精准肝切除快速康复护理的风险因素及护理对策

Risk factors and nursing countermeasures of rapid rehabilitation nursing for precision liver resection

目的探究精准肝切除快速康复护理的风险因素及护理对策。方法回顾性选取2018年1月至2019年3月于九江学院附属医院进行精准肝切除快速康复护理的44例患者设为对照组,并依据护理效果分为预后良好组(26例)和预后不佳组(18例);2019年6月至2020年10月于九江学院附属医院进行优化精准肝切除快速康复护理患者30例作为研究组。对照组患者给予精准肝切除快速康复护理,研究组患者给予优化精准肝切除快速康复护理。统计两组临床基本资料并进行单因素分析,对影响精准肝切除快速康复护理的相关危险因素进行多因素非条件logistic回归分析并探讨护理对策。结果单因素结果分析显示,预后不佳组的ASA分级Ⅲ~Ⅳ级、总胆红素(TBil)>21μmol/L、谷丙转氨酶(ALT)>50 U/L、活化部分凝血活酶时间(APTT)>40.0 s、输血及术中出血量>400 ml的患者比例高于预后良好组,差异有统计学意义(P<0.05);多因素分析结果提示,ASA分级Ⅲ~Ⅳ级、TBIL>21μmol/L、ALT>50 U/L、APTT>40.0 s、输血及术中出血量>400 ml均为精准肝切除快速康复护理方案失败的危险因素(P<0.05)。研究组患者的术后肛门排气时间、住院时间均短于对照组,差异有统计学意义(P<0.05);研究组护理后的中文版心理弹性量表(CD-RISC)分数高于对照组,差异有统计学意义(P<0.05)。结论制定针对风险因素的护理策略,优化精准肝切除快速康复护理方法有助于缩短患者的治疗时间,缓解患者不良情绪,从而促进病情恢复。

Objective To discuss the risk factors and nursing countermeasures of rapid rehabilitation nursing for precision liver resection.Methods A retrospective selection of 44 patients who underwent precision liver resection and rapid rehabilitation care in the Affiliated Hospital of Jiujiang University from January 2018 to March 2019 were selected as the control group,and were divided into a good prognosis group(26 cases)and a poor prognosis group based on the nursing effect group(18 cases),and then from June 2019 to October 2020,a total of 30 patients with optimized precision liver resection and rapid rehabilitation care at the Affiliated Hospital of Jiujiang University served as the research group.Patients in the control group were given rapid rehabilitation care for precision liver resection,and patients in the study group were given rapid rehabilitation care for optimized precision liver resection.Calculate the basic clinical data of the two groups and conduct single-factor analysis,conduct multi-factor unconditional logistic regression analysis on related risk factors that affect precision liver resection and rapid rehabilitation care,and discuss nursing strategies.Results Univariate analysis showed that the poor prognosis group had ASA gradeⅢ-Ⅳ,total bilirubin(TBil)>21μmol/L,alanine aminotransferase(ALT)>50 U/L,activated partial thromboplastin time(APTT)>40.0 s,blood transfusion and intraoperative blood loss>400 ml,the proportion of patients with good prognosis were higher than those of the good prognosis group,the differences were statistically significant(P<0.05);the results of multivariate analysis indicated that ASA gradeⅢ-Ⅳ,TBIL>21μmol/L,ALT>50 U/L,APTT>40.0 s,blood transfusion and intraoperative blood loss>400 ml were all precision liver resection rapid rehabilitation care plans Risk factors for failure(P<0.05).The postoperative anal exhaust time and hospital stay in the research group were shorter than those in the control group,the differences were statistically significant(P<0.05).The Connor-Davidson resilience scale(CD-RISC)scores after nursing in the research group were higher than those in the control group,the differences were statistically significant(P<0.05).Conclusion Formulating nursing strategies for risk factors and optimizing precise liver resection and rapid rehabilitation nursing methods can help shorten the treatment time of patients,alleviate the patients′bad mood,and promote the recovery of the disease.