为乙型肝炎肝硬化患者肝移植等待期构建多模式预康复优化项目，探讨其在临床实践中的应用效果。

选取吉林大学第一医院移植中心2021年1月至10月等待行原位肝移植的乙型肝炎肝硬化患者为研究对象，以主要结局指标6分钟步行距离(6MWD)进行样本量估算，采用随机数字表法分为干预组和对照组。干预组48例患者接受为期4周的术前多模式预康复优化项目，包括运动训练、营养支持与心理护理。对照组45例患者接受肝移植等待期患者的术前常规护理方案。采用两独立样本t检验或χ²检验比较两组患者性别、手术年龄、营养风险筛查2002(NRS 2002)量表评分、终末期肝病模型(MELD)评分和术后住院时间，采用两独立样本t检验比较干预前、肝移植术前1 d及术后30 d两组患者6MWD、血清营养学指标(白蛋白和前白蛋白)及医院焦虑抑郁量表(HADS)评分。P<0.05为差异具有统计学意义。

两组患者性别、手术年龄、NRS 2002量表评分和MELD评分差异均无统计学意义(χ²/t＝0.022、0.389、0.194和－1.521，P均>0.05)。干预组和对照组患者术后住院时间分别为(12.7±1.1)、(17.3±2.3)d，差异有统计学意义(t＝12.372，P<0.05)。干预组和对照组患者干预前6MWD、白蛋白、前白蛋白和HADS评分差异均无统计学意义(t＝0.982、1.751、－1.124和－1.471，P均>0.05)。肝移植术前1 d，干预组患者6MWD、白蛋白、前白蛋白和HADS评分分别为(580±6)m、(40.01±4.32)g/L、(310.05±14.61)g/L和(6.4±1.2)分，均优于对照组(562±7)m、(35.53±3.41)g/L、(278.79±9.29)g/L和(11.3±1.8)分，差异均有统计学意义(t＝13.502、5.527、12.388和－15.415，P均<0.05)。肝移植术后30 d，干预组患者6MWD、白蛋白、前白蛋白和HADS分别为(556±5)m、(35.37±4.99)g/L、(279.56±14.01)g/L和(6.8±1.2)分，均优于对照组(536±7)m、(31.90±4.75)g/L、(244.43±11.92)g/L和(11.4±1.8)分，差异均有统计学意义(t＝15.122、3.424、12.982和－14.345，P均<0.05)。

对乙型肝炎肝硬化肝移植等待期患者开展多模式预康复优化项目，可有效改善其围手术期活动能力、焦虑抑郁及营养状况，缩短术后住院时间，促进术后康复。

To construct a multimodal pre-rehabilitation optimization program in patients with hepatitis B virus-related live cirrhosis awaiting liver transplantation, and to explore its application effect in clinical practice.

Patients with hepatitis B virus-related cirrhosis who were waiting for orthotopic liver transplantation in the Transplant Center of the First Hospital of Jilin University from January to October 2021 were enrolled as the study subjects. The sample size was estimated according to the main outcome of index 6 minutes walking distance (6MWD), and the patients were divided into the intervention group and the control group by random number table method. Forty-eight patients in the intervention group received a multimodal pre-rehabilitation optimization program for four weeks, including exercise training, nutritional support and psychological care. Forty-five patients in the control group received routine nursing plan while waiting for liver transplantation. Using two independent sample t tests or Chi-square test to compare the general data of the two groups of patients, such as sex, age of operation, nutrition risk screening 2002 (NRS 2002) scale score, model for end-stage liver disease (MELD) score, and length of postoperative hospital stay. Using two independent samples t test to compare the 6MWD, serum nutritional science indicators (albumin and prealbumin) and hospital anxiety and depression scale (HADS) score of the two groups of patients at different time points (before intervention, 1 day before liver transplantation and 30 days after surgery). P<0.05 was considered statistically significant.

There were no significant differences in sex, preoperative age, NRS 2002 scales score and MELD scores between the two groups (χ²/t=0.022、0.389、0.194 and -1.521, all P>0.05). The postoperative hospitalization time in the intervention group and the control group was (12.7±1.1) and (17.3±2.3) d, respectively, and the difference was statistically significant (t=12.372, P<0.05). There were no significant differences in 6MWD, albumin, prealbumin and HADS scores between the intervention group and the control group before intervention (t=0.982, 1.751, -1.124 and -1.471, all P>0.05). The 6MWD, albumin, prealbumin, and HADS scores of the intervention group were (580±6) m, (40.01±4.32) g/L, (310.05±14.61) g/L, and (6.4±1.2) points 1 day before surgery, which were better than the control group [(562±7) m, (35.53±3.41) g/L, (278.79±9.29) g/L, and (11.3±1.8) points, respectively], and the differences were statistically significant (t=13.502, 5.527, 12.388 and -15.415, all P<0.05). On the 30th day after surgery, 6MWD, albumin, prealbumin, and HADS scores in the intervention group were (556±5) m, (35.37±4.99) g/L, (279.56±14.01) g/L and (6.8±1.2) points, which were better than those in the control group [(536±7) m, (31.90±4.75) g/L (244.43±11.92) g/L, and (11.4±1.8) points, respectively], and the differences were statistically significant (t=15.122, 3.424, 12.982 and -14.345, all P<0.05).

The multimode pre-rehabilitation optimization program for liver transplantation patients with hepatitis B virus-related cirrhosis in the waiting period can effectively improve the patients′ perioperative activity, anxiety, depression and nutritional status, shorten the length of postoperative hospital stay, and promote postoperative rehabilitation.