集束化管理预防肝移植患者术后肺部感染的效果

目的探讨集束化管理预防肝移植患者术后肺部感染的效果，以降低肺部感染发病率。方法选择2016年1月—2017年12月某院肝胆外科行肝移植的患者为研究对象。2016年1月—2017年3月的患者为对照组，实施常规护理措施，2017年4—12月的患者为试验组，实施集束化肺部管理。比较两组患者肺部感染发病率、肺不张发生率、第一次下床活动时间、住院费用和患者满意度。结果对照组共110例肝移植患者，试验组67例肝移植患者。两组患者均顺利完成手术。试验组肺部感染发病率为6.0％，低于对照组的16.4％，差异有统计学意义（P＜0.05）。试验组肺不张发生率为7.5％，低于对照组的18.2％，差异有统计学意义（P＜0.05）。试验组第一次下床活动时间为（83.81±7.56）h ，短于对照组的（91.67±13.93）h，差异有统计学意义（P＜0.01）。试验组住院时间为（30.22±3.23）d ，短于对照组的（31.49±4.34）d，差异有统计学意义（P＜0.05）。试验组患者对护理的总体满意度为92.5％，优于对照组的78.2％，差异有统计学意义（P＜0.05）。结论采用集束化管理能有效降低肝移植患者术后肺部感染发病率、肺不张发生率，缩短卧床时间及住院时间，提高患者满意度。

Effect of bundle management on preventing pulmonary infection in patients after liver transplantation

ObjectiveTo investigate the effect of bundle management on preventing pulmonary infection(PI) in patients after liver transplantation, and reduce the incidence of PI.MethodsPatients who underwent liver transplantation in the department of hepatobiliary surgery of a hospital between January 2016 and December 2017 were selected as studied subjects. Patients who underwent liver transplantation between January 2016 and March 2017 were in control group, they were given routine nursing measures, and patients who underwent liver transplantation in April December 2017 were in trial group, they were given bundle management. Incidences of PI and atelectasis, first ambulation time, hospitalization cost, and patients’ satisfaction were compared between two groups.ResultsThere were 110 patients in control group and 67 in trial group with liver transplantation. Two groups of patients all successfully completed surgery. Incidence of PI in trial group was lower than control group (6.0% vs 16.4%, P<0.05). Incidence of atelectasis in trial group was lower than control group (7.5% vs 18.2%, P<0.05). The first ambulation time in trial group was shorter than control group（［83.81±7.56］ h vs ［91.67±13.93］ h, P<0.01). Length of hospital stay in trial group was shorter than control group（［30.22±3.23］ d vs ［31.49±4.34］ d，P<0.05). The total rate of patients’ satisfaction for nursing in trial group was higher than control group (92.5% vs 78.2%, P<0.05).ConclusionBundle management can effectively reduce the incidences of PI and atelectasis, shorten the first ambulation time and length of hospital stay, and improve patients’ satisfaction.