论文部分内容阅读
目的:探讨聚集解决护理模式对肝硬化食管胃底静脉曲张患者再次出血的预防作用。方法:回顾性分析中国医科大学绍兴医院消化内科2009年11月至2013年11月收治的120例肝硬化食管胃底静脉曲张患者的临床资料。按照入院先后顺序分为对照组与观察组各60例。对照组采用常规护理,观察组采用聚集解决护理模式。观察两组预防再出血疗效、护理干预前后门静脉压力指标及静脉主干血流动力学变化情况。结果:两组预防再出血效果对比分析,观察组有效56例(93.3%),对照组有效43例(71.7%),观察组预防再出血效果显著优于对照组,差异有统计学意义(χ2=9.76,P<0.01);两组护理干预前后门静脉压力指标变化情况对比,所有患者护理前FHVP、WHVP及HVPG水平差异无统计学意义;两组患者在行护理干预后FHVP水平较护理干预前明显升高,WHVP及HVPG水平较护理干预前显著降低,且观察组护理干预后上述指标水平均优于对照组,差异均有统计学意义(P<0.05);两组护理干预前后静脉主干血流动力学变化对比,两组护理前Dpv、Vpv及Qpv水平差异无统计学意义;护理干预后,观察组各血流动力学指标均较护理干预前显著降低,对照组Dpv、Vpv水平较护理干预前显著降低,且观察组护理干预后各指标均显著低于对照组,差异均有统计学意义(P<0.05)。结论:与常规护理模式相比,聚集解决护理能够更好地降低肝硬化食管胃底静脉曲张患者的门静脉压力,减少门静脉血流量,从而更好地预防再出血。
Objective: To explore the preventive effect of intensive care mode on rebleeding of patients with esophageal varices after liver cirrhosis. Methods: The clinical data of 120 patients with esophageal varices of the liver cirrhosis who were admitted to Department of Gastroenterology, Shaoxing Hospital, China Medical University from November 2009 to November 2013 were retrospectively analyzed. In accordance with the order of admission was divided into control group and observation group of 60 cases. The control group received routine nursing, and the observation group used agglomeration to solve the nursing model. The curative effect of preventing hemorrhage and the changes of portal venous pressure index and venous trunk hemodynamics before and after nursing intervention were observed. Results: Compared with the control group, 56 cases (93.3%) were effective in the observation group and 43 cases (71.7%) in the control group, the effect of preventing rebleeding in the observation group was significantly better than that in the control group (χ2 = 9.76, P <0.01) .Comparison of changes of portal venous pressure before and after nursing intervention showed no significant difference in the levels of FHVP, WHVP and HVPG before and after nursing intervention in both groups. Before and after nursing intervention, FHVP levels in both groups were significantly higher than those before nursing intervention WHVP and HVPG were significantly lower than those before nursing intervention, and the above indexes were better than the control group after nursing intervention in the observation group (P <0.05). Before and after the intervention There was no significant difference in the levels of Dpv, Vpv and Qpv between the two groups before nursing; after nursing intervention, the indexes of hemodynamics in observation group were significantly lower than those before nursing intervention, while the levels of Dpv and Vpv in the control group were more nursing After intervention, the scores of intervention group were significantly lower than those of control group (P <0.05). CONCLUSIONS: Aggregation-based care can better reduce portal pressure and reduce portal venous flow in patients with cirrhosis and esophageal varices compared with conventional care, thereby better preventing rebleeding.