摘要
目的探讨清单式护理管理结合不同人工肝治疗模式在肝衰竭患者中的应用效果。方法本研究为类实验研究,采用便利抽样法选取2020年7月至2021年7月在山西白求恩医院住院治疗的53例肝衰竭患者为对照组,2021年7月至2022年7月收治的63例肝衰竭患者为干预组。2组患者人工肝治疗模式均涉及血浆置换(PE)模式、双重血浆分子吸附系统(DPMAS)模式及PE+DPMAS治疗模式3种。对照组采用常规护理,干预组采用清单式护理管理。分别比较实施前后不同治疗模式2组间白蛋白、凝血酶原时间指标变化,及治疗后2组并发症的发生情况。结果2组基线资料及治疗模式的组间分布比较差异均无统计学意义(均P>0.05),具有可比性。治疗后干预组接受DPMAS和PE+DPMAS治疗模式的患者的白蛋白水平分别为25.3(24.0,27.9)、23.2(22.4,26.3)g/L,均显著低于对照组的28.2(26.3,29.7)、29.4(27.2,30.0)g/L,差异均有统计学意义(Z=2.47、3.55,均P<0.05)。治疗后干预组患者的凝血酶原时间在3个治疗模式上分别为15.8(14.8,16.8)、22.7(19.2,26.2)、16.0(14.6,20.0)s,均显著低于对照组的17.4(15.9,20.9)、26.3(21.4,36.4)、21.2(16.9,23.4)s,差异均有统计学意义(Z=2.10、2.07、2.21,均P<0.05)。干预组DPMAS治疗模式患者低血压、过敏反应、出血、凝血及感染并发症共计6例,与对照组的11例相比差异有统计学意义(χ^(2)=4.97,P<0.05);干预组PE+DPMAS治疗模式患者上述并发症发生共计4例,与对照组的11例相比差异有统计学意义(χ^(2)=6.87,P<0.01)。结论人工肝治疗可改善患者的肝功能及凝血,清单式护理管理可能有助于提升人工肝治疗的效果;可提升护士的风险预判意识,降低治疗过程中的各类风险,降低不良反应的发生率,提升医护及患者满意度。
Objective To explore the application of list nursing management combined with different artificial liver treatment modes in patients with liver failure.Methods Fifty-three patients with liver failure hospitalized in Bethune Hospital of Shanxi Province from July 2020 to July 2021 were selected as the control group,63 patients with liver failure hospitalized in Bethune Hospital of Shanxi Province from July 2021 to July 2022 were selected as the intervention group.According to the different treatment modes of artificial liver for patients,plasma exchange(PE),double plasma molecular adsorption system(DPMAS)and PE+DPMAS treatment were set up in the two groups.The control group received routine nursing care,while the intervention group received checklist nursing care in addition.The changes of albumin(ALB)and prothrombin time(PT)indexes before and after the different treatment modes were compared,together with the occurrence of complications between the two groups after the intervention.Results The baseline data between the two groups was balanced,the difference had no statistical significant(P>0.05).After the therapy,the level of ALB of patients who had accepted DPMAS and PE+DPMAS in the intervention group were 25.3(24.0,27.9)and 23.2(22.4,26.3)g/L,which were lower than the 28.2(26.3,29.7)and 29.4(27.2,30.0)g/L in the control group,the differences were significant(Z=2.47,3.55,both P<0.05).After the therapy,the level of PT of patients in the intervention group under all three treatment modes were 15.8(14.8,16.8),22.7(19.2,26.2)and 6.0(14.6,20.0)s,which were lower than the 17.4(15.9,20.9),26.3(21.4,36.4)and 21.2(16.9,23.4)s in the control group,the differences were significant(Z=2.10,2.07,2.21,all P<0.05).In the intervention group,there were 6 cases of hypotension,anaphylaxis,bleeding,coagulation and infection under the DPMAS treatment mode,which was significant lower than the 11 cases in the control group(χ^(2)=4.97,P<0.05).There were 4 cases in the intervention group with the PE+DPMAS treatment mode occurred complications in above,which were significant lower than the 11 cases in the control group(χ^(2)=6.87,P<0.01).Conclusions Artificial liver treatment can improve patients′liver function and coagulation,and list nursing management may help to improve the effect of artificial liver treatment.It can improve nurses′awareness of risk prejudgement,reduce various risks in the treatment process,reduce the incidence of adverse reactions,and enhance health care and patient satisfaction.
作者
张建伟
单海虹
岳丽红
段佳宇
郝文静
王艳
Zhang Jianwei;Shan Haihong;Yue Lihong;Duan Jiayu;Hao Wenjing;Wang Yan(Infectious Diseases Department,Shanxi Bethune Hospital,Shanxi Academy of Medical Sciences,Tongji Shanxi Hospital,the Third Hospital of Shanxi Medical University,Taiyuan 030032,China)
出处
《中国实用护理杂志》
2023年第11期822-830,共9页
Chinese Journal of Practical Nursing
基金
山西省软科学研究一般项目(2017041043-2)。
关键词
肝功能衰竭
急性
肝
人工
清单式护理
Liver failure,acute
Liver,artificial
List type nursing
作者简介
通信作者:岳丽红,Email:yuelihong611@126.com。
