Application of enhanced recovery after surgery strategy in perioperative period of kidney transplant patients

Li Hongqin, Mu Hanmeng.

2020, (3): 170-173. DOI:10.3969/j.issn.2095-5332.2020.03.003

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Objective To explore the application and clinical effect of enhanced recovery after surgery （ERAS）strategy in patients undergoing renal transplantation. Methods A total of 188 patients undergoing renal transplantation from July 2017 to July 2018 were assigned into a control group and an intervention group， patients in control group received conventional perioperative care and patients in intervention group received ERAS intervention. Results The intervention group showed lower self-rating anxiety scale（SAS）scores（P ＜ 0.05）， experienced shorter postoperative hospital stay（P ＜ 0.05）compared with the control group. The complications and patient satisfaction didn’t show statistical differences（all P ＞ 0.05）. Besides，hospitalization costs decreased in intervention group（P ＜ 0.05）. Conclusion Application of ERAS concept in perioperative period of renal transplantation accelerated rehabilitation，shortened postoperative hospital stay and decreased costs.

Application of VTE three-level management and four-level network comprehensive prevention and control system in perioperative period of kidney transplant patients

Wang Jing , Qiao Jianhong , Zhang Shuxiang , Wang Zhaohao , Zhang Ensheng , Men Tongyi , Shen Bin , Cao Xiaohong .

2020, (3): 174-180. DOI:10.3969/j.issn.2095-5332.2020.03.004

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Objective To assess the venous thromboembolism（VTE）three-level management and fourlevel network comprehensive prevention and control system in effectively preventing perioperative venous thrombosis in kidney transplant patients. Methods The case control study was used for cluster sampling. A total number of222 kidney transplant patients operated in 2019 were selected as the experimental group, and 190 kidney transplant patients operated in 2018 were used as the control group. Patients in both groups received kidney transplantation. The VTE routine preventive care measures were used in the control group. The VTE three-level management and fourlevel network comprehensive prevention and control system for VTE risk prevention and management were used in the experimental group. Plasma D-Dimer（DD）levels were monitored at 1 day before surgery as well as 1 d and 7 d after surgery in both groups, and color Doppler ultrasound examination of blood flow in both lower limbs was performed at 1 d and 7 d after surgery. The experimental group was scored by the Caprini 2005 risk assessment model at 1 d before surgery as well as 1 d, 7 d and 14 d after surgery, the corresponding early warning program was adopted. The incidence of VTE, mortality and length of hospital stay were compared between the two groups, and the Caprini2005 risk assessment model score and stratification of the experimental group were analyzed. Results There was no significant difference in D-D index between the two groups before surgery and 1 d after surgery（P ＞ 0.05），there was a statistically significant difference between the two groups in D-D index at 7 days after surgery（P ＜ 0.05）. The positive venous blood flow in the lower limbs of the control group was significantly higher than the experimental group（P ＜ 0.05）. The control group had significant longer hospital stays than the experimental group（P ＜ 0.05）. No postoperative PTE and death occurred in the two groups of patients. The incidence of VTE in the control group was higher than that in the experimental group, and the difference was statistically significant（P ＜ 0.05）. Two patients in the experimental group developed calf muscular vein thrombosis（CMVT）at 7 d and 14 d after surgery, and were stratified into high-risk and very high-risk. Conclusion The venous thromboembolism three-level management and four-level network comprehensive prevention and control system can be used to screen the occurrence of VTE in kidney transplant patients during perioperative period, it provides effective intervention measures, which can detect and prevent the occurrence of VTE at an early stage and ensure the safety of patients.

Perioperative nursing of 64 cases of modified ipsilateral simultaneous pancreas kidney transplantation:a clinical effect evaluation analysis

Deng Xuanyin, Zhang Weiting, Li Jiali, Jin Min, Zhang Wanyi.

2020, (3): 180-185. DOI:10.3969/j.issn.2095-5332.2020.03.005

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Objective To explore the clinical effect of perioperative nursing on modified ipsilateral simultaneous pancreas and kidney transplantation. Methods From September 2016 to December 2018， 64 patients who underwent ipsilateral simultaneous pancreas and kidney transplantation with modified operation in the Organ Transplantation Center of the Second Affiliated Hospital of Guangzhou Medical University were analyzed. The main points of perioperative nursing were discussed. Results 64 patients achieved good clinical results. The serum creatinine levels at 1，3，6，12 and 24 months after operation were（119.85±51.39）μmol/L，（114.38± 43.78）μmol/L，（115.42±44.62）μmol/L，（110.96±28.94）μmol/L，（112.48±34.57）μmol/L，fasting blood glucose were（5.63±1.38）mmol/L，（4.80±0.45 mmol/L，（4.95±0.66）mmol/L，（4.80±0.56）mmol/L，（4.82±0.53）mmol/L. The cumulative survival rates of recipient, pancreas and kidney in one year and two years were 94.4%，92.9%，92.9% and 94.4%，92.9% and 92.9%，respectively. One patients underwent pancreatectomy due to pancreaticoduodenal leakage caused by pancreatic rejection and sepsis; one patient due to pancreatic thrombosis after transplantation. The other patients recovered well in terms of pancreatic function，and blood sugar could be reduced to normal level at 2 to 3 days after operation，insulin could be completely withdrawn after operation. One case had delayed recovery of renalallograft function，one case had renal allograft failure，the rest of the recipients recovered well. Conclusion The nursing experience on 64 cases of simultaneous pancreas and kidney transplantation summarized in our center has certain significance of guidance and reference for clinical nursing.

Analysis of interventional strategies of cluster nursing in patients undergoing heart transplantation

Cai Xin, Cai Zhongxiang, Chai Hui, Zheng Yao, Li Qianyu, Liu Xiao, Fang Ting, Song Yujuan.

2020, (3): 186-189. DOI:10.3969/j.issn.2095-5332.2020.03.006

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Objective To investigate the efficacy of clustering care program for heart transplant patients. Methods Twenty five heart transplant patients admitted to our hospital from June 2015 to December 2017 were enrolled as the control group，38 heart transplant patients admitted to our hospital from January 2018 to April 2019 were selected for observation group. The control group received the routine nursing method of heart transplantation. The observation group received the evidence-based clustering nursing program to implement the heart transplantation bundled nursing training，the nurses mastered the bundled nursing program and implemented it accurately. The postoperative mechanical ventilation time，intensive care unit stay time，hospitalization time， infection rate and incidence of severe rejection were compared between the two groups. The effect of cluster nursing on heart transplantation patients was analyzed. Results Compare to the control group，there were significant differences on the postoperative mechanical ventilation time（9.2±6.43）h vs.（14.92±12.44）h，the intensive care unit stay time（4.26±1.71）d vs.（6.21±1.19）d and the hospitalization time（18.05±4.1）d vs.（20.79±7.03）d， respectively（P ＜ 0.01）. While there were no differences in the incidence of infection and the incidence of severe rejection of the two groups. Conclusion For the nursing management of heart transplant patients，the application of clustered nursing intervention strategy can shorten the time of mechanical ventilation，intensive care unit stay time and hospitalization time.

Study on the management of standardized intravenous insulin pump for early blood glucose increase afterliver transplantation

Wang Haitao, Li Ling, Pan Li.

2020, (3): 190-193. DOI:10.3969/j.issn.2095-5332.2020.03.007

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Objective To evaluate the effect of intravenous insulin pump on early hyperglycemia after liver transplantation, so as to provide a basis for the standardized management of early hyperglycemia after liver transplanta tion. Methods Retrospective analysis was performed on the effect of intravenous insulin pump on the management of early hyperglycemia after liver transplantation in patients who underwent liver transplantation from October 2018 to August 2019 and the impact on the related postoperative indicators. According to whether standardized intravenous insulin pump management was implemented, the patients were divided into two groups: the control group（n ＝ 40）, and the group without standardized intravenous insulin pump management from October 2018 to March 2019. Observation group（n ＝ 40）. The standardized intravenous insulin pump management group was implemented from March to August, 2019. That is, according to the patient's medical history and blood glucose situation, the treatment plan of the intravenous insulin pump was jointly developed by doctors and nurses, and the nurse conducted dynamicquantitative monitoring and adjustment according to the patient's blood glucose level. The blood glucose level 2 hours before and after diet and before and after sleep, the time when blood glucose was normal after surgery, daily insulin intake, wound healing degree and recovery time in the same period, the number of patients with re-infection, the number of cases of hypoglycemia and other indicators were counted. Results Postoperative hyperglycemia control effect in hospitalized liver transplantation patients was significantly better in the observation group than in the control group, with statistically significant difference（P ＞ 0.5）. Conclusion The standardized intravenous insulin pump treatment can better control patients' hyperglycemia, reduce blood glucose fluctuations and effectively reduce the incidence of hypoglycemia, etc.. This strategy is better than the conventional intravenous insulin pump treatment and it is worth of clinical application.

Practice and effectiveness of multidisciplinary team model led by specialized nurses in postoperativemanagement of adult DCD kidney transplantation

Li Yanhua, Cao Jie, Lu Xiaoying, Meng Xianli. D

2020, (3): 194-197. DOI:10.3969/j.issn.2095-5332.2020.03.008

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Objective To discuss the practice and effectiveness of the multidisciplinary team model led by specialized nurses in the post-surgery management of adult DCD kidney transplantation. Methods A retrospective study was performed in our center from September 2017 to August 2018 including 118 cases of adult renal transplant patients. The control group was given routine nursing，while the observation group received the MDT management led by specialized nurses. We recorded the nursing quality as well as the complications such as the catheter related complications and nursing related symptoms. Results The observation group suffered from lower incidence of catheter related complications（PICC catheter，central venous catheter，peritoneal dialysis catheter，P ＜ 0.05）， fewer and milder incident of the main complications and had a higher nursing quality score（primary care ，early warning of complications，infection control，health education，and patients satisfaction）than those of control group after renal transplantation（P ＜ 0.05）. Conclusion The MDT mode led by specialized nurses in the management of adult DCD kidney transplantation played a promising role in reducing nursing related complications，improving patient recovery and promoting the clinical nursing quality.

Analysis of depression in renal transplant patients and its influencing factors

Xiao Panpan, Liu Jia, Liu Lifang, Wu Xiaoxia, Wang Zhimin, Liu min, Xie Jianfei

2020, (3): 198-202. DOI:10.3969/j.issn.2095-5332.2020.03.009

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Objective The purpose of this study was to investigate the development of early post-transplant depression in renal transplant patients and analyze the influencing factors. Methods A longitudinal study was designed to retrospectively analyze the clinical data of 128 patients with end-stage renal disease who received kidney transplantation from August 2018 to January 2019. A self-designed general questionnaire was used to understand the sociodemographic information and measure depression with the Self-rating Depression Scale（SDS）. Hemoglobin and creatinine levels were monitored by collecting hematological samples. The measurement time was before（T0）, 1 month（T1），2 months（T2）and 3 months（T3）after renal transplantation. The differences between the four measurements were compared with the repeated measures analysis of variance，the influence factors of depression were analyzed by using the generalized estimation equation. Results The depression scores of the patients were 60.14±8.440，51.12±9.092，49.55±8.597 and 48.79±7.992. Rates of depressive symptoms were 91.6%，53.9%， 41.4% and 44.5%，respectively. Post-transplant time，educational background and hemoglobin level were determined to be the influencing factors of depression. Conclusion The depressive symptoms of patients with end-stage renal disease improved rapidly within 1 month after receiving kidney transplantation. Some patients still had moderate and severe depressive symptoms，and the depression level was dynamic. Education levels and hemoglobin had a lastingeffect on the depression status of kidney transplant patients in the immediate future.

The application of planned behavior theory in the psychological experience and compliance of patients after kidney transplantation

Nie Xuemei, Nie Dongmei, Huang Wei.

2020, (3): 203-206. DOI:10.3969/j.issn.2095-5332.2020.03.010

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Objective To analyze the influence of planned behavior theory on psychological experience and medication compliance in patients after renal transplantation. Methods Fifty cases of kidney transplant patients admitted to our hospital from March 2017 to March 2019 were divided into a control group and an observation group. 25 patients in the control group received traditional nursing，and 25 patients are listed in the observation group. The planned behavioral theory intervention was adopted to compare the self-rating anxiety scale（SAS）scores，medication compliance，and complications. Results The SAS score was significantly lower in the observation group than in the control group after 3 days of nursing. The medication compliance（96.00%）in the observation group was significantly higher than that in the control group（68.00%）. The incidence of complications in the observation group （4.00%）was significantly lower than that in the control group（28.00%），differences were statistically significant （P ＜ 0.05）. Conclusion The theory of planned behavior can be applied to postoperative nursing of renal transplant patients，it is safe and effective to alleviate patients' psychological anxiety，improve medication compliance and reduce the incidence of complications.

Application of continuous quality improvement in reducing the rate of wrist band wearing defects in children with liver transplantation#br#

Di Mengxue, Dong Huan.

2020, (3): 207-210. DOI:10.3969/j.issn.2095-5332.2020.03.011

Abstract ( ) PDF (1124KB)( )

Objective Reduce the rate of wrist band wearing defect in children with liver transplantation through continuous quality improvement. Methods 78 cases of children admitted to our department in March 2018 participated in 709 wrist strap investigations, and underwent the analysis of wrist strap wearing management. In view of the reasons affecting the effective wearing, a continuous quality improvement nursing team was established in April to improve the quality according to PDCA（Plan，Do，Check，Act）cycle. Results Through PDCA circulation, the rate of wrist band wearing defects in our department decreased from 23.41%（ before improvement ）to 8.6%（ after improvement）. Conclusion Continuous quality improvement of wristband management in children with liver transplantation can effectively reduce the rate of wristband wearing defects, ensure the accuracy and safety of nursing behavior, and improve the quality of nursing.

Application of cluster care in prevention and treatment of perianal dermatitis in patients with diarrhea after liver transplantation#br#

Zhou Xiaojun , Yang Min , Zhou Yanrong .

2020, (3): 211-213. DOI:10.3969/j.issn.2095-5332.2020.03.012

Abstract ( ) PDF (726KB)( )

Objective To explore the effects of cluster nursing in prevention and treatment of perianal dermatitis in patients with diarrhea after liver transplantation. Methods A total number of 94 cases with diarrhea after liver transplantation were randomly divided into control group and observation group, with 47 cases in each group. Routine nursing procedure was adopted in the control group and cluster nursing intervention was given to the observation group. The incidence, severity and recovery time of perianal dermatitis in the two groups were compared. Results Comprehensive special management was carried out by cluster nursing, including preevaluation and examination, early intervention nursing, standard management of perianal skin cleaning, construction of local skin barrier, strengthening of special inspection scope and improvement of nursing execution. In the observation group with cluster nursing, the incidence and severity of perianal dermatitis were significantly lower than that of the control group（P ＜ 0.05）, and the recovery time of perianal dermatitis was significantly shortened （P ＜ 0.05）. Conclusion The application of cluster nursing measures can effectively reduce the occurrence and severity as well as promote the early recovery of perianal dermatitis in patients with diarrhea after liver transplantation.

Analysis of influencing factors of postoperative life quality in liver transplant recipients

Han Xueli, Ye Haidan, Zhang Lishan, Yu Rui.

2020, (3): 214-218. DOI:10.3969/j.issn.2095-5332.2020.03.013

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Objective To investigate the quality of life after liver transplantation and its influencing factors. Methods From December 2017 to January 2018，a total number of 117 cases of liver transplant recipients who participated in the 7th organ transplantation exchange meeting as well as follow-up visits in the first affiliated hospital of Sun Yat-sen University were included in the study. The present life quality was analyzed using general questionnaire and the World Health Organization quality of life questionnaire. Multiple linear regression method is applied to analyze the factors affecting the quality of life in liver transplant recipients. Results The average grade of life quality in 117 cases of liver transplant recipients of this study was（209.3±56.6）scores，the average physical field scoring was（52.7±18.0）scores，the average psychological field scoring was（51.8±18.8）scores， the average score for social relations field was（51.9±16.5）scores，the average environmental scoring was（50.1± 16.9）scores. The scoring of all four areas was lower than the normal population，in addition to the environmental area，the difference was statistically significant（P < 0.05）. Conclusion The quality of life of liver transplantation recipients is mainly affected by marital status，postoperative survival time，postoperative complications，postoperative employment and irregular follow-up etc. Medical staff should pay more attention and help the liver transplantation recipients improve their quality of life.

nvestigation and analysis of influencing factors on health-related quality of life of lung transplant recipients

Wu Ting, Cai Yinghua, Zhou Haiqin, Zhu Xuefen, Xu Zhenghong.

2020, (3): 219-224. DOI:10.3969/j.issn.2095-5332.2020.03.014

Abstract ( ) PDF (826KB)( )

Objective To analyze the health-related quality of life（HRQOL）of lung transplant recipients in the first year after surgery，and to explore the influencing factors of HRQOL in lung transplant recipients. Methods A total of 132 patients were surveyed before lung transplantation as well as at 3，6，9 and 12 months after lung transplantation. The demographic characteristics，clinical characteristics，and health-related quality of life SF-36 （Chinese version）were used to conduct longitudinal surveys of recipients during outpatient follow-up. The HRQOL score was determined. Results According to the analysis of clinical characteristics before and after transplantation: FEV1%、6MWD and mMRC were negatively correlated with postoperative time（all P ＜ 0.001），all were statistically significant（P ＜ 0.001）. The over-time HRQOL analysis showed that the physiological functions，physiological functions，physical pain，overall health，energy，social function，mental health，and total scores of the points were different at different time points, with statistical significance（P ＜ 0.05），while the difference in emotional functions at different time points were not statistically significant.（P ＝ 0.709）. A pairwise comparison of the dimensions showed statistically significant differences between the groups ；The factors affecting the quality of life in physiological aspects were the type of transplant，endocrine system and respiratory complications ；The factors influencing the quality of life in terms of psychological aspects were education，primitive disease，complications in blood system，digestive system and respiratory system. Conclusion The quality of life of lung transplantation recipients was affected and reduced by multiple factors. Therefore，we should focus on the factors that affect the quality of life of patients in order to carry out targeted nursing measures.

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