集束化护理对PTCD患者口服胆汁依从性的影响及临床意义

目的分析集束化护理在经皮经肝胆管引流术（PTCD）患者中口服胆汁（OBR）的应用效果及对依从性的影响。 方法2018年1月至2020年12月，北京大学首钢医院肝胆胰外科共为91例梗阻性黄疸患者实施PTCD手术，并签署知情同意口服胆汁患者随机分为对照组和干预组。对照组接受肝胆胰外科常规护理，干预组在此基础上接受集束化护理干预。比较两组患者根治手术前肝脏功能和营养状态、评价2组患者对口服胆汁的依从性和潜在的临床意义。 结果干预组（n=46）和对照组（n=45）中分别有44例（95.65%）和34例（75.56%）坚持接受口服胆汁至根治手术前（χ²=7.50，P=0.006）；干预组依从性良好比率（32/46，69.60%）显著高于对照组（21/45，46.7%，χ²=4.90，P=0.027）。2组病人根治术前肝功能水平没有显著性差异，但干预组病人的血清白蛋白水平（35.32±4.10 vs 33.48±4.16，P=0.011）和淋巴细胞计数（2.54×10⁹/L±0.85×10⁹/L vs 2.26×10⁹/L±0.66×10⁹/L，P=0.031）高于对照组，反映出干预组病人的营养状态优于对照组。 结论集束化护理能有效提高PTCD患者口服胆汁的依从性，有效改善病人根治术前营养状况。

Effect of care bundles on compliance to oral bile reinfusion in patients undergoing percutaneous transhepatic cholangial drainage and its clinical significantce

ObjectiveTo analyze the application effects of care bundles in oral bile reinfusion (OBR) patients undergoing percutaneous transhepatic cholangial drainage (PTCD), and to evaluate its effect on compliance to OBR. MethodsFrom January 2018 to December 2020, a total of 136 patients with obstructive jaundice underwent PTCD surgery at our department, 91 patients of whom were randomly divided into either a control group or an observation group after informed consent for OBR was obtained. Both groups received routine nursing care for hepatopancreatobiliary surgery, while the observation group additionally received care bundles. Liver function and nutritional status before curative operation were compared between the two groups. Compliance to OBR was also compared, and potential clinical significance was analyzed. ResultsIn the observation group (n=46) and the control group (n=45), there were 44 (95.65%) and 34 cases (75.56%) who received comtinued OBR until curativel operation, respectively (χ²=7.50, P=0.006). The good compliance rate (32/46, 69.60%) in the observation group was significantly higher than that in the control group (21/45, 46.7%; χ²=4.90, P=0.027). There was no significant difference in liver function between the two groups before curative operation. However, nutritional status indicators of patients, such as serum albumin and peripheral blood lymphocyte count, were significantly better in the observation group than in the control group (35.32±4.10 vs 33.48±4.16, P=0.011; 2.54×10⁹/L ±0.85×10⁹/L vs 2.26×10⁹/L±0.66×10⁹/L, P=0.031). ConclusionCare bundles can effectively improve the rate of compliance to OBR in PTCD patients and the nutritional status of patients before curative operation.