Objective To study the effect of early activity based on structured quality improvement in ICU patients after liver transplantation. Methods Liver transplantation patients admitted to the ICU of a tertiary class A hospital in Beijing from September 2019 to May 2022 were selected as the study objects. Sixty-three patients from January 2021 to May 2022 were included into experimental groups according to the order of surgery. Early activities based on structured quality improvement were carried out. A total of 62 patients from September 2019 to December 2020 served as the control group and received routine early activities. The risk level of pressure injury after ICU and discharge,the level of daily self-care ability after ICU and discharge,postoperative pain,and the incidence of deep venous thrombosis of lower limbs were compared between the two groups. Results The risk level of pressure injury out of ICU in experimental group was lower than that in control group,and the level of daily living activity ability out of ICU and out of hospital was higher than that in control group,the difference was statistically significant(P<0.05). 13 patients(2.06%)had postoperative pain in the experimental group and 12 patients(1.93%)in the control group,the difference was not statistically significant(P>0.05). No deep vein thrombosis occurred in the experimental group,and 1 case(1.6%)in the control group(P>0.05). Conclusion The early activity nursing plan of ICU patients after liver transplantation based on structured quality improvement is helpful to reduce the risk of pressure injury,improve the self-care ability of patients after liver transplantation,and improve the quality of life of patients.
[1] 陶开山,陈栋,杨诏旭,等. 中国肝移植术操作规范(2019版)[J]. 中华移植杂志(电子版),2019,13(3):171-176.
Tao KS,Chen D,Yang ZX,et al.Technical specification for the operation of liver transplantationin China(2019 edition)[J]. Chin J Transplant Electron Ed,2019,13(3):171-176.
[2] 谢莉萍,谢海英,江艺,等. 1例肝移植术后并发下肢静脉血栓的护理[J]. 局解手术学杂志,2012,21(2):224.
Xie LP,Xie HY,Jiang Y,et al.Nursing care of a case complicated with venous thrombosis of lower limbs after liver transplantation[J]. J Reg Anat Oper Surg,2012,21(2):224.
[3] 杨滢,郭晓东,鲍鹤玫,等. 思维导图对肝移植患者依从性的临床应用价值[J]. 现代生物医学进展,2014,14(11):2152-2155.
Yang Y,Guo XD,Bao HM,et al.Clinical application value of mind map on the compliance of liver transplant recipients[J]. Prog Mod Biomed,2014,14(11):2152-2155.
[4] Walker D,Adebajo A,Heslop P,et al.Patient education in rheumatoid arthritis:the effectiveness of the ARC booklet and the mind map[J]. Rheumatology(Oxford),2007,46(10):1593-1596.
[5] Williams FR,Berzigotti A,Lord JM,et al.Review article:impact of exercise on physical frailty in patients with chronic liver disease[J]. Aliment Pharmacol Ther,2019,50(9):988-1000.
[6] 杨滢,郭晓东,褚静茹,等. 早期康复训练及自理能力监测表在肝移植患者术后康复中的应用[J]. 现代生物医学进展,2014,14(18):3542-3545.
Yang Y,Guo XD,Chu JR,et al.Application of early rehabilitation and monitoring of self-care for patients with liver transplantation[J]. Prog Mod Biomed,2014,14(18):3542-3545.
[7] Needham DM,Korupolu R.Rehabilitation quality improvement in an intensive care unit setting:implementation of a quality improvement model[J]. Top Stroke Rehabil,2010,17(4):271-281.
[8] Aquim EE,Bernardo WM,Buzzini RF,et al.Brazilian guidelines for early mobilization in intensive care unit[J]. Rev Bras Ter Intensiva,2019,31(4):434-443.
[9] BERRYA,BEATTIEK,BENNETTJ,et al. Physical activityand move-ment:A guideline for critically ill adults[EB/OL]. (2017-07-26)[2021-03-12]. https://www.researchgate.net/publication/337452449_Physical_activity_and_movement_A_guideline_for_critically_ill_adults_Intensive_Care_NSW_CLINICAL_GUIDELINE
[10] Bein T,Bischoff M,Brückner U,et al.S2e guideline:positioning and early mobilisation in prophylaxis or therapy of pulmonary disorders[J]. Anaesthesist,2015,64(1):1-26.
[11] Devlin JW,Skrobik Y,Gélinas C,et al.Clinical practice guide-lines for the prevention and management of pain,agitation/sedation,delirium,immobility,and sleep disruption in adult patients in the ICU[J]. Crit Care Med,2018,46(9):e825-e873.
[12] 赵洪圉,易梦瑶,周奕,等. 肝移植受者康复运动的最佳证据总结[J]. 护理学杂志,2022,37(3):84-87,96.
Zhao HY,Yi MY,Zhou Y,et al.Evidence summary on rehabilitation exercise in liver transplant recipients[J]. J Nurs Sci,2022,37(3):84-87,96.
[13] 倪莹莹,王首红,宋为群,等. 神经重症康复中国专家共识(中)[J]. 中国康复医学杂志,2018,33(2):130-136.
Ni YY,Wang SH,Song WQ,et al.China expert consensus on rehabilitation of severe neuropathy(Ⅱ)[J]. Chin J Rehabil Med,2018,33(2):130-136.
[14] National Institute for Health and Care Excellence. Rehabilitation after critical illness in adults[EB/OL]. (2017-09-07)[2021-03-12]. https://www.nice.org.uk/Guidance/CG83
[15] 周鑫滢,陈香萍,庄一渝,等. 细胞力学在压力性损伤中的作用及影响因素研究进展[J]. 护理学杂志,2022,37(19):96-100.
Zhou XY,Chen XP,Zhuang YY,et al.The role of cell mechanics in pressure injury and the influencing factors:a review[J]. J Nurs Sci,2022,37(19):96-100.
[16] 沈燕,陈兰,费凯红,等. 肝移植术后患者ICU早期活动方案的构建及应用[J]. 护理学杂志,2021,36(11):33-36.
Shen Y,Chen L,Fei KH,et al.Application of early mobilization program to ICU patient after liver transplantation[J]. J Nurs Sci,2021,36(11):33-36.
[17] 翁峰霞,徐之鹏,卫建华,等. 早期活动强化策略对ICU后综合征患者预后的影响[J]. 中华急危重症护理杂志,2021,2(3):216-220.
Weng FX,Xu ZP,Wei JH,et al.The effect of early enhanced activity strategy on the prognosis of patients with post-intensive care syndrome[J]. Chin J Emerg Crit Care Nurs,2021,2(3):216-220.
[18] Ma L,Lu Q,Luo Y.Vascular complications after adult living donor liver transplantation:evaluation with ultrasonography[J]. World J Gastroenterol,2016,22(4):1617-1626.
[19] Feltracco P,Barbieri S,Cillo U,et al.Perioperative thrombotic complications in liver transplantation[J]. World J Gastroenterol,2015,21(26):8004-8013.