现代临床护理
現代臨床護理
현대림상호리
Modern Clinical Nursing
2015年
9期
31-37
,共7页
肝移植%精神障碍%护理
肝移植%精神障礙%護理
간이식%정신장애%호리
liver transplantation%mental disorder%nursing
目的 探讨肝移植术后患者并发精神障碍的影响因素及护理对策. 方法 肝移植术后患者72例,其中并发精神障碍38例,未发生精神障碍34例,比较并发与未并发精神障碍患者在不同性别、年龄、机械通气时间、平均动脉压低于基础压百分比、术中出血量、手术持续时间、住ICU时间、术后疼痛持续时间及程度、普乐可复(商品名FK506)血药浓度,及术前有无肝性脑病史、术后有无使用镇静剂、术后有无约束、术后有无代谢异常或障碍、术后有无感染情况,并采用Logistic回归分析法分析患者发生精神障碍的危险因素. 结果 平均动脉压低于基础压百分比>20%以上、术后疼痛持续时间>5 h及疼痛数字评分法(numerical rating scale, NRS)>4分、FK506血药浓度>13 ng/mL、术后代谢异常或障碍、术后感染是肝移植术后患者并发精神障碍的独立危险因素(均P<0.01). 结论 肝移植术后患者并发精神障碍发生率高,患者血压情况、术后疼痛持续时间及程度、FK506血药浓度、术后代谢异常或障碍、术后感染是肝移植术后患者并发精神障碍的危险因素.提供亲情护理、有效控制血压、做好术后镇痛、监测药物浓度、维持内环境稳定、预防感染对降低肝移植术后患者并发精神障碍具有重要意义.
目的 探討肝移植術後患者併髮精神障礙的影響因素及護理對策. 方法 肝移植術後患者72例,其中併髮精神障礙38例,未髮生精神障礙34例,比較併髮與未併髮精神障礙患者在不同性彆、年齡、機械通氣時間、平均動脈壓低于基礎壓百分比、術中齣血量、手術持續時間、住ICU時間、術後疼痛持續時間及程度、普樂可複(商品名FK506)血藥濃度,及術前有無肝性腦病史、術後有無使用鎮靜劑、術後有無約束、術後有無代謝異常或障礙、術後有無感染情況,併採用Logistic迴歸分析法分析患者髮生精神障礙的危險因素. 結果 平均動脈壓低于基礎壓百分比>20%以上、術後疼痛持續時間>5 h及疼痛數字評分法(numerical rating scale, NRS)>4分、FK506血藥濃度>13 ng/mL、術後代謝異常或障礙、術後感染是肝移植術後患者併髮精神障礙的獨立危險因素(均P<0.01). 結論 肝移植術後患者併髮精神障礙髮生率高,患者血壓情況、術後疼痛持續時間及程度、FK506血藥濃度、術後代謝異常或障礙、術後感染是肝移植術後患者併髮精神障礙的危險因素.提供親情護理、有效控製血壓、做好術後鎮痛、鑑測藥物濃度、維持內環境穩定、預防感染對降低肝移植術後患者併髮精神障礙具有重要意義.
목적 탐토간이식술후환자병발정신장애적영향인소급호리대책. 방법 간이식술후환자72례,기중병발정신장애38례,미발생정신장애34례,비교병발여미병발정신장애환자재불동성별、년령、궤계통기시간、평균동맥압저우기출압백분비、술중출혈량、수술지속시간、주ICU시간、술후동통지속시간급정도、보악가복(상품명FK506)혈약농도,급술전유무간성뇌병사、술후유무사용진정제、술후유무약속、술후유무대사이상혹장애、술후유무감염정황,병채용Logistic회귀분석법분석환자발생정신장애적위험인소. 결과 평균동맥압저우기출압백분비>20%이상、술후동통지속시간>5 h급동통수자평분법(numerical rating scale, NRS)>4분、FK506혈약농도>13 ng/mL、술후대사이상혹장애、술후감염시간이식술후환자병발정신장애적독립위험인소(균P<0.01). 결론 간이식술후환자병발정신장애발생솔고,환자혈압정황、술후동통지속시간급정도、FK506혈약농도、술후대사이상혹장애、술후감염시간이식술후환자병발정신장애적위험인소.제공친정호리、유효공제혈압、주호술후진통、감측약물농도、유지내배경은정、예방감염대강저간이식술후환자병발정신장애구유중요의의.
Objective To investigate the influential factors and nursing measures for mental disorders after liver transplantation. Methods Seventy-two patients had undergone liver transplantation and thirty-eight of them affected mental disorders and 34 of them did not. The mental disorder group and the non-mental disorder group were compared in terms of sex, age, mechanical ventilation time, pressure percentage mean of arterial pressure, intraoperative blood loss, duration of operation time, ICU stay time, postoperative pain duration and degree, Bullock complex (tacrolimus, FK506) blood drug concentration, history of preoperative hepatic encephalopathy, postoperative use of sedatives, postoperative constraint, postoperative metabolic abnormalities and disorders and infection. The plain logistic regression analysis was used to abstract the risk factors for mental disorders. Results The independent influential factors for the complicated mental disorders included the mean arterial pressure lower than that of pressure percentage> 20%, postoperative pain duration > 5 h and score by the numerical rating scale ( NRS ) > 4 , FK506 blood drug concentration> 13 ng/mL, postoperative abnormality, disturbance of metabolism and infection (P < 0.01). Conclusion The incidence rate of postoperative mental disorders is high among the patients having undergone liver transplantation. The influential factors for the mental disorder include blood pressure and postoperative pain duration and degree , FK506 blood drug concentration and metabolic abnormalities and disorders, and infection. The nursing measures like family nursing, effective control of blood pressure, postoperative analgesia, monitoring the drug concentration, maintaining a stable environment and preventing infection after liver transplantation are critical for the reduced rate of mental disorder.
