肝移植术后代谢病患者标准化非药物管理方案的构建及应用

沈琛; 李丽莎; 傅建英; 徐萍; 李娟

doi:10.16766/j.cnki.issn.1674-4152.003418

肝移植术后代谢病患者标准化非药物管理方案的构建及应用

doi: 10.16766/j.cnki.issn.1674-4152.003418

宁波市医疗中心李惠利医院甲状腺乳腺外科二，浙江宁波 315000

基金项目:

浙江省医药卫生科技计划项目 2023KY1031

浙江省医学会临床医学科研专项基金 2022ZYC-A160

详细信息

通讯作者:
李娟，E-mail：1259075033@qq.com

中图分类号: R473.6 R657.3
计量
- 文章访问数: 71
- HTML全文浏览量: 30
- PDF下载量: 3
- 被引次数: 0
出版历程
- 收稿日期: 2023-11-08
- 网络出版日期: 2024-05-27

Construction and application of standardized non-drug management scheme for progeny patients with degenerative diseases after liver transplantation

Department of Thyroid and Breast Surgery 2, Li Huili Hospital, Ningbo Medical Center, Ningbo, Zhejiang 315000, China

摘要

摘要: 目的基于德尔菲专家函询法构建肝移植术后代谢病患者标准化非药物管理方案，分析应用效果。方法选取2021年5月—2023年3月宁波市医疗中心李惠利医院收治的69例肝移植术后代谢病患者为研究对象，根据不同干预方式分为研究组(34例)与对照组(35例)，研究组行肝移植术后代谢病患者标准化非药物管理，对照组进行常规护理管理，对比观察2组患者干预前及干预3、6个月后血糖、血压、血尿酸、血脂、BMI水平。结果 2组患者空腹血糖、收缩压、舒张压、血尿酸、低密度脂蛋白胆固醇、甘油三酯、总胆固醇、BMI水平均随时间的延长逐渐降低(P＜0.001)，且除BMI外均存在交互作用(P < 0.05)；干预3、6个月，研究组患者空腹血糖[(7.20±1.23)mmol/L vs. (7.92±1.56)mmol/L、(6.82±1.09)mmol/L vs. (7.51±1.35)mmol/L, t=2.125、2.332, P=0.037、0.023]、收缩压、舒张压、血尿酸、低密度脂蛋白胆固醇、甘油三酯、总胆固醇、BMI水平均低于对照组(P＜0.05)。结论建立肝移植术后代谢病患者标准化非药物管理方案，指导患者健康饮食、合理运动、改变不良生活习惯、提升心理健康状态，有利于纠正代谢紊乱。
- 肝移植 /
- 代谢病 /
- 血脂异常 /
- 高血压 /
- 糖尿病 /
- 标准化 /
- 非药物管理
Abstract: Objective To establish standardized non-drug management scheme for progeny patients with degenerative diseases based on Delphi expert correspondence method, and analyze the practical effect. Methods Sixty-nine patients with progeny degenerative disease after liver transplantation treated in Li Huili Hospital of Ningbo Medical Center from May 2021 to March 2023 were selected as the study objects. According to different intervention methods, they were divided into the study group (34 cases) and the control group (35 cases). The study group received standardized non-drug management of progeny degenerative disease patients after liver transplantation, while the control group received routine nursing management. The blood glucose, blood pressure, blood uric acid, blood lipid and BMI levels of the two groups were compared before intervention and 3 and 6 months after intervention. Results The levels of fasting blood glucose, systolic blood pressure, diastolic blood pressure, blood uric acid, low density lipoprotein cholesterol, triglyceride, total cholesterol and BMI in both groups decreased gradually with the extension of time (P < 0.001), and there were interactions except BMI (P < 0.05). Regardless of time, 3 to 6 months after the intervention, the levels of fasting blood glucose[(7.20±1.23) mmol/L vs. (7.92±1.56) mmol/L, (6.82±1.09) mmol/L vs. (7.51±1.35) mmol/L, t=2.125, 2.332, P=0.037, 0.023], systolic blood pressure, diastolic blood pressure, blood uric acid, low density lipoprotein cholesterol, triglyceride, total cholesterol and BMI in the study group were lower than those in the control group (P < 0.05). Conclusion The establishment of a standardized non-drug management program for patients with degenerative diseases after liver transplantation, which guides patients to eat a healthy diet, exercise reasonably, change their bad habits, and enhance their mental health status, is conducive to the correction of metabolic disorders.
- Liver transplantation /
- Metabolic disease /
- Abnormal blood lipids /
- High blood pressure /
- Diabetes mellitus /
- Standardization /
- Non-drug management

HTML全文

表 1 2组肝移植术后代谢病患者一般资料比较

Table 1. Comparison of general data in patients with degenerative diseases post-liver transplantation between the two groups

组别	例数	性别(例)		年龄(x±s, 岁)	原发病(例)				并发糖尿病(例)	并发高血压(例)	并发血脂异常(例)	并发高尿酸血症(例)	并发肥胖(例)
组别	例数	男性	女性	年龄(x±s, 岁)	肝炎	肝癌	肝硬化	其他	并发糖尿病(例)	并发高血压(例)	并发血脂异常(例)	并发高尿酸血症(例)	并发肥胖(例)
研究组	34	23	11	54.37±12.55	5	19	8	2	12	25	19	6	8
对照组	35	21	14	53.76±13.06	7	17	8	3	11	27	17	8	7
统计量		0.437^a		0.198^b	0.630^a				0.116^a	0.121^a	0.369^a	0.289^a	0.126^a
P值		0.509		0.844	0.890				0.733	0.728	0.543	0.591	0.722
注：^a为χ²值，^b为t值。

下载: 导出CSV

表 2 2组肝移植术后代谢病患者血糖、血压、血尿酸、血脂、BMI水平比较(x±s)

Table 2. Comparison of blood glucose, blood pressure, blood uric acid, blood lipid, and BMI levels in patients with degenerative diseases post-livertransplantation between the two groups (x±s)

组别	例数	空腹血糖(mmol/L)			收缩压(mmHg)			舒张压(mmHg)			血尿酸(μmol/L)
组别	例数	干预前	干预3个月	干预6个月	干预前	干预3个月	干预6个月	干预前	干预3个月	干预6个月	干预前	干预3个月	干预6个月
研究组	34	9.81±1.62	7.20±1.23^a	6.82±1.09^a	146.7±6.5	128.1±8.4^a	125.6±7.8^a	96.6±5.8	85.9±4.9^a	83.8±5.1^a	394.2±32.5	357.5±36.4^a	352.1±35.8^a
对照组	35	9.68±1.65	7.92±1.56^a	7.51±1.35^a	145.8±7.1	137.4±9.8^a	133.3±10.1^a	97.3±6.1	91.6±5.3^a	88.1±5.6^ab	389.9±34.4	378.8±35.6	374.6±36.9
F值		0.330	2.125	2.332	0.549	4.227	3.532	0.488	4.635	3.332	0.533	2.457	2.570
P值		0.742	0.037	0.023	0.585	＜0.001	0.001	0.627	＜0.001	0.001	0.596	0.017	0.012

组别	例数	低密度脂蛋白胆固醇(mmol/L)			甘油三酯(mmol/L)			总胆固醇(mmol/L)			BMI
组别	例数	干预前	干预3个月	干预6个月	干预前	干预3个月	干预6个月	干预前	干预3个月	干预6个月	干预前	干预3个月	干预6个月
研究组	34	4.67±0.51	3.85±0.49^a	3.67±0.52^a	3.03±0.56	2.17±0.31^a	2.05±0.32^a	7.06±0.83	5.91±0.57^a	5.77±0.61^a	25.65±2.74	23.91±2.59	23.27±2.63
对照组	35	4.74±0.54	4.31±0.62^a	4.15±0.60^a	2.98±0.52	2.36±0.37^a	2.28±0.41^a	6.98±0.88	6.35±0.76^a	6.11±0.72^a	25.75±2.80	25.26±2.78	24.65±2.81
F值		0.553	3.413	3.547	0.385	2.309	2.593	0.388	2.714	2.113	0.150	2.086	2.105
P值		0.582	0.001	0.001	0.702	0.024	0.012	0.699	0.008	0.038	0.881	0.041	0.039
注：与组内干预前比较，^aP＜0.05；与组内干预3个月比较，^bP＜0.05。

下载: 导出CSV

参考文献(20)

[1]	GITTO S, FALCINI M, MARRA F. Metabolic disorders after liver transplantation[J]. Metab Syndr Relat Disord, 2021, 19(2): 65-69. doi: 10.1089/met.2020.0068
[2]	HESSHEIMER A J, RIQUELME F, FUNDORA-SUAREZ Y, et al. Normothermic perfusion and outcomes after liver transplantation[J]. Transplant Rev (Orlando), 2019, 33(4): 200-208. doi: 10.1016/j.trre.2019.06.001
[3]	叶少炜, 钱均霖, 胡泽民. 肝移植后代谢综合征及其防治的研究进展[J]. 岭南现代临床外科, 2022, 22(2): 199-204. doi: 10.3969/j.issn.1009-976X.2022.02.016
[4]	QU W, WEI L, ZHU Z J, et al. Considerations for use of domino cross-auxiliary liver transplantation in metabolic liver diseases: a review of case studies[J]. Transplantation, 2019, 103(9): 1916-1920. doi: 10.1097/TP.0000000000002602
[5]	KOK B, DONG V, KARVELLAS C J. Graft dysfunction and management in liver transplantation[J]. Crit Care Clin, 2019, 35(1): 117-133. doi: 10.1016/j.ccc.2018.08.002
[6]	中国医药生物技术协会慢病管理分会. 肝硬化合并糖尿病患者血糖管理专家共识[J]. 中华糖尿病杂志, 2022, 14(8): 749-763. doi: 10.3760/cma.j.cn115791-20220624-00291
[7]	高血压患者药物治疗管理路径编写委员会. 高血压患者药物治疗管理路径专家共识[J]. 临床药物治疗杂志, 2022, 20(1): 1-24. doi: 10.3969/j.issn.1672-3384.2022.01.001
[8]	中国医师协会器官移植医师分会, 中华医学会器官移植学分会肝移植学组. 中国肝移植受者代谢病管理专家共识(2019版)[J]. 器官移植, 2020, 11(1): 19-29. https://www.cnki.com.cn/Article/CJFDTOTAL-QGYZ202001004.htm
[9]	沃琪, 任咪, 张金彦, 等. 肥胖与肝病: 肝移植的新时代[J]. 肝脏, 2019, 24(11): 1227-1228. doi: 10.3969/j.issn.1008-1704.2019.11.005
[10]	LONARUDO A, MANTOVANI A, PETTA S, et al. Metabolic mechanisms for and treatment of NAFLD or NASH occurring after liver transplantation[J]. Nat Rev Endocrinol, 2022, 18(10): 638-650. doi: 10.1038/s41574-022-00711-5
[11]	PFLUGRAD H, NÖSEL P, DING X, et al. Brain function and metabolism in patients with long-term tacrolimus therapy after kidney transplantation in comparison to patients after liver transplantation[J]. PLoS One, 2020, 15(3): e0229759. DOI: 10.1371/journal.pone.0229759.
[12]	SANADA Y, SAKUMA Y, ONISHII Y, et al. Outcomes after living donor liver transplantation in pediatric patients with inherited metabolic diseases[J]. Ann Transplant, 2021, 26: e932994. DOI: 10.12659/AOT.932994.
[13]	WANG Y J, LI J H, GUAN Y, et al. Diabetes mellitus is a risk factor of acute kidney injury in liver transplantation patients[J]. Hepatobiliary Pancreat Dis Int, 2021, 20(3): 215-221. doi: 10.1016/j.hbpd.2021.02.006
[14]	VAN SON J, STAM S P, GOMES-NETO A W, et al. Post-transplant obesity impacts long-term survival after liver transplantation[J]. Metabolism, 2020, 106: 154204. DOI: 10.1016/j.metabol.2020.154204.
[15]	CZARNECKA K, CZARNECKA P, TRONINA O, et al. Multidirectional facets of obesity management in the metabolic syndrome population after liver transplantation[J]. Immun Inflamm Dis, 2022, 10(1): 3-21. doi: 10.1002/iid3.538
[16]	杨倩, 陈玲, 李亚玲, 等. 肝移植术后代谢综合征预防与管理的证据总结[J]. 中华现代护理杂志, 2022, 28(18): 2424-2430. doi: 10.3760/cma.j.cn115682-20211011-04589
[17]	中国医师协会器官移植医师分会移植免疫学专业委员会, 中国康复医学会器官移植康复专业委员会, 广东省医师协会器官移植医师分会. 慢加急性肝衰竭肝移植围手术期康复评估与干预专家共识[J]. 器官移植, 2022, 13(5): 543-554. doi: 10.3969/j.issn.1674-7445.2022.05.001
[18]	SAKAI T, K0 J S, CROUCH C E, et al. Perioperative management of adult living donor liver transplantation: Part 1 - recipients[J]. Clin Transplant, 2022, 36(6): e14667. DOI: 10.1111/ctr.14667.
[19]	庄莉, 刘相艳. 肝移植受者围手术期管理及并发症预防与治疗[J]. 中华消化外科杂志, 2021, 20(10): 1037-1041. doi: 10.3760/cma.j.cn115610-20210915-00459
[20]	王宇航, 沈振亚. 脂代谢对主动脉疾病发生发展及预后的影响[J]. 中华全科医学, 2023, 21(8): 1374-1378. doi: 10.16766/j.cnki.issn.1674-4152.003126