应用临床路径管理特利加压素治疗肝硬化并发食管胃底静脉曲张破裂出血不良反应的效果

Value of clinical pathway in the management of adverse effects of terlipressin in the treatment of cirrhosis complicated with bleeding from esophageal varices or gastric varices

目的观察临床护理路径(clinical nursing path,CNP)在特利加压素治疗肝硬化并发食管胃底静脉曲张破裂出血不良反应管理中的应用效果,探讨CNP干预在其中的临床价值。方法纳入2015年12月—2016年12月杭州市西溪医院收治的72例特利加压素治疗肝硬化并发食管胃底静脉曲张破裂出血患者进行研究,采用随机数字表法分为常规组(34例)和观察组(38例),常规组患者予常规护理干预,观察组患者予CNP干预,比较特利加压素相关不良反应发生率、治疗依从性、护理满意度和1周出血控制率等4个指标的组间差异,统计学比较差异有无统计学意义。结果观察组患者特利加压素的不良反应(腹痛腹泻、血压增高、心率减慢和低钠血症)发生率与常规组相近(44.7%vs.44.1%,P>0.05),治疗依从性(97.4%vs.82.4%)、护理满意度(89.5%vs.70.6%)和1周出血控制率(100.0%vs.85.3%)等均高于常规组,差异均有统计学意义(均P<0.05)。结论特利加压素治疗肝硬化并发食管胃底静脉曲张破裂出血时不良反应常见,CNP干预不能降低其发生率,但能提高患者的治疗依从性和护理满意度,为早期止血带来显著临床获益。

Objective To investigate the value of clinical path in the management of adverse effects of terlipressin for cir- rhosis complicated with Bleeding from esophageal varices （EVs） or gastric varices （GVs）. Methods Seventy-two cases of cirrhosis with bleeding from esophageal varices or gastric varices received terlipressin in our hospital between Decem- ber, 2015 and December, 2016, and were divided into observational group （n = 38） and normal group （n = 34） random- ly. The observational group was managed by clinical path, whereas the normal group received the conventional measures. The incidence of adverse effects related to terlipressin, treatment compliance, nursing satisfaction index and bleeding con- trol in one week were compared between the two groups. The differences about the four aforementioned parameters were statistically analyzed. Results The incidence of adverse effects （ abdominal pain, diarrhea, increased blood pressure, bradycardia and hyponatremia） in the observational group was similar to those in the normal group （44.7% vs. 44. 1% , P 〉 0.05 ） , while treatment compliance, nursing satisfaction and bleeding control were all higher than those in the normal group significantly （97.4% vs. 82.4%, 89.5% vs. 70.6%, and 100% vs. 85.3% ）, respectively, the difference was statistical significant, P 〈 0. 05. Conclusion The adverse effects of terlipressin in the treatment of cirrhosis with esopha- geal and gastric variceal bleeding are relatively common. Clinical path intervention fails to reduce the incidence of those adverse effects, but can improve treatment compliance and nursing satisfaction of the patients, thus benefits the early con- trol of bleeding significantly.