陈辉容 藏莉 陈萌

摘要：目的  探讨对肝癌患者行肝切除术后根据肝功能衰竭（PHLF）分级进行护理的应用价值。方法  选取2018年2月～2019年10月于我科行肝癌切除术的患者84例作为研究对象，按照随机数表法将其分为研究组和对照组，各42例。研究组使用根据PHLF分级制定的护理方案，对照组使用常规的肝切除术后护理方案，比较两组术后并发症发生状况（伤口渗血、发热、感染、胸水及腹水及肝功能衰竭状况）、肝功能衰竭例数、诊断时限及预后状况，住院时间及住院费用。结果  研究组术后发生伤口渗血、发热、感染、胸水及腹水及肝功能衰竭状况等术后并发症发生状况均低于对照组，但差异无统计学意义（P>0.05）;研究组PHLF诊断时限、住院时间及住院费用均低于对照组[（5.28±1.80）d vs（6.11±0.72）d]、[（17.23±8.96）d vs（32.59±7.81）d]、[（43600.97±5000.47）元vs（52400.36±3450.24）元]，差异有统计学意义（P<0.05）。结论  对肝癌行肝切除术的患者结合肝功能衰竭分级进行护理，可以降低其手术后的住院时长及住院费用，提高临床医师对患者肝功能衰竭的诊断时限，值得推广应用。

关键词：PHLF分级;肝癌;肝切除术

Abstract：Objective  To explore the application value of nursing according to liver failure （PHLF） classification after hepatectomy in patients with liver cancer.Methods  84 patients who underwent liver cancer resection in our department from February 2018 to October 2019 were selected as the research object， and they were divided into a reaearch group and a control group according to the random number table method， with 42 cases in each group. The research group used a nursing plan based on PHLF classification， and the control group used a routine nursing program after hepatectomy， the postoperative complication status （wound bleeding， fever， infection， pleural effusion and ascites， and liver failure status）， number of liver failure cases， diagnosis time limit and prognosis status， hospital stay and hospitalization costs were compared between the two groups.Results  Postoperative complications such as bleeding， fever， infection， pleural effusion， ascites， and liver failure in the study group were lower than those in the control group， but the difference was not statistically significant （P>0.05）; PHLF diagnosis in the study group time limit， length of stay and hospitalization costs were lower than the control group [（5.28±1.80）d vs （6.11±0.72）d]， [（17.23±8.96） d vs （32.59±7.81） d]， [（43600.97±5000.47 ） Yuan vs （52400.36±3450.24） Yuan]，the difference was statistically significant（P<0.05）.Conclusion  Caring for patients with liver cancer undergoing hepatectomy combined with liver failure classification can reduce the length of hospitalization and hospitalization costs after surgery， and increase the time limit for clinicians to diagnose patients with liver failure， which is worthy of popularization and application.

Key words：PHLF classification;Liver cancer;Hepatectomy

肝癌（liver cancer）作為临床常见的恶性肿瘤中之一，流行病学调查研究显示[1，2]，肝癌占我国癌症发病总数的12.9%，因其起病较为隐匿，早期无明显的临床症状，发现时已为中晚期，丧失了最佳治疗时机。目前针对肝癌最常见的治疗手段为手术切除治疗、肝移植、化学药物及放射性治疗等综合手段，其中手术切除为其常用方法，但多数患者行肝癌手术切除术后易发生肝功能不全甚至肝衰，研究表明[3]，术后3～5 d内凝血酶原活动度（PTA）低于50%及血清总胆红素（TBIL）高于50 μmol/L是致死性肝功能衰竭的极敏感指标。传统的护理方法不能满足肝癌切除术后患者的护理需要，2011年肝功能衰竭分级提……