2020 were searched in PubMed,Web of Science,EMBASE,Ovid,EBSCO,CNKI and other evidence-based guidance websites such as FIGO,SIGN and GIN.The guidelines and other types of literature were screened according to the established standards of inclusion and exclusion criteria.The guidelines were evaluated by AGREE Ⅱ.The other were evaluated by the Australian JBI Evidence-based Health Care Center(2016edition),including systematic reviews,expert consensus and original literature.This process was aimed to find the best evidence of DVT nursing prevention for pregnant and lying-in women and construct the preliminarily nursing prevention program of DVT referring to the influencing factors in Meta-analysis.3.20 experts were invited to evaluate preliminary nursing and program of DVT for pregnant and lying-in women.After the first round of expert inquiry,the items were adjusted after discussion by the research group,and the inquiry volume of the second round of expert inquiry is established.After two rounds of expert correspondence,the content of the program was improved.Results:1.A total of 12 articles were included for Meta-analysis,of which 10 influencing factors were included in Meta-analysis.The risk factors included:(1)twins or multiparous(P<0.001),(2)age≥35 years old(P=0.13),(3)gestational hypertension(P<0.001),(4)bed rest time≥3 days(P<0.001),(5)gestational diabetes mellitus(P<0.001),(6)history of thrombus(P<0.001),(7)postpartum hemorrhage(P<0.001),(8)cesarean section(P<0.001),(9)eclampsia(P<0.001),(10)BMI(P=0.005).2.A total of 73 articles were included in the preliminary nursing prevention program of deep vein thrombosis for pregnant and lying-in women,including evidencebased guidelines,systematic review,expert consensus and original literature.There were 9 pieces of grade I evidence,29 pieces of grade II evidence,30 pieces of grade III evidence,and 5 pieces of grade IV evidence.In the end,the nursing prevention program of deep vein thrombosis for pregnant and lying-in women included 4 primary entries,11 secondary entries,59 three entries.3.After two rounds of expert letter inquiries,8 items at the third level were deleted and 8 items at the third level were revised.Finally,the nursing prevention program of deep vein thrombosis for pregnant and lying-in women included 48 items at the third level.The effective recovery rate of the first round of expert letter questionnaires was85%,and the rate of suggestions made was 52.9%.In the second round of expert letters,the effective recovery rate was 100%,and the suggestion rate was 23.5%.The coefficient of variation(CV)of the first round of expert letter inquiry was in the range of 0.10～0.37,the expert authority coefficient was 0.830,the coordination coefficient was 0.25 and 0.22,Significance test results are all P<0.05.The coefficient of variation(CV)of the second round of expert letter inquiry was in the range of 0.09～0.36,the expert authority coefficient was 0.838,and the coordination coefficient was 0.23 and0.21,Significance test results are all P<0.05.Conclusions:1.The influencing factors of DVT among pregnant women in my country included twins or multiple pregnancies,hypertension during pregnancy,bed time≥3days,gestational diabetes,history of thrombosis,postpartum hemorrhage,cesarean section,etc.The Meta-analysis of this study cannot show that age≥35 years old was the influencing factor of DVT in pregnant women in my country.2.This study constructed the nursing prevention program of deep vein thrombosis for pregnant and lying-in women based on my country’s national conditions and in line with the actual conditions.The program included 4 first-level items,11 second-level items,and 48 third-level items.The results of expert correspondence were reliable,and had a reference and guiding role for clinical practice.