Abstract: ［Abstract］ Objective To explore the effect of whole nursing combined with low molecular weight heparin on postoperative coagulation in patients with cervical malignant tumor and preventive effect of venous thrombosis. Methods A total of 110 patients were enrolled in our hospital from April 2014 to December 2016. The patients were divided into control group and observation group. Two groups of patients were the same group of medical staff to complete the project. The patients in the control group were given routine nursing mode，and the patients in the observation group the whole nursing mode. The effects of nursing care and number of hypercoagulability and the incidence of postoperative thrombotic disease in two groups were recorded and analyzed. The indexes of coagulation at different time between two groups were analyzed. Results A total of 38 surgical nurses were chosen to participate in this study，with an average age 32（21?55）. Patients compliance rate was 42.3% in the control group while it was 95.0% in the observation group. In the control group，only one patient in 5 patients with mild swelling legs was detected. Evidence of warmth or increasing heat of 6 patients was not recorded in the nursing record. In the observation group，four patients with mild swelling legs were detected，and evidence of high skin temperature of only 3 patients was not recorded in the nursing record. There was no significant difference in the proportion of blood coagulation between the two groups（P>0.05）. There was no significant difference between PLT，PT APTT（all P values >0.05）except for D?Dimer between two groups. Conclusion Whole?course nursing integral nursing care for postoperative observation of patients with thoracic malignant tumor using low molecular weight heparin helps prevent postoperative VTE.

Key words: coagulation, thoracic malignancy, full care, thrombotic disease

摘要： ［摘要］ 目的 整体护理对于胸部恶性肿瘤患者术后使用低分子肝素减少静脉血栓（VTE）的预防作用。方法 研究选择对象为佛山市顺德区两家医院 2014 年 4 月至 2016 年 12 月收治拟行限期胸部恶性肿瘤根治术的患者 110 例，分为对照组和观察组，各 55 例。术后早期给予低分子肝素皮下注射。对照组患者给予常规护理方式，观察组患者给予整体护理模式。记录两组护理效果和患者高凝患者比例及术后血栓性疾病的发生率，观察两组患者不同时间凝血相关指标。结果 该项目共有38 名外科护士得到参与这项研究检查，平均年龄为32 岁（21~55 岁）。对照组患者依从性达 42.3%，观察组患者为 95.0%。在对照组评估中伴有下肢轻度肿胀的 5 位患者中只有 1 位被发现，并且 6 位患者的肢体中有温暖或热量增加的证据都没有记录在护理记录中。在观察组在评估中伴有下肢轻度肿胀的 4 位患者中全部被发现，8 名有肢体温暖证据的患者中只有 3 名没有记录。两组血液高凝患者比例及血栓性疾病比例差异均无统计学意义（P>0.05）；两组患者 PLT、APTT 组间比较及与各自治疗前相比及无显著差异（P>0.05）；对照组患者PT、D?Dimer 术后与术前相比差异均显著（P<0.05），观察组 PT 与术前比较差异不显著，与对照组相比差异显著（P<0.05）；观察组患者 D?Dimer 术后 1 天较术前均上升（P<0.05），术后 14 天与术前相比差异不显著（P>0.05），观察组各时间点 Fib 与术前相比差异不显著（P>0.05），对照组术后 14天与术前相比增高显著（P<0.05）。结论 整体护理方式对胸部恶性肿瘤患者术后观察使用低分子肝素后的护理有利于预防术后VTE 的发生。

关键词: 胸外科护理, 护理满意度, 医护一体化模式, 疼痛评分