肝移植患者术后精神异常的影响因素与护理对策

Influencing factors and nursing strategy for post-liver transplantation patients with mental disorders

目的探讨引起肝移植术后患者精神异常的相关因素及护理对策。方法回顾性分析2002年6月—2012年1月于上海交通大学医学院附属瑞金医院行肝移植患者371例,根据Riker镇静-激越评分系统(SAS)是否大于5级,将患者分为有精神异常组(激越组)和无精神异常组(对照组),比较两组患者的病史、Child评分、无肝期时间、手术时间、出血量、术后重症监护室(ICU)住院天数及FK-506浓度等指标。结果 371例患者中,术后出现精神异常74例,占19.9%,激越组与对照组在无肝期时间、总手术时间、同时期的血药浓度等方面比较,差异无统计学意义(P>0.05);与对照组相比,激越组的Child C级评分患者及有肝性脑病史的患者更多,且术中及术后出血量更多,ICU住院时间更长(P均<0.05)。结论肝移植术后早期发生精神异常是多种因素联合作用的结果,护士可通过及时观察患者意识状态,密切观察出血并维持血液动力学稳定,改善肝功能状态,改善ICU环境,做好患者心理护理等措施,以促进患者精神状态的恢复,提高肝移植手术的成功率。

Objective To investigate the influencing factors and nursing strategy for post-liver transplantation patients with mental disorders. Methods A total of 371 cases of liver transplantation were collected in Ruijin Hosptial, Shanghai Jiao Tong University School of Medicine from June 2002 to January 2012. The patients were assigned into the agitation group and normal group according to their mental status, which was evaluated every- day by Riker Sedation-Agitation Scale （SAS）. The mental status was considered abnormal if SAS score excee- ded grade 5. A comparison analysis was made including medical history, preoperative Child score, anhepatic phase time, operation time, blood loss, postoperative intensive care unit （ICU） stay and FK-506 concentration. Results 74 （ 19.9% ） patients experienced mental disorders after liver transplantation. There were no signifi- cant differences in anhepatic phase time, total operation time and blood drug concentration between the two groups （P 〉 0.05 ）. Compared with the normal group, the agitation group had higher preoperative Child score, more cases with history of hepatic encephalopathy, larger volume of blood loss and longer ICU stay （ P 〈 0.05 ）. Conclusion The mental disorders at early stage after liver transplantation are caused by a combination of multi- ple factors. The nursers should strengthen nursing support and safety management to promote the mental rehabil- itation of patients and improve the success rate of liver transplantation.