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护理学报 ›› 2021, Vol. 28 ›› Issue (16): 16-21.doi: 10.16460/j.issn1008-9969.2021.16.016

• 循证护理 • 上一篇    下一篇

肝移植术后患者早期活动最佳证据总结

沈燕1,2a, 陈兰2a, 费凯红2a, 潘恒德2b, 俞佳琦2a, 王莹2a, 姜艳华2a, 张洁2a, 姚叶英2a   

  1. 1.上海交通大学 护理学院,上海 200025;
    2.上海市第一人民医院 a.护理部;b.康复科,上海 200080
  • 收稿日期:2021-04-17 出版日期:2021-08-25 发布日期:2021-09-10
  • 通讯作者: 陈兰(1978-),女,江苏江阴人,博士研究生在读,副主任护师,护理部副主任。E-mail:chenlan781118@126.com
  • 作者简介:沈燕(1980-),女,上海人,本科学历,硕士研究生在读,主管护师,护士长。
  • 基金资助:
    上海市卫生和计划生育委员会科研基金项目(201940074); 上海市松江区科技攻关项目(19SJKJGG89)

Best Evidence Summary of Early Mobilization after Liver Transplantation

SHEN Yan1,2a, CHEN Lan2a, FEI Kai-hong2a, PAN Heng-de2b, YU Jia-qi2a, WANG Ying2a, JIANG Yan-hua2a, ZHANG Jie2a, YAO Ye-ying2a   

  1. 1. School of Nursing, Shanghai Jiaotong University, Shanghai 200025,China;
    2a. Dept. of Nursing Administration,2b. Dept. of Rehabilitation, Shanghai General Hospital, Shanghai 200080, China
  • Received:2021-04-17 Online:2021-08-25 Published:2021-09-10

摘要: 目的 总结与肝移植术后患者早期活动的最佳证据,为护理人员提供参考依据。方法 通过护理循证方法提出实践问题,按照循证证据检索数据库的“6S”分类模型,检索与“成人肝脏移植术后早期活动”相关的证据,包括临床指南、专家共识、系统评价、随机对照试验和证据总结。结果 共纳入证据9篇,包括临床指南2篇、专家共识2篇、系统评价3篇、证据总结1篇、随机对照试验1篇。并对相关证据进行汇总,最终从7个维度总结了22条最佳证据。结论 肝移植术后患者需开展早期活动,需要有专业的实施团队、实施前充分评估安全性、运用专业的辅助工具、实施过程中进行安全监测及疼痛管理;管理者需加强对护理人员进行早期活动实施及安全观察等方面的培训,降低住院并发症,提升患者满意度。

关键词: 肝移植术, 早期活动, 加速康复外科, 循证护理, 证据

Abstract: Objective To summarize the best evidence of early mobilization in patients after liver transplantation, and to provide reference for nursing staff. Methods With nursing evidence-based method, practical problems were identified and PIPOST analysis was carried out. According to the “6S” pyramid model of evidence resource, studies on early activities after liver transplantation were retrieved, including clinical guidelines, expert consensus, systematic evaluation, randomized controlled trials and evidence summary. Results Totally 9 articles were enrolled including 2 clinical guideline, 1 expert consensus, 3 systematic reviews, 2 randomized controlled trials and 1 summary of evidence, and 7 items including 22 pieces of best evidence were summarized. Conclusion Early activities should be carried out in patients after liver transplantation. Professional team, safety assessment, professional auxiliary tools, safety monitoring and pain management are all needed during the implementation. The training of early activity implementation and safety observation for nursing staff should be strengthened, so as to provide quality nursing service for patients, reduce hospitalization complications and improve patient satisfaction.

Key words: liver transplantation, early mobilization, enhanced recovery after surgery, evidence-based nursing, evidence

中图分类号: 

  • R473.6
[1] 寇建涛,刘喆,朱继巧,等.肝移植治疗危重症肝病的临床疗效研究[J].器官移植,2020,11(4):482-486. DOI:10.3969/j.issn.1674-7445.2020.04.010.
[2] Semmler A,0kulla T,Kaiser M,et al.Long-term Neuromuscular Sequelae of Critical Illness[J].J Neurol,2013,260(1):151-157.DOI:10.1007/s00415-012-6605-4.
[3] Needham DM, Korupolu R, Zanni JM, et al.Early Physical Medicine and Rehabilitation for Patients with Acute Respiratory FaiJure:A Quality Improvement Project[J].Arch Phys Med Rehabil,2010,91(4):536-542.DOI:10.1016/j.apmr.2010.01.002.
[4] Tsuboi N, Hiratsuka M, Kaneko S, et al.Benefits of Early Mobilization after Pediatric Liver Transplantation[J]. Pediatr Crit Care Med,2019,20(2):e91-e97.DOI:10.1097/PCC.0000000000001815.
[5] Fuest K, Schaller SJ.Recent Evidence on Early Mobilization in Critical-ill Patients[J]. Curr Opin Anaesthesiol,2018,31(2):144-150. DOI:10.1097/ACO.0000000000000568.
[6] 杨墨丹,鲁迪,陈俊丽,等.大数据时代背景下的中国肝移植质量提升[J].实用器官移植电子杂志,2020, 8(2):93-95. DOI:10.3969/j.issn.2095-5332.2020.02.004.
[7] 赵东,夏强. 肝移植相关领域的研究进展[J]. 国际消化病杂志,2020, 40(2):71-74.DOI:10.3969/j.issn.1673-534X.2020.02.001.
[8] Moayed MS, Ebadi A,Khodaveisi M,et al.Factors Influencing Health Self-management in Adherence to Care and Treatment among the Recipients of Liver Transplantation[J]. Patient Prefer Adherence,2018, 11(12):2425-2436.DOI:10.2147/PPA.S180341.
[9] Brustia R,Monsel A,Conti F,et al.Enhanced Recovery in Liver Transplantation:A Feasibility Study[J].World J Surg,2019(43):230-241.DOI:10.1007/s00268-018-4747-y.
[10] Lai JC, Segev DL, McCulloch CE, et al. Physical Frailty after Liver Transplantation[J]. Am J Transplant,2018,18(8):1986-1994. DOI:10.1111/ajt.14675.
[11] Tipping CJ,Harrold M,Holland A,et al.The Effects of Active Mobilisation and Rehabilitation in ICU on Mortality and Function: A Systematic Review[J]. Intensive Care Med,2017,43(2):171-183. DOI:10.1007/s00134-016-4612-0.
[12] Shea BJ, Reeves BC, Wells G, et al.AMSTAR 2: A Critical Appraisal Tool for Systematic Review That Include Randomised or Non-randomised Studies of Healthcare Intervention,or Both[J]. BMJ,2017(358):j4008. DOI:10.1136/bmj. j4008.
[13] 卢舒颖,刘宁,魏璐华,等.产后出血预防及管理的最佳证据总结[J].护理学报,2020,27(12):18-22. DOI:10.16460/j.issn1008-9969.2020.12.018.
[14] Brouwers MC, Kho ME, Browman GP, et al.AGREE II:Advancing Guideline Development, Reporting and Evaluation in Health Care[J]. CMAJ,2010,182(18):E839-E842. DOI:10.1503/cmaj.090449.
[15] 熊俊,陈日新.系统评价/Meta分析方法学质量的评价工具AMSTAR[J]. 中国循证医学杂志,2011,11(9):1084-1089. DOI:10.3969/j.issn.1672-2531.2011.09.017.
[16] 胡雁,郝玉芳.循证护理学[M].北京:人民卫生出版社,2018.
[17] 王春青,胡雁.JBI证据预分级及证据推荐级别系统(2014版)[J].护士进修杂志,2015,30(11):964-967.
[18] 李佳梅,陈鸿芳,刘宁,等.脑梗死偏瘫患者良肢位管理的最佳证据总结[J].护理学报,2019,26(24):22-27. DOI:10.16460/j.issn1008-9969.2019.24.022.
[19] National Institute for Health and Clinical Excellence.Rehabilitation after Critical Illness in Adults[EB/OL].(2009-03-30)[2017-09-30]. https://www.nice.org.uk/guidance/qs158.
[20] Carmichael JC,Keller DS,Baldini G,et al.Clinical Practice Guidelines for Enhanced Recovery after Colon and Rectal Surgery from the American Society of Colon and Rectal Surgeons and Society of American Gastrointestinal and Endoscopic Surgeons[J].Dis Colon Rectum,2017,60(8):761-784. DOI:10.1097/DCR.0000000000000883.
[21] 国家卫生计生委医管中心加速康复外科专家委员会. 中国肝移植围手术期加速康复管理专家共识(2018版)[J].中华普通外科杂志,2018,33(3):268-272.DOI:10.3760/cma.j.issn.1007-631X.2018.03.030.
[22] 中国医师协会器官移植分会移植免疫学组,中华医学会外科学分会手术学组,广东省医师协会器官移植医师分会.加速康复外科优化重型肝炎肝移植围手术期管理临床实践的专家共识[J].器官移植,2017, 8(4):251-259. DOI:10.3969/j.issn.1001-5256.2017.09.05.
[23] Wang C,Zheng G,Zhang W, et al.Enhanced Recovery after Surgery Programs for Liver Resection: A Meta-analysis[J].J Gastrointest Surg, 2017,21(3):472-486.DOI:10.1007/s11605-017-3360-y.
[24] Doiron KA, Hoffmann TC, Beller EM. Early Intervention (Mobilization or Active Exercise) for Critically Ill Adults in the Intensive Care Unit[J]. Cochrane Database Syst Rev,2018,3(3):CD010754.DOI:10.1002/14651858.CD010754.pub2.
[25] 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. DOI:10.1111/apt.15491.
[26] 卢芳燕,吴小燕,封秀琴,等.肝切除术后患者早期活动的最佳证据总结[J].中国护理管理,2018,18(12):1595-1600.DOI:10.3969/j.issn.1672-1756.2018.12.003.
[27] Maffei P, Wiramus S, Bensoussan L, et al.Intensive Early Rehabilitation in the Intensive Care Unit for Liver Transplant Recipients: A Randomized Controlled Trial[J]. Arch Phys Med Rehabil, 2017,98(8):1518-1525. DOI:10.1016/j.apmr.2017.01.028.
[28] 熊亮,黎利娟,安玉玲,等.肝移植术后腹腔出血原因分析及防治体会(附82例报告)[J].器官移植,2016, 7(6):463-466. DOI:10.3969/j.issn.1674-7445.2016.06.010.
[29] 吕露露,张雪静.三级医院ICU重症患者早期活动现状及障碍因素调查[J].护理学杂志,2020,35(10):31-34. DOI:10.3870/j.issn.1001-4152.2020.10.031.
[30] MeWilliams D,Weblin J,Atkins G,et al.Enhancing Rehabilitation of Mechanically Ventilated Patients in the Intensive Care Unit:A Quality Improvement Project[J]. J Crit Care,2015,30(1):13-18. DOI:10.1016/j.jcrc.2014.09.018.
[31] 杨富,方芳,陈兰,等.早期渐进式康复方案对SICU机械通气患者术后康复的影响[J].护士进修杂志, 2019,34(16):1502-1505. DOI:10.16821/j.cnki.hsjx.2019.16.017.
[32] 蔡俊刚,李占军,吴安石.原位肝移植术后急性肺损伤临床因素分析[J].广东医学,2020,41(5):511-514.DOI:10.13820/j.cnki.gdyx.20190335.
[33] Wang TH, Wu CP, Wang LY.Chest Physiotherapy with Early Mobilization May Improve Extubation Outcome in Critically Ill Patients in the Intensive Care Units[J]. Clin Respir J,2018,12(11):2613-2621. DOI:10.1111/crj.12965.
[34] Kayambu G, Boots R, Paratz J.Early Physical Rehabilitation in Intensive Care Patients with Sepsis Syndromes: A Pilot Randomised Controlled Trial[J]. Intensive Care Med,2015,41(5):865-874. DOI:10.1007/s00134-015-3763-8.
[35] 叶海丹,芮丽涵,廖昌贵,等.不同下床活动时间对肝移植患者术后康复的影响[J].现代临床护理,2016,15(4):36-39. DOI:10.3969/j.issn.1671-8283.2016.04.010.
[36] King AB,Kensinger CD,Shi Y,et al.Intensive Care Unit Enhanced Recovery Pathway for Patients Undergoing Orthotopic Liver Transplants Recipients: A Prospective,Observational Study[J]. Anesth Analg,2018, 126(5):1495-1503. DOI:10.1213/ANE.0000000000002851.
[37] 中华医学会重症医学分会.中国成人ICU镇痛和镇静治疗指南[J].中华危重病急救医学,2018, 30(6):497-514. DOI:10.3760/cma.j.issn.2095-4352.2018.06.001.
[38] Tong K, Nolan W, O’Sullivan DM, et al. Implementation of a Multimodal Pain Management Order Set Reduces Perioperative Opioid Use after Liver Transplantation[J]. Pharmacotherapy,2019,39(10):975-982.DOI:10.1002/phar.2322.
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