肺移植等候期患者肌少症管理方案的应用研究

doi:10.3761/j.issn.0254-1769.2025.13.008

摘要/Abstract

摘要：

目的基于跨理论模型构建肺移植等候期患者肌少症管理方案并进行实证研究，旨在改善患者术前肌肉状态，提高对肺移植手术的耐受性。方法以跨理论模型为理论基础，在文献回顾基础上，通过2轮专家函询，构建肺移植等候期患者肌少症管理方案。采取便利抽样方法，选取2022年1月—2024年1月在浙江省某三级甲等医院肺移植科住院的患者进行初步应用，其中2023年2月—2024年1月的患者为试验组，2022年1月—2023年1月的患者为对照组。试验组在常规预康复护理的基础上实施基于跨理论模型的肌少症管理方案，对照组给予常规预康复护理。干预周期均为8周。比较干预前两组肌少症五项评分联合小腿围问卷得分、握力、6 min步行距离、上臂肌围及其干预前后差值的差异，以及干预前后两组行为阶段性转变情况和不良事件发生率的差异。结果试验组脱落8例，最终纳入32例，对照组脱落9例，最终纳入31例。干预后，试验组肌少症五项评分联合小腿围问卷评分、握力、6 min步行距离和上臂肌围差值均大于对照组（P<0.05）。干预后，试验组行为阶段性转变与对照组相比，差异有统计学意义（P<0.001）。干预过程中，两组均未出现不良事件。结论基于跨理论模型构建的肺移植等候期患者肌少症管理方案能够提高患者对方案的依从性，改善术前肌肉状态，在提升活动能力和改善营养状态方面也具有一定的优势。

关键词: 肺移植, 术前, 肌少症, 跨理论模型, 护理

Abstract:

Objective This study aimed to develop and empirically evaluate a sarcopenia management program for lung transplant candidates based on the Transtheoretical Model（TTM）. The objective was to improve preoperative muscle condition and enhance patients’ tolerance to lung transplantation. Methods Using the TTM as the theoretical framework，the sarcopenia management program was developed through a literature review and 2 rounds of expert consultations. A convenience sampling method was employed to recruit inpatients from the lung transplant department of a tertiary hospital in Zhejiang Province between January 2022 and January 2024. Patients admitted between February 2023 and January 2024 were assigned to an intervention group，while those admitted between January 2022 and January 2023 were allocated to a control group. The intervention group received an 8-week sarcopenia management program based on the TTM in addition to standard prehabilitation care，whereas the control group received only standard prehabilitation care. Outcome measurements included pre- and post-intervention comparisons of the modified Strength，Assistance with Walking，Rise from a Chair，Climb Stairs，Falls，and Calf Circumference（SARC-CalF） score，handgrip strength，6-minute walking distance（6MWD），and upper arm circumference，as well as their respective changes before and after the intervention. Additionally，stage-based behavioral change assessment and adverse event incidence were compared between the 2 groups. Results A total of 8 patients from the intervention group and 9 from the control group dropped out，resulting in a final sample of 32 patients in the intervention group and 31 in the control group. Compared to the control group，the intervention group demonstrated significantly greater improvements in SARC-CalF scores，handgrip strength，6MWD，and upper arm circumference（P<0.05）. After the intervention，the intervention group had a statistically significant difference in behavioral stage transition compared to the control group（P<0.05）. During the intervention process，neither group experienced any adverse events. Conclusion The sarcopenia management program based on the TTM effectively improved patient adherence，enhanced preoperative muscle condition，and demonstrated potential benefits in improving physical function and nutritional status.

Key words: Lung Transplantation, Preoperative, Sarcopenia, Transtheoretical Model, Nursing Care

曾妃, 兰美娟, 顾培培, 王衍蝶, 蔡凌云, 朱倩寅. 肺移植等候期患者肌少症管理方案的应用研究[J]. 中华护理杂志, 2025, 60(13): 1581-1587.

ZENG Fei, LAN Meijuan, GU Peipei, WANG Yandie, CAI Lingyun, ZHU Qianyin. An empirical study of a program for lung transplant candidates with sarcopenia[J]. Chinese Journal of Nursing, 2025, 60(13): 1581-1587.

图/表 5

表1 肺移植等候期患者肌少症管理方案

Table 1 Management of sarcopenia in lung transplant candidates

表2 两组一般资料的比较

Table 2 Comparison of general data between the 2 groups

表3 两组干预前后肌少症五项评分联合小腿围问卷和握力的比较

Table 3 Comparison of Strength，Assistance with Walking，Rise from a Chair，Climb Stairs，Falls and Calf Circumference and grip strength between 2 groups before and after intervention

表4 两组干预前后6 min步行距离和上臂肌围的比较

Table 4 Comparison of 6-minute walking distance and upper arm muscle circumference between 2 groups before and after intervention

表5 两组干预前后行为阶段性转变情况的比较[例（百分比，%）]

Table 5 Comparison of the behavioral stage transition assessment questionnaires between the 2 groups before and after intervention[cases（percentage，%）]

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