提高肝移植手术护理配合的有效性和标准化的策略  

Clinical effects of application of nursing process in living donor liver transplant operation

作　　者：李玉红[1] 闫玉川 杨丽芳[1] 

机构地区：[1]唐山工人医院肿瘤外科,河北省唐山市063000

出　　处：《世界华人消化杂志》2014年第26期3986-3989,共4页World Chinese Journal of Digestology

摘　　要：目的:探讨活体肝移植手术护理流程的应用效果.方法:比较应用护理流程的7例行活体肝移植手术的患者(实验组)与未应用护理流程的6例行活体肝移植手术的患者(对照组)供肝冷缺血时间、手术时间、手术费用、新肝期血气分析指标[pH值、碱剩余(base excess,BE)、HCO-3、PaCO2、Na+、K+、Cl-、Ca2+]和血流动力学指标[心率(heart rate,HR)、平均动脉压(mean arterial pressure,MAP)、中心静脉压(central venous pressure,CVP)]水平以及两组医生对手术配合的满意度.结果:实验组患者供肝冷缺血时间和手术时间均显著低于对照组(81.13 min±19.65 min vs 106.93 min±21.36 min;11.15 h±1.05 h vs 15.96 h±3.81 h),差异具有统计学意义(P<0.05);实验组患者麻醉药费、监护费和一次性物品费均显著低于对照组(5026.57元±805.12元vs 5669.05元±740.17元;1020.89元±132.77元vs 1268.10元±150.52元;5500.22元±615.33元vs 6263.31元±505.48元),差异具有统计学意义(P<0.05);实验组医生对器械护士、巡回护士等的手术配合满意度显著高于对照组(100.00%vs 83.33%),差异具有统计学意义(P<0.05);两组间血气分析指标水平比较(7.32±0.04 vs 7.30±0.08;-4±4 vs-4±4;20.01 mmol/L±3.02 mmol/L vs 19.71 mmol/L±3.39 mmol/L;33.59 mmHg±3.31 mmHg vs32.29 mmHg±3.79 mmHg;132.51 mmol/L±3.69 mmol/L vs 136.69 mmol/L±4.11 mmol/L;3.34 mmol/L±0.19 mmol/L vs 3.90 mmol/L±0.97mmol/L;108.12 mmol/L±6.01 mmol/L vs105.13 mmol/L±8.02 mmol/L;1.04 mmol/L±0.13 mmol/L vs 1.10 mmol/L±0.35 mmol/L),差异无统计学意义(P>0.05);两组患者新肝期血流动力学指标水平比较(102.12 min±5.28min vs 99.34 min±6.41 min;9.25 kpa±0.79kpa vs 9.13 kpa±0.68 kpa;9.58 cmH2O±3.48cmH2O vs 9.68 cmH2O±4.61 cmH2O),差异无统计学意义(P>0.05).结论:活体肝移植手术护理流程的应用能够提高肝移植手术护理配合的有效性和标准化,提高护理配合效率和效果,节约卫生资源,减少治疗费用,提高活体肝移植手术的效�AIM： To explore the clinical effects of application of nursing process in living donor liver trans- plant operation. METHODS： Seven patients who underwent liv- ing donor liver transplantation were cared using the nursing process （experiment group）, and 6 patients who underwent living donor liver transplantation did not receive care using the nursing process （control group）. The donor liver cold ischemia time, operative time, surgery cost, pH, BE, HCO3, PaCO2, Na＋, K＋, CI, Ca2＋, heart rate （HR）, mean arterial pressure （MAP）, central venous pressure （CVP） and surgeon＇s satisfac- tion to nursing were compared between the two groups. RESULTS： The donor liver cold ischemia time and operative time in the experiment group were significantly lower than those in the control group （81.13 min± 19.65 min vs 106.93 min ± 21.36 rain, 11.15 h ± 1.05 h vs 15.96 h ±3.81 h, P 〈 0.05）. The costs of anesthesia, trans- portation, and one-time items were signifi- cantly lower in the experiment group than in the control group （5026.57 yuan ± 805.12 yuan vs 5669.05 yuan ± 740.17 yuan, 1020.89 yuan± 132.77 yuan vs 1268.10 yuan ± 150.52 yuan, 5500.22 yuan±615.33 yuan vs 6263.31 yuan± 505.48 yuan, P 〈 0.05）. The surgeon＇s satisfac- tion to nursing in the experiment group was significantly higher than that in the control group （100.00% vs 83.33%, P 〈 0.05）. There were no significant differences in blood gas parameters tested （P 〉 0.05） or hemodynamic indexes in the new liver between the two groups （P 〉 0.05）. CONCLUSION： Application of the nursing process can improve the effectiveness and stan- dardization of nursing in living donor liver transplant operation in terms of enhancing the nursing cooperation efficiency, saving health resources, reducing the costs of treatment, and improving the clinical effects.

关 键 词：活体肝移植手术 护理流程 应用效果 

分 类 号：R473.6[医药卫生—护理学]