整体护理在酒精性肝硬化患者行自体骨髓间充质干细胞经肝动脉介入移植术围术期的作用

Effects of Holistic Nursing Care in the Perioperative Period of Intrahepatic Transplantation of Autologous BMSCs for Patients with Alcoholic Cirrhosis

目的观察整体护理(HNC)干预对酒精性肝硬化(AC)患者行自体骨髓间充质干细胞(BMSCs)经肝动脉介入移植术围术期的疗效。方法将AC失代偿期患者58例,随机分为整体护理组(HNC组)与传统护理组(TN组),各29例。分别被实施HNC干预、TN干预。结果两组入院当天状态焦虑评分差异无统计学意义(P>0.05)。在介入移植术当天、术后第4周末、出院当天HNC组状态焦虑评分均低于TN组(P<0.05);两组临床症状与体征改善情况比较,HNC组术后第4周末,腹胀、纳差、乏力、腹水的有效率分别为100.00%(29/29)、96.68%(28/29)、93.15%(27/29)、89.72%(26/29);TN组术后第4周末腹胀、纳差、乏力、腹水的有效率分别为62.15%(18/29)、58.64%(17/29)、65.52%(19/29)、55.25%(16/29)。两组比较,各症状与体征有效率差异均有统计学意义(P<0.05);HNC组出院时健康教育覆盖率、患者满意度、医疗纠纷发生率与住院天数分别为100.00%(29/29)、93.10%(27/29)、3.45%(1/29)、(44±4.29)d;TN组出院时健康教育覆盖率、患者满意度、医疗纠纷发生率与住院天数分别为79.31%(23/29)、75.86%(22/29)、10.34%(3/29)、(48±4.66)d。两组比较,教育覆盖率、患者满意度、医疗纠纷发生率与住院天数差异均有统计学意义(P<0.05);两组术后不良反应与并发症发生率比较,结果为HNC组穿刺点局部血肿、发热、肝区疼痛不适以及全身酸痛发生率分别为3.45%(1/29)、6.90%(2/29)、10.34%(3/29)、10.34%(3/29);TN组分别为13.79%(4/29)、17.24%(5/29)、20.69%(6/29)、24.14%(7/29)。两组比较,HNC组穿刺点局部血肿、发热、肝区疼痛不适以及全身酸痛发生率均低于TN组(P<0.05)。结论整体护理可以通过降低AC失代偿期患者行自体BMSCs介入移植术围术期的负性心理,改善其症状与体征以及减少手术并发症的发生,从而提高疗效与护理质量。

Objective：To discuss the effects of holistic nursing care（HNC）in the perioperative period of intrahepatic transplantation of autologous bone marrow-derived mesenchymal stem cells（BMSCs）for patients with alcoholic cirrhosis（AC）.Methods：58 patients with decompensated AC were hospitalized in our department from July 2012 to June 2014.They were randomly divided into two groups,HNC group and the traditional nursing（TN）group.Patients in the two groups were treated by HNC and TN intervention,respectively.Results：1）Compared with TN group,the anxiety degree of HNC group was obviously lower on the day of interventional transplantation,at the end of 4th week after the operation,and on the day of discharge（P〈0.05）.2）On the day of hospital discharge,abdominal distension,poor appetite,fatigue and ascites status were obviously improved in the HNC group,with the total effective rates of 100%,96.6%,93.1% and 89.7%,while the rates in the TN group were 62.1%,58.6%,65.5% and 55.2%,respectively;the degree of improvement was significantly different in the two groups（P〈0.05）.3）On the day of hospital discharge,the coverage rate of health education,degree of patient＇s satisfaction,incidence of medical dissension and length of hospital stay were 100%,93.1%,3.4% and（44±4.29）d,respectively,while these indicators in the TN group were 89.3%,85.9%,10.3%（3/29）and（48±4.66）d;the former two indicators in the HNC group were obviously increased（P〈0.05）,and the later two indicators declined obviously（P〈0.05）.4）Compared with TN group,the incidence of complications such as local hematoma on the puncture site,fever,liver pain and muscular stiffness was considerably lower in the HNC group（P〈0.05）.No myelosuppression,positive AFP and tumor were found in either groups.Conclusion：By alleviating the negative psychology,improving symptoms and physical signs and reducing operative complications,holistic nursing care can promote the treatment effect and nursing quality in the perioperative period of interventional transplantation of autologous BMSCs for patients with alcoholic cirrhosis.