Abstract:

Objective To establish a scheme of immunosuppressant（tacrolimus） tube administration after lung transplantation and evaluate the effect. Methods Utilizing evidence summary and the Delphi method with the Structure-Process-Outcome（SPO） model，a tacrolimus administrating via feeding tubes scheme was established for lung transplantations，incorporating 5 aspects “medication management”“risk assessment”“enteral feeding implementation”“process monitoring” and “evaluation and feedback” from July to September 2023. A convenience sampling method was employed to select patients with lung transplant surgery of a tertiary hospital in Zhejiang Province from November 2023 to June 2024. Among them，18 patients admitted from March to June 2024 were designated as an experimental group，receiving the developed tacrolimus enteral feeding administration plan；18 patients admitted from November 2023 to February 2024 were designated as a control group，receiving standard enteral feeding administration measures.The standard trough concentration of tacrolimus，the coefficient of variation of tacrolimus trough concentration，the daily dosage of tacrolimus and its coefficient of variation，and the rate of achieving the target trough concentration of tacrolimus were compared between the 2 groups. Results Of the initially recruited subjects，15 in the experimental group and 18 in the control group were included in the final analysis. After intervention，the coefficient of variation of trough concentrations and daily doses of tacrolimus in the experimental group were lower than those in the control group，while the rate of achieving target trough concentrations was higher，with all differences being statistically significant（P<0.05）. There was no statistically significant difference in the comparison of standardized blood drug concentrations and the coefficient of variation of daily doses between the 2 groups（P>0.05）. Conclusion The tacrolimus administrating via feeding tubes scheme for lung transplantations based on the SPO model is scientific and practical，providing clinical references for the use of tacrolimus enteral medication after lung transplantation，in order to promote the standardization of tacrolimus enteral administration.

Key words: Lung Transplantation, Immunosuppressant, Medication Care, Delphi Technology

摘要：

目的 构建肺移植患者术后免疫抑制剂（他克莫司）管饲给药方案并评价其应用效果。 方法 以结构—过程—结果为理论框架，于2023年7月—9月通过证据总结、德尔菲法构建肺移植患者术后他克莫司管饲给药方案，包含用药管理、风险评估、管饲实施、过程监测、评价与反馈5个方面。采用便利抽样法，选取2023年11月—2024年6月于浙江省某三级甲等综合医院行肺移植术的患者作为研究对象，其中2024年3月—6月收治的18例患者作为试验组，采用构建的他克莫司管饲给药方案；2023年11月—2024年2月收治的18例患者作为对照组，采用常规管饲给药措施。比较两组他克莫司标准化谷浓度、谷浓度变异系数、日剂量及其变异系数、谷浓度达标率的差异。 结果 最终试验组纳入15例，对照组纳入18例。干预后，试验组他克莫司谷浓度变异系数、日剂量低于对照组，谷浓度达标率高于对照组，差异均具有统计学意义（P<0.05）；两组标准化谷浓度、日剂量变异系数比较，差异无统计学意义（P>0.05）。 结论 构建的肺移植患者术后他克莫司管饲给药方案具有科学性和实用性，可为肺移植患者术后他克莫司管饲用药提供临床参考，以促进他克莫司管饲给药的规范化。

关键词: 肺移植, 免疫抑制剂, 用药护理, 德尔菲技术