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术前循证实践预防肝移植术后早期感染。

Preoperative Evidence-Based Practice for Prevention of Early Postoperative Infections in Patients Receiving a Liver Transplant.

机构信息

Department of Infection, Beijing Youan Hospital, Capital Medical University, Beijing, China.

Department of Nursing, Beijing Youan Hospital, Capital Medical University, Beijing, China.

出版信息

Ann Transplant. 2024 Sep 17;29:e943610. doi: 10.12659/AOT.943610.

DOI:10.12659/AOT.943610
PMID:39285624
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11416044/
Abstract

BACKGROUND This study aimed to evaluate the effectiveness of implementing evidence-based preoperative nursing interventions in reducing postoperative infections and intensive care unit (ICU) length of stay among liver transplant recipients. MATERIAL AND METHODS A controlled study was conducted, comparing postoperative outcomes between an intervention group receiving standardized, evidence-based preoperative care and a control group receiving routine preoperative care. Patients undergoing elective liver transplantation from September 2020 to March 2021 were included and assigned to either the intervention or control group. The intervention group received preoperative interventions based on best available evidence, while the control group received standard preoperative care. The primary outcomes measured were postoperative infection rates and length of ICU stay. RESULTS In the control group the overall Intensive Care Unit (ICU) length of stay was 3 days and the infection rate was 33.30%, while in the intervention group it was 3 days and 13.80% (P<0.05). There was no significant difference in the length of ICU stay between the control and the intervention groups (P>0.05). There was a significant improvement in the awareness, acceptance, and compliance of doctors and nurses. CONCLUSIONS Using the best evidence-based intervention for preoperative nursing of liver transplantation patients can standardize preoperative nursing behavior. Although we did not find significant differences in outcomes before and after the intervention, it is necessary to prevent postoperative infection and improve nursing compliance.

摘要

背景

本研究旨在评估实施循证术前护理干预措施对降低肝移植受者术后感染和重症监护病房(ICU)住院时间的有效性。

材料与方法

进行了一项对照研究,比较了接受标准化、循证术前护理的干预组和接受常规术前护理的对照组之间的术后结果。纳入 2020 年 9 月至 2021 年 3 月期间择期行肝移植的患者,并将其分配至干预组或对照组。干预组接受基于最佳现有证据的术前干预,而对照组接受标准术前护理。主要结局指标为术后感染率和 ICU 住院时间。

结果

在对照组中,ICU 总住院时间为 3 天,感染率为 33.30%,而在干预组中,ICU 总住院时间为 3 天,感染率为 13.80%(P<0.05)。对照组和干预组 ICU 住院时间无显著差异(P>0.05)。医生和护士的意识、接受度和依从性均显著提高。

结论

对肝移植患者采用最佳循证术前护理干预措施,可以规范术前护理行为。虽然我们未发现干预前后结果有显著差异,但仍有必要预防术后感染并提高护理依从性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0f3e/11416044/1937630eba89/anntransplant-29-e943610-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0f3e/11416044/23805754b12a/anntransplant-29-e943610-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0f3e/11416044/5fd8d4d679a7/anntransplant-29-e943610-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0f3e/11416044/1937630eba89/anntransplant-29-e943610-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0f3e/11416044/23805754b12a/anntransplant-29-e943610-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0f3e/11416044/5fd8d4d679a7/anntransplant-29-e943610-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0f3e/11416044/1937630eba89/anntransplant-29-e943610-g003.jpg

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本文引用的文献

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Guideline on multimodal rehabilitation for patients with post-intensive care syndrome.《重症监护后综合征患者的多模式康复指南》。
Crit Care. 2023 Jul 31;27(1):301. doi: 10.1186/s13054-023-04569-5.
2
Representations of clinical practice guidelines and health equity in healthcare literature: An integrative review.医疗保健文献中临床实践指南与健康公平的呈现:一项综合综述。
J Nurs Scholarsh. 2023 Mar;55(2):506-520. doi: 10.1111/jnu.12847. Epub 2022 Nov 23.
3
Effects of admission systemic inflammatory indicators on clinical outcomes in patients with vertebrobasilar artery occlusion: insight from the PERSIST registry.
入院系统性炎症指标对椎基底动脉闭塞患者临床结局的影响:来自 PERSIST 登记研究的观察。
4
Early post-liver transplantation infections and their effect on long-term survival.肝移植后早期感染及其对长期生存的影响。
Transpl Infect Dis. 2021 Aug;23(4):e13673. doi: 10.1111/tid.13673. Epub 2021 Jul 9.
5
Study on the relieving effect of evidence-based nursing model on pain nursing of patients after liver transplantation.循证护理模式对肝移植术后患者疼痛护理的缓解效果研究
Minerva Med. 2021 Oct;112(5):676-677. doi: 10.23736/S0026-4806.20.06581-7. Epub 2020 Apr 27.
6
Applications of transcatheter embolotherapy in preparation for liver transplantation and resection.经导管栓塞治疗在肝移植和肝切除术前准备中的应用。
Chin Clin Oncol. 2019 Dec;8(6):59. doi: 10.21037/cco.2019.12.03. Epub 2019 Dec 12.
7
Cryptococcosis in solid organ transplantation-Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice.实体器官移植中的隐球菌病——美国移植感染病学会实践社区指南。
Clin Transplant. 2019 Sep;33(9):e13543. doi: 10.1111/ctr.13543. Epub 2019 Apr 14.
8
Management of bacterial and fungal infections in end stage liver disease and liver transplantation: Current options and future directions.终末期肝病和肝移植中细菌和真菌感染的管理:现有选择和未来方向。
World J Gastroenterol. 2018 Oct 14;24(38):4311-4329. doi: 10.3748/wjg.v24.i38.4311.
9
Early mortality after liver transplantation: Defining the course and the cause.肝移植术后早期死亡:定义病程和病因。
Surgery. 2018 Oct;164(4):694-704. doi: 10.1016/j.surg.2018.04.039. Epub 2018 Jul 31.
10
Infectious Complications and Malignancies Arising After Liver Transplantation.肝移植术后出现的感染性并发症和恶性肿瘤
Anesthesiol Clin. 2017 Sep;35(3):381-393. doi: 10.1016/j.anclin.2017.04.002. Epub 2017 Jul 5.