基于肝切除术后肝衰竭分级的针对性护理对肝癌患者的影响

Effect of targeted nursing based on grading of post-hepatectomy liver failure on patients with liver cancer

目的探讨基于肝切除术后肝衰竭(PHLF)分级的针对性护理对肝癌患者的影响。方法以2018年1月至2019年12月浙江大学医学院附属第二医院收治的96例肝癌患者为研究对象,按抽签法随机分为对照组和观察组,各48例。对照组给予常规护理,观察组在常规护理的基础上给予基于PHLF分级的针对性护理,并比较2组的护理效果。结果2组在干预3 d后的白蛋白(ALB)水平均较入院时升高(P均<0.05),丙氨酸氨基转移酶、总胆红素、天门冬氨酸氨基转移酶、碱性磷酸酶和γ谷氨酰转肽酶水平均较入院时降低(P均<0.05);出院时,2组的ALB水平均较干预3 d后升高,上述其余肝功能指标水平均较干预3 d后降低,肝癌患者生活质量测定量表(QOL-LC)评分均较入院时提高,且观察组在干预3 d后及出院时的肝功能指标,以及在出院时的QOL-LC评分均优于对照组,差异均有统计学意义(P均<0.05)。观察组的术后并发症总发生率低于对照组(P<0.05),引流管拔除时间早于对照组(P<0.05),住院时间短于对照组(P<0.05)。结论肝癌患者在行肝切除术后应用基于PHLF分级的针对性护理,可改善其肝功能和生活质量,并降低并发症总发生率和加速康复进程。

Objective To explore the effect of targeted nursing based on the grading of posthepatectomy liver failure(PHLF)on patients with liver cancer.Methods A total of 96 patients with liver cancer who were admitted to the Second Affiliated Hospital Zhejiang University School of Medicine from January 2018 to December 2019 were selected as the research objects.They were randomly allocated into a control group and an observation group by drawing lots,with 48 cases in each group.The control group was given routine nursing,and the observation group was given targeted nursing based on PHLF grading on the basis of routine nursing.The nursing effect of the two groups was compared.Results After 3 days of intervention,the level of albumin(ALB)in the two groups was higher than that at admission(both P<0.05),and the levels of glutamic-pyruvic transaminase,total bilirubin,glutamic-oxaloacetic transaminase,alkaline phosphatase,and glutamyl transpeptidase were lower than those at admission(all P<0.05).At discharge,the level of ALB in the two groups was higher than that after 3 days of intervention(both P<0.05),and the levels of other abovementioned liver function indicators were lower than those after 3 days of intervention(all P<0.05).At discharge,the scores of quality of life-liver cancer(QOL-LC)questionnaire in the two groups were higher than those at admission(all P<0.05).The levels of liver function indicators after 3 days of intervention and at discharge,as well as the QOL-LC scores at discharge in the observation group were better than those in the control group(all P<0.05).The incidence of postoperative complications in the observation group was lower than that in the control group(P<0.05),and the removal time of drainage tube and length of hospital stay was shorter than those in the control group(both P<0.05).Conclusion The application of targeted nursing based on PHLF grading in patients with liver cancer after hepatectomy can improve the liver function and quality of life,reduce the incidence of postoperative complications,and accelerate the rehabilitation.