Effect of plan-do-check-active method combined with air pressure wave therapy on the prevention of deep venous thrombosis in critically ill patients in neurosurgery.

Background: Deep vein thrombosis (DVT) is prone to occur in the recovery of critically ill neurosurgical patients, increasing economic and psychological pressure, and even endangering life. Plan-Do-Check-Action (PDCA) cycle is a kind of quality management cycle procedure, which can help DVT treatment correctly understand the cause of disease and take effective preventive and nursing measures. The air wave pressure therapy instrument takes pressure therapy as the core, forming circulating pressure on limbs and tissues, promoting the flow of blood and lymph, improving the effect of microcirculation, accelerating the return of limb tissue fluid, and preventing thrombosis and limb edema.

Methods: A total of 98 critical neurosurgery patients were selected as the study subjects. On the basis of PDCA circulation treatment, the patients were treated with air pressure wave for 30 minutes/time, twice/day and 14 days. Before and after treatment, the indexes of coagulation function, hemorheology (plasma viscosity, whole blood high shear viscosity and whole blood low shear viscosity), lower limb circumference (15 cm above and below the patella) and Barthel index (BI) scores were observed and recorded. DVT was observed by vascular Doppler ultrasound before and after treatment, and the incidence was calculated.

Results: The prothrombin time (18.09 s) and thrombin time (17.66 s) after treatment were higher than those before treatment (12.98 s, 130.7 s), and fibrinogen decreased (4.21 vs. 3.31 g/L). The hemorheological indexes of the patients after treatment were plasma viscosity (1.49 mPa/s, 10.8 mPa/s), whole blood high shear viscosity (6.34 mPa/s, 4.47 mPa/s), whole blood low shear viscosity (9.89 mPa/s, 6.32 mPa/s), circumference at 15 cm below the patella (52.29 cm, 45.23 cm), and circumference at 15 cm above the patella (36.17 cm, 31.38 cm). The BI score showed that the number of patients with severe dependence on grade A (46/15) and moderate dependence on grade B (50/14) decreased after treatment, and the average BI score of patients with combined treatment increased (43.87 and 79.86). After treatment, the number of patients with DVT (20/4) and the incidence of DVT (20.40816327%, 4.081632653%) decreased significantly (P<0.05).

Conclusions: PDCA circulation combined with barometric wave therapy can significantly improve DVT in critical neurosurgical patients.