Application Of Collaboration Care Model In Deep Venous Thrombosis After Hip Arthroplasty In Elderly Patients

ObjectiveTo explore the effect of the Collaboration Care Model in preventing deep venous thrombosis of lower limbs after hip arthroplasty in elderly patients.MethodsA randomized controlled trial was conducted and 84 elderly patients who underwent hip arthroplasty surgery were selected from October 2017 to June 2018 in 903 Hospital,Sichuan Province.The patients were randomly assigned to the intervention group and the control group according to the admission sequence,with 42 cases in each group.The control group received routine thrombotic prophylaxis,and the intervention group received additional collaboration care.The social demographic characteristics,personal history,primary diseases,complications and surgical conditions of the two groups were analyzed.The scores of DVT prevention knowledge,the Harris scores and the optimal rate of hip function,the incidence of gastrocnemius pain(Homan sign)and the incidence of DVT in lower limbs under Color Doppler Ultrasound examination were compared between the two groups.Excel was used to establish the database,SPSS 21.0 was used for statistical analysis.The quantitative variables were statistically described by(x+s)or M(P25,P75),and the univariate analysis used t test,one-way ANOVA or rank sum test.The classification variables were described by rate or percentage,and the univariate analysis used ?2 With P<0.05,the difference was statistically significant.Results1 Among the 84 patients who were included in the study,67.9%(57/84)were femoral neck fractures and 61.9%(52/84)were complicated with at least one internal diseases.There was no significant difference in gender,age,occupation,personal history(smoking,drinking)between the two groups(p>0.05).There was no significant difference in primary diseases(femoral neck fracture,femoral head necrosis,osteoarthritis),complications and surgical conditions(operation time,intraoperative bleeding volume and hospital stay)between the two groups(P>0.05).2 The average score of DVT prevention knowledge of all subjects before the intervention was(28.1±4.2),and the score rate was 46.8%.There was no significant difference in the score of DVT prevention knowledge between the two groups before the intervention(P>0.05).After the intervention,the score of DVT prevention knowledge in the intervention group was higher than that in the control group,and the difference was statistically significant(P<0.001).3 The Harris score of hip function in the intervention group was(86.5±10.8)and that in the control group was(80.8±11.7),which was higher than that in the control group with statistically significant difference(t=2.330,P=0.022).There was a positive correlation between the DVT prevention knowledge score after intervention and the Harris score of hip function in the intervention group,and the Pearson correlation coefficient had statistical significance(r=0.312,P=0.044).4 The optimal rate of hip function was 78.6%in the intervention group and 57.1%in the control group.The optimal rate of hip function in the intervention group was higher than that in the control group with statistically significant difference(?2=4.421,P=0.035).5 The incidence of Homan sign was 2.4%in the intervention group and 11.9%in the control group,with no significant difference(P>0.05).6 The results of Color Doppler Ultrasonography of the lower limbs showed that the incidence of DVT was 7.1%in the intervention group and 23.8%in the control group.The incidence of DVT in the intervention group was lower than that in the control group with statistically significant difference(?2=4.459,P=0.035).In the intervention group,the incidence of DVT in patients who were alcoholics(?2=4.747,P=0.029)and had more bleeding during operation(>200 ml)(?2=5.457,P=0.019)was higher than those who were non-alcoholics and had less bleeding during operation(?200 ml),and the difference was statistically significant.In the control group,the incidence of DVT in the smokers(?2=16.195,P<0.001)and the alcoholics(?2=11.813,P=0.001)was higher than that in the non-smokers and the non-alcoholics,with significant difference.ConclusionsCollaboration Care Model can improve the DVT prevention knowledge in elderly patients after hip arthroplasty,improve the hip function,and play a positive role in preventing DVT in lower limbs of patients.The intervention effect of Collaboration Care Model is influenced by many factors.It is necessary to take the individual,social support network and medical service factors into consideration and constantly update and improve them in clinical practice.