多学科协作下的快速康复管理措施对肝移植术后住院时间及并发症的影响

Effect of rapid rehabilitation management measures by multidisciplinary cooperation on hospital stay and complications after liver transplantation

目的探讨多学科协作下的快速康复管理措施对肝移植术后住院时间及并发症的影响。方法采用便利抽样法,收集四川大学华西医院肝脏外科2015年1月至2017年12月期间实施肝移植的患者,其中2017年1月至2017年12月期间的患者围术期采取的是多学科协作下的快速康复管理措施(研究组),2015年1月至2016年12月期间的患者采取的是常规管理措施(对照组);记录2组患者术后重症加强护理病房(intensive care unit,ICU)停留时间、术后住院时间及术后并发症情况。结果本研究共纳入175例肝移植患者,其中研究组78例,对照组97例。2组患者的年龄、性别、血红蛋白、白细胞计数、血小板计数、总胆红素、天冬氨酸转氨酶、谷丙转氨酶、白蛋白、凝血酶原时间、急性肝功能衰竭、终末期肝病模型评分及肝移植手术方式、手术时间、术中出血量比较差异均无统计学意义(P>0.05)。研究组术后ICU停留时间和术后住院时间均短于对照组(P<0.001),术后总并发症发生率及并发症分级均低于对照组(P<0.05)。结论从本研究初步研究结果看,实施多学科协作下的快速康复管理措施可缩短肝移植术后患者入住ICU时间和住院时间,降低术后并发症发生率,更有利于患者术后康复。

Objective To explore effect of rapid rehabilitation management measures by multidisciplinary cooperation on hospital stay and complications after liver transplantation.Methods The convenience sampling method was used to collect the liver transplant patients in the Department of Liver Surgery of West China Hospital of Sichuan University.The patients underwent the rapid rehabilitation management measures by multidisciplinary cooperation from January 2017 to December 2017 as the study group and the patients underwent the routine management measures from January 2015 to December 2016 as the control group.The postoperative intensive care unit(ICU)stay time and postoperative hospitalization time were recorded and the postoperative complications were observed.Results A total of 175 patients with liver transplantation were included,including 78 cases in the study group and 97 cases in the control group.There were no significant differences in the age,gender,hemoglobin,leukocyte count,platelet count,total bilirubin,aspartate aminotransferase,alanine aminotransferase,albumin,prothrombin time,acute liver failure,model for end-stage liver disease score,liver transplantation mode,operation time,and intraoperative bleeding between the two groups(P>0.05).The postoperative ICU stay time and postoperative hospitalization time were shorter and the incidences of total postoperative complications and gade of complications were lower in the study group as compared with the control group(P<0.05).Conclusion From preliminary results of this study,rapid rehabilitation management measures by multidisciplinary cooperation could shorten postoperative ICU stay time and postoperative hospitalization time,reduce incidence of postoperative complications,and be more conducive to postoperative rehabilitation.