护士主导的肝移植患儿腹内压管理方案的构建及应用研究

Construction and application of a nurse-led intra-abdominal pressure management program in children undergoing liver transplantation

目的构建护士主导的肝移植患儿腹内压管理方案,并探讨其应用效果。方法通过文献回顾、半结构式访谈和专家会议论证,构建护士主导的肝移植患儿腹内压管理方案。采用方便抽样法,选择2023年1月—12月浙江省某三级甲等医院肝移植ICU收治的162例患儿作为研究对象,按手术时间顺序分为试验组和对照组,将手术时间为2023年7月—12月的患儿作为试验组,将2023年1月—6月的患儿作为对照组。试验组在常规护理的基础上,采用护士主导的肝移植患儿腹内压管理方案进行干预;对照组采用肝移植术后常规护理。比较两组在ICU住院期间的平均腹内压、腹内高压发生率和分级、机械通气时长和ICU住院时长。结果护士主导的肝移植患儿腹内压管理方案包含4个一级条目、10个二级条目和20个三级条目。在方案应用过程中,共脱落4例,最终试验组纳入78例、对照组纳入80例。干预后,试验组在ICU住院期间的平均腹内压为(8.63±2.40)mmHg(1 mmHg=0.133 kPa),对照组为(9.23±3.19)mmHg,两组比较,差异无统计学意义(P=0.186);试验组腹内高压发生率为23.07%,对照组为41.25%,两组比较,差异具有统计学意义(P=0.015);试验组13例(16.67%)为I级腹内高压、5例(6.41%)为Ⅱ级,对照组22例(27.50%)为Ⅰ级腹内高压、9例(11.25%)为Ⅱ级、2例(2.50%)为Ⅲ级,两组比较,差异均无统计学差异(P>0.05);试验组机械通气时长为3.00(1.00,13.25)h,对照组为7.50(1.00,27.75)h,两组比较,差异具有统计学意义(P=0.034);试验组ICU住院时长为6.00(4.00,8.25)d,对照组为5.00(3.00,8.00)d,两组比较,差异无统计学意义(P=0.061)。结论该研究构建的护士主导的肝移植患儿腹内压管理方案具有科学性及实用性,实施该方案可有效降低患儿腹内高压的发生率、缩短机械通气时长。

Objective In this research,we constructed a nurse-led intra-abdominal pressure(IAP)management program in children undergoing liver transplantation,and explored its clinical application effect.Methods Based on literature review,semi-structured interviews,and expert meetings,a nurse-led program for IAP management is constructed.By convenience sampling method,162 children admitted to the pediatric liver transplant intensive care unit of a tertiary hospital in Zhejiang Province from January to December 2023 were selected.The experimental group implemented a nurse-led IAP management program,while the control group received routine postoperative care after liver transplantation.The average IAP values during ICU period,incidence and grading of intra-abdominal hypertension(IAH),duration of mechanical ventilation,and length of ICU stay were compared between 2 groups.Results Finally,the IAP management program in children undergoing liver transplantation included 4 first-level items,10 second-level items and 20 third-level items.During the application of this program,4 cases dropped,and 78 cases were finally included in the experimental group and 80 cases in the control group.After the intervention,the IAP value in the experimental group was(8.63±2.40)mmHg(1 mmHg=0.133 kPa),lower than(9.23±3.19)mmHg in the control group,but there was no statistically significant difference between the 2 groups(P=0.186).The incidence of IAH in the experimental group was 23.07%,lower than 41.25%in the control group.The difference between the 2 groups was statistically significant(P=0.015).13 cases(16.67%)in the experimental group developed gradeⅠIAH,while 22 cases(27.50%)in the control group;5 cases(6.41%)in the experimental group developed gradeⅡIAH,while 9 cases(11.25%)in the control group;no cases in the experimental group developed gradeⅢIAH,while 2 cases(2.50%)in the control group.There was no statistically significant difference between the 2 groups(P>0.05).The mechanical ventilation time in the experimental group was 3.00(1.00,13.25)hours,and 7.50(1.00,27.75)hours in the control group.The difference between the 2 groups was statistically significant(P=0.034).The length of ICU stay in the experimental group was 6.00(4.00,8.25)days,and 5.00(3.00,8.00)days hours in the control group.The difference between the 2 groups was statistically significant(P=0.061).Conclusion The nurse-led IAP management program in children undergoing liver transplantation can effectively reduce the incidence of IAH,shorten the duration of mechanical ventilation.