张珍　　吴慧婷　　张晓青　　熊墨龙

[關键词] 集束化护理;双重血浆分子吸附系统;人工肝支持系统;肝衰竭

[中图分类号] R575.3          [文献标识码] B          [文章编号] 1673-9701（2021）29-0184-04

Application of bundle nursing in the treatment of patients with liver failure with double plasma molecular adsorption system

ZHANG Zhen   WU Huiting   ZHANG Xiaoqing   XIONG Molong

Artificial Liver Treatment Center， the Ninth Hospital of Nanchang City， Nanchang   330002， China

[Abstract] Objective To investigate the application effect of bundle nursing in the treatment of patients with liver failure with double plasma molecular adsorption system （DPMAS）. Methods A total of 68 patients with liver failure admitted to our hospital from January 2018 to December 2019 were selected as the study objects， and they were divided into the control group and the experimental group， with 34 cases in each group according to the random number table method. Both groups were treated with general drugs and DPMAS. The control group was treated with conventional nursing， while the experimental group was treated with bundle nursing. TBiL， ALT， CHE， PTA， hospitalization time， mortality， the incidence of catheter related infection and abnormal hemorrhage were compared between the two groups. Results There were statistically significant differences in TBiL and CHE between the two groups before and after intervention（P<0.05）. There were no statistically significant differences in ALT and PTA between the two groups before and after intervention（P>0.05）. Before intervention， there were no statistically significant differences in TBiL， ALT， CHE and PTA indices between the two groups （P>0.05）. There were no statistically significant differences in TBiL， ALT， CHE and PTA between the two groups after intervention（P>0.05）. However， the hospitalization time in the experimental group was significantly shorter than that in the control group， with statistically significant difference（P<0.05）. The mortality， incidence of catheter related infection and abnormal hemorrhage in the experimental group were significantly lower than those in the control group， with statistically significant differences（P<0.05）. Conclusion The application of bundle nursing in DPMAS treatment of patients with liver failure can significantly reduce the incidence of catheter related infection and abnormal hemorrhage， shorten the hospitalization time， and has certain clinical promotion value.

[Key words] Bundle nursing; Double plasma molecular adsorption system; Artificial liver support system; Liver failure

肝衰竭（Liver failure，LF）是指由各种诱因引起以急性黄疸加深、凝血功能障碍为临床表现的综合征，可合并包括肝性脑病、腹水、电解质紊乱、感染、肝肾综合征、肝肺综合征等并发症，以及肝外器官功能衰竭[1]。肝衰竭病理上以肝细胞大面积坏死为主要特点，疾病发展迅速，预后差，缺乏特效治疗手段，是各种类型肝病中病死率居于首位的重症疾病。近年来针对肝衰竭患者采用人工肝支持系统治疗技术，取得一定的疗效[2]，其中双重血浆分子吸附系统（Double plasma molecular absorb system，DPMAS）是方法之一。因其尚属于新型治疗技术的范畴，很多患者在接受该治疗时存在安全性方面的担忧。该技术在实施过程中确实存在一定的并发症风险，如导管相关感染、穿刺部位异常出血等情况，因此，对接受该治疗方法患者的护理要求更高。集束化护理是依托循证医学验证的护理措施集合而成，每个护理操作均被证实对患者有利，能够有效提高护理质量，常用于治疗难治疾病[3]，以期达到改变患者转归的目的[4]。本研究将集束化护理应用于行DPMAS治疗的肝衰竭患者，观察其效果，现报道如下。

1 资料与方法

1.1 一般资料

选取2018年1月至2019年12月我院收治的肝衰竭患者68例作为研究对象，随机分为试验组与对照组，每组各34例。试验组男21例，女13例，平均年龄（42.12±6.56）岁;对照组男23例，女 11例，平均年龄（43.21±5.43）岁。所有患者均符合中华医学会感染病学分会肝衰竭与人工肝学组制定的《肝衰竭诊治指南（2018年版）》中的诊断标准。……