Study On The Establishment And Evaluation Of Venous Thrombosis Risk Assessment Scale During Gynecological Surgery

BACKGROUND:Venous thromboembolism,including deep venous thrombosis and pulmonary embolism,which are two clinical manifestations of thrombosis at different sites and stages.It is the second most common complication and the third leading cause of death during perioperative period.Due to the special anatomical structure of female pelvic cavity,such as dense veins,thin venous wall,lack of venous flap,intraoperative lithotomy recumbent position,obesity,old age and other individual factors,the incidence of perioperative VTE is higher than that of other abdominal pelvic surgeries.The incidence of VTE in perioperative period of gynecology is 15%-45%.The occurrence of VTE seriously affects the postoperative recovery and quality of life,and brings great pressure on the body and mind of patients.For a long time most scholars and clinical staff focused on preoperative and postoperative evaluation and prevention,However,relevant studies have shown that more than 50%of the VTE in the perioperative period begins during the operative period.In recent years,scholars and clinical staff have become more and more aware of the importance of preventive management of venous thrombosis during surgery.Scientific and effective prevention must be based on an accurate assessment of risk.However,there are many specific risk factors for patients during gynecological surgery,such as intraoperative hypothermia and anesthesia.Currently,the commonly used VTE risk assessment tools,such as Caprini scale and Rogers risk assessment model,are not comprehensive in assessing the risk of VTE in patients during gynecological surgery.Therefore,it is necessary to establish a VTE risk assessment scale for patients during gynecological surgery,which can better meet the needs of clinical nursing work.OBJECTIVE:The purpose of this study was to identify the risk factors of venous thrombosis in patients undergoing gynecological surgery,to elaborate the assessment tools and assessment status of venous thrombosis in patients undergoing gynecological surgery at home and abroad,to construct the risk assessment scale of venous thrombosis during gynecological surgery,and to verify the reliability and validity of the scale.To provide assessment tools for venous thrombosis during gynecological surgery and standardize the contents of evaluation during surgery,so as to provide scientific basis for further identifying high-risk groups,implementing scientific and effective intraoperative prevention,and providing theoretical basis for establishing and regulating venous thrombosis prevention programs during gynecological surgery and improving guidelines for thrombosis prevention during surgery.METHODS:1.Through extensive literature review,based on the three elements of Virchow thrombosis as the theoretical basis,Caprini and Rogers risk assessment table were referred,and group discussion was conducted to list and organize the scale indicators in combination with the characteristics of patients undergoing gynecological surgery and clinical practical work needs,to preliminarily draw up the items of venous thrombosis assessment table for patients during surgery.2.Using Delphi expert consultation method,rating on the importance of the entry,according to experts grading results of entry,carries on the analytic hierarchy process,to calculate weight of the item,and preliminary operation period vein thrombosis evaluation table.3.300 cases of patients undergoing gynecological surgery in a third-class first-class hospital in hubei province from July to October 2019 were selected to be evaluated with the evaluation form of venous thrombosis during gynecological surgery,and the reliability and validity of the preliminary evaluation form was verified.RESULTS:(1)By consulting a large number of literatures,this study summarized the risk factors related to venous thrombosis in patients undergoing gynecological surgery,the assessment tools and assessment status of venous thrombosis in patients undergoing gynecological surgery at home and abroad,and the current situation of prevention2.Through Delphi expert consultation,2 rounds of expert positive coefficients of 100%,the authority of the expert level is 0.81,two rounds of consulting the Kendall harmonious coefficient were 0.55 and 0.58,the preliminary period of gynecologic surgery venous thrombosis evaluation table contains 4 primary index(generally,disease and treatment related factor,operation method,laboratory test report).17 secondary indexes(age,BMI,preoperative bed time,women's special factors,present high risk of disease,medical and family history,treatment and medication history,operation time,surgical procedure,intraoperative special status,anesthesia,intraoperative posture,D-dimer,fibrinogen(FIB),activated partial thrombin time(APTT),platelet count(ALT),38 tertiary indicators.3.After the test,the Cronbach's Alpha coefficient of this scale is 0.729,the Guttman half-score coefficient is 0.764,indicating that the reliability of the evaluation table is good.Four common factors were extracted by exploratory factor analysis,and the cumulative contribution rate to the total variance was 58.835%,which was consistent with the preset structure.The scale was used to evaluate the structural validity of patients during gynecological surgery.CONCLUSION:(1)by consulting a large number of literatures,this study summarized the risk factors of venous thrombosis in patients undergoing gynecological surgery,the assessment tools and assessment status of venous thrombosis in patients undergoing gynecological surgery at home and abroad,and the current situation of prevention.(2)in this study,the literature review method and Delphi expert consultation method were used to construct the evaluation scale of venous thrombosis during gynecological surgery,which included 4 first-level indicators,16 second-level indicators and 38 third-level indicators.(3)according to the test,the evaluation scale of venous thrombosis in gynecological operation has good reliability and validity,and it can quickly evaluate patients in the process of clinical verification,with strong operability.