20例小肠移植患者围手术期医护一体化感染防控的管理

Management of infection prevention and control with integrated medical care in the perioperative period in 20 cases of small intestine transplantation

目的:总结某院2019年8月至2021年4月实施的20例小肠移植患者围手术期医护一体化感染防控的管理经验。方法:通过组建多学科医护团队,共同进行风险管理评估,分析小肠移植术后感染发生的原因并提出对策。通过制订感染防控措施查检表,共同参与培训学习;执行医护一体化感染防控管理措施,包括控制呼吸道及腹腔感染、导管相关性血流感染、腹部切口及移植肠造口等相关感染的发生;全程医护共同监督、协作,持续进行质量改进。结果:1例患者术后8天因腹腔感染致感染性休克放弃治疗后出院;1例因重症肺炎伴多发性感染术后79天死亡;其余18例患者术后移植肠均存活,术后(22.58±6.72)天脱离肠外营养,经口进食。结论:医护一体化管理模式最大限度地控制了小肠移植术后感染,加速移植肠功能恢复,且促进了团队合作及护理专业的发展。

Objective:To summarize the management experience of perioperative infection prevention and control of 20 cases of small intestine transplantation from August 2019 to April 2021.Methods:Risk management assessment was conducted to analyze of the causes of infection after small intestine transplantation and countermeasures were proposed by multi-disciplinary medical team.Checklists for infection prevention and control measures were made and implemented.Infection prevention and control management measures with integrated medical care was conducted,including control of respiratory and abdominal infection,catheter-related bloodstream infection and infection related to abdominal incisions and transplanted intestinal stoma.The joint supervision,collaboration and continuous quality improvement of the integrated medical team was conducted during the whole process.Results:One patient gave up treatment for septic shock led by abdominal infection 8 days after operation and was discharged.One patient died 79 days after operation due to severe pneumonia with multiple infections.Eighteen patients were alive after small intestine transplantation,and were taken off the parenteral nutrition for(22.58±6.72)days after the operation.Conclusion:The management model of integrated health care maximizes the control of postoperative infection of small intestine transplantation,accelerates the functional recovery of the transplanted intestine,and promotes cooperation and the development of the nursing profession.