乙型肝炎肝硬化患者肝移植等待期应用多模式预康复优化项目的临床研究  

Clinical research of multimodal prehabilitation optimization program in patients with hepatitis B virus-related liver cirrhosis awaiting liver transplantation

作　　者：雷雪雪[1] 于颖[2] 李虹彦[3] Lei Xuexue;Yu Ying;Li Hongyan(Department of Radiotherapy,the First Hospital of Jilin University,Changchun 130021,China;Department of Hepatobiliary Pancreatic Surgery,the First Hospital of Jilin University,Changchun 130021,China;Department of Nursing,the First Hospital of Jilin University,Changchun 130021,China)

机构地区：[1]吉林大学第一医院放疗科,长春130021 [2]吉林大学第一医院肝胆胰外一科,长春130021 [3]吉林大学第一医院护理部,长春130021

出　　处：《中华移植杂志（电子版）》2023年第3期158-163,共6页Chinese Journal of Transplantation(Electronic Edition)

基　　金：吉林大学第一医院2020年护理科研基金(20200202)。

摘　　要：目的为乙型肝炎肝硬化患者肝移植等待期构建多模式预康复优化项目,探讨其在临床实践中的应用效果。方法选取吉林大学第一医院移植中心2021年1月至10月等待行原位肝移植的乙型肝炎肝硬化患者为研究对象,以主要结局指标6分钟步行距离(6MWD)进行样本量估算,采用随机数字表法分为干预组和对照组。干预组48例患者接受为期4周的术前多模式预康复优化项目,包括运动训练、营养支持与心理护理。对照组45例患者接受肝移植等待期患者的术前常规护理方案。采用两独立样本t检验或χ^(2)检验比较两组患者性别、手术年龄、营养风险筛查2002(NRS 2002)量表评分、终末期肝病模型(MELD)评分和术后住院时间,采用两独立样本t检验比较干预前、肝移植术前1 d及术后30 d两组患者6MWD、血清营养学指标(白蛋白和前白蛋白)及医院焦虑抑郁量表(HADS)评分。P<0.05为差异具有统计学意义。结果两组患者性别、手术年龄、NRS 2002量表评分和MELD评分差异均无统计学意义(χ^(2)/t=0.022、0.389、0.194和-1.521,P均>0.05)。干预组和对照组患者术后住院时间分别为(12.7±1.1)、(17.3±2.3)d,差异有统计学意义(t=12.372,P<0.05)。干预组和对照组患者干预前6MWD、白蛋白、前白蛋白和HADS评分差异均无统计学意义(t=0.982、1.751、-1.124和-1.471,P均>0.05)。肝移植术前1 d,干预组患者6MWD、白蛋白、前白蛋白和HADS评分分别为(580±6)m、(40.01±4.32)g/L、(310.05±14.61)g/L和(6.4±1.2)分,均优于对照组(562±7)m、(35.53±3.41)g/L、(278.79±9.29)g/L和(11.3±1.8)分,差异均有统计学意义(t=13.502、5.527、12.388和-15.415,P均<0.05)。肝移植术后30 d,干预组患者6MWD、白蛋白、前白蛋白和HADS分别为(556±5)m、(35.37±4.99)g/L、(279.56±14.01)g/L和(6.8±1.2)分,均优于对照组(536±7)m、(31.90±4.75)g/L、(244.43±11.92)g/L和(11.4±1.8)分,差异均有统计学意义(t=15.122、3.424、12.98Objective To construct a multimodal pre-rehabilitation optimization program in patients with hepatitis B virus-related live cirrhosis awaiting liver transplantation,and to explore its application effect in clinical practice.Methods Patients with hepatitis B virus-related cirrhosis who were waiting for orthotopic liver transplantation in the Transplant Center of the First Hospital of Jilin University from January to October 2021 were enrolled as the study subjects.The sample size was estimated according to the main outcome of index 6 minutes walking distance(6MWD),and the patients were divided into the intervention group and the control group by random number table method.Forty-eight patients in the intervention group received a multimodal pre-rehabilitation optimization program for four weeks,including exercise training,nutritional support and psychological care.Forty-five patients in the control group received routine nursing plan while waiting for liver transplantation.Using two independent sample t tests or Chi-square test to compare the general data of the two groups of patients,such as sex,age of operation,nutrition risk screening 2002(NRS 2002)scale score,model for end-stage liver disease(MELD)score,and length of postoperative hospital stay.Using two independent samples t test to compare the 6MWD,serum nutritional science indicators(albumin and prealbumin)and hospital anxiety and depression scale(HADS)score of the two groups of patients at different time points(before intervention,1 day before liver transplantation and 30 days after surgery).P<0.05 was considered statistically significant.Results There were no significant differences in sex,preoperative age,NRS 2002 scales score and MELD scores between the two groups(χ^(2)/t=0.022、0.389、0.194 and-1.521,all P>0.05).The postoperative hospitalization time in the intervention group and the control group was(12.7±1.1)and(17.3±2.3)d,respectively,and the difference was statistically significant(t=12.372,P<0.05).There were no significant differences in 6MWD,

关 键 词：肝移植 乙型肝炎肝硬化 预康复 术前优化 运动疗法 营养 

分 类 号：R657.3[医药卫生—外科学]