经颈静脉肝内门体分流术的介入护理体会  

Interventional Nursing Experience of Transjugular Intrahepatic Portosystemic Shunt

作　　者：马强 林志鹏 邹旭公 周修彬 汤易成 王宁泊 MA Qiang;LIN Zhipeng;ZOU Xugong;ZHOU Xiubin;TANG Yicheng;WANG Ningbo(Zhongshan People's Hospital,Zhongshan 528403,China)

机构地区：[1]中山市人民医院,广东中山528403

出　　处：《中国医药指南》2023年第30期5-8,共4页Guide of China Medicine

基　　金：肝硬化门脉高压患者TIPS术后血小板释放损肝因子和护肝因子的改变及相关信号通路研究(中山市卫健局课题号:2021J047)。

摘　　要：目的 总结经颈静脉肝内门体分流术(TIPS)的介入手术护理经验与心得体会。方法 选取2018年1月至2022年7月由我院收治行TIPS术的102例患者作为研究对象,对其病历资料进行整理分析研究,对术前准备、术中护理配合及围手术期护理进行归纳总结,将患者以随机分组方式分为观察组和对照组,每组各51例。对照组患者予普通常规护理,观察组患者实施精细化的介入护理。观察分析两组患者的一般资料、治疗效果、护理前后心理状况及护理总体满意度。结果 两组患者一般资料的差异均无统计学意义(P>0.05)。观察组术后6个月肝性脑病发生率低于对照组(P<0.05),差异具有统计学意义。术后患者门静脉压(cm H_(2)O)下降至术前的30%以内发生率、术后6个月再出血发生率、术后复查胃镜检查食管胃底静脉曲张程度减轻、分流道失功发生率,组间比较差异不具统计学意义(P>0.05)。观察组护理后心理状态、护理总体满意度均优于对照组(P<0.05),差异有统计学意义。结论 TIPS是现阶段非外科手术治疗肝硬化的一种介入治疗方法,术中默契的手术护理配合,精细化的护理干预,有利于促进手术取得成功,能有效减少术后并发症,术后有针对性的延续护理可提高患者门诊随访的依从性,改善患者远期生活质量。Objective To summarize the nursing experience and experience of interventional operation of transjugular intrahepatic portosystemic shunt(TIPS).Methods A total of 102 patients who underwent TIPS in our hospital from January 2018 to July 2022 were selected as the object of study.The medical records were analyzed,and the preoperative preparation,intraoperative nursing cooperation and perioperative nursing were summarized.The patients were divided into observation and control groups by random grouping,with 51 cases in each group.The patients in the control group were given routine nursing,and the patients in the observation group were given fine interventional nursing.The general data,treatment effect,psychological status before and after nursing and overall nursing satisfaction of the two groups were observed and analyzed.Results There was no significant difference in the general data between the two groups(P>0.05).The incidence of hepatic encephalopathy at 6 months after surgery was lower in the observation group than in the control group(P<0.05).There were no significant differences in the incidence of portal venous pressure(cm H_(2)O)decreased to less than 30%after surgery,the incidence of rebleeding 6 months after surgery,the degree of esophageal varices in postoperative follow-up gastroscopy,and the incidence of shunt tract failure were not statistically significant between the two groups(P>0.05).The postoperative psychological state and overall nursing satisfaction of the observation group were better than those of the control group(P<0.05).Conclusion TIPS is an interventional therapy for non-surgical treatment of liver cirrhosis at the present stage.Tacit operative nursing cooperation and fine nursing intervention during the operation can help to promote the success of the operation and effectively reduce postoperative complications.Postoperative targeted continuous nursing can improve the compliance of outpatient follow-up and improve the long-term quality of life of patients.

关 键 词：经颈静脉肝内门体分流术(TIPS) 护理 介入 体会 

分 类 号：R473[医药卫生—护理学] R657.31[医药卫生—临床医学]