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.

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.

Objective:To systematically evaluate the effect of different pressing time on bleeding in patients with subcutaneous injection of low molecular weight heparin (LMWH) .Methods:We retrieved the randomized controlled trial (RCT) or controlled clinicial trials (CCT) on local pressing time and bleeding in patients with subcutaneous injection of LMWH by searching PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI) , China Biology Medicine (CBM) , Wanfang Data and VIP from the database establishment to September 2019. Two researchers independently screened literature based on inclusion and exclusion criteria, evaluated quality and extracted data. RevMan 5.3 was used to conduct Meta-analysis on the extracted data.Results:A total of 9 studies that met the criteria were finally included and the included documents were all in Chinese, of which 4 were RCTs and 5 were CCTs. Subcutaneous hemorrhage diameter <5 mm was defined as no bleeding, subcutaneous hemorrhage ≥5 mm was defined as bleeding, and bleeding incidence was used as the final outcome indicator. According to different pressing time, they were divided into non-pressing group, group of pressing for 3 minutes, group of pressing for 5 minutes and group of pressing for 10 minutes, and were compared each group in pairs. Meta-analysis results showed there were significantly statistical differences between non-pressing group and group of pressing for 3 minutes [ OR=0.44, 95% CI (0.25, 0.78) , P=0.005], between group of pressing for 3 minutes and group of pressing for 5 minutes [ OR=2.12, 95% CI (1.18, 3.83) , P=0.010]; there were no significantly statistical differences between non-pressing group and group of pressing for 5 minutes [ OR=0.94, 95% CI (0.32, 2.81) , P=0.920], between non-pressing group and group of pressing for 10 minutes [ OR=1.11, 95% CI (0.33, 3.70) , P=0.870], between group of pressing for 5 minutes and group of pressing for 10 minutes [ OR=2.56, 95% CI (0.72, 9.11) , P=0.150]. Conclusions:Subcutaneous injection of LMWH without pressing is better than pressing for 3 minutes, and pressing for 5 minutes is better than pressing for 3 minutes. Considering the limited number of included documents and the quality grades are all B, research conclusions still need to be verified by large samples and rigorous experimental design.