综合护理预防妇科腹腔镜手术头低脚高位引发眼球结膜水肿的效果观察
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摘要
目的探讨综合护理预防妇科腹腔镜手术头低脚高位引发眼球结膜水肿的效果。方法妇科腹腔镜手术患者240例随机分为观察组(n=120)和对照组(n=120)。患者取头低脚高位,气管插管全身麻醉下行妇科腹腔镜手术。围手术期间,对照组采用常规护理,观察组采用综合护理干预。比较2组不同时间眼压情况和眼球结膜水肿发生率。结果 2组术中视野暴露情况差异无统计学意义(P>0.05)。观察组变更体位5 min、30 min,术中1 h、恢复平卧拔管时的眼压均低于对照组(P<0.01)。观察组眼球结膜水肿发生率4.17%(5/120),低于对照组的12.50%(15/120),差异有统计学意义(P<0.05)。观察组下肢疼痛麻木以及肩部疼痛的发生率低于对照组(P<0.05)。结论综合护理干预能够有效预防妇科腹腔镜手术头低脚高位引发的眼球结膜水肿。
Objective To explore the effect of comprehensive nursing interventions on preventing conjunctival edema caused by Trendelenburg position in gynecological laparoscopic surgery. Methods Totally 240 patients undergoing gynecological laparoscopic surgery were selected and divided into the observation group(n=120) and the control group(n=120) according to the random number table. Trendelenburg position was adopted in the gynecological laparoscopic surgery. Patients in the control group were given routine care, and those in the observation group were given comprehensive nursing interventions. The intraocular pressure was assessed during the surgery, and the incidence of conjunctival edema as compared between two groups. Results There was no significant difference in surgical field exposure between the two groups(P>0.05). The intraocular pressure of the observation group was lower than that of the control group at 5 and30 minutes after taking Trendelenburg position, 1 hour after surgery onset and time-point of tube withdrawal, respectively(P<0.01). The incidence of conjunctival edema was lower in the observation group than that in the control group(4.17% vs. 12.50%, P<0.05). The incidence rates of postoperative lower limb pain and shoulder pain were lower in the observation group than those in the control group(P<0.05). Conclusion Comprehensive nursing interventions can effectively prevent conjunctival edema caused by Trendelenburg position in gynecological laparoscopic surgery.
Objective To explore the effect of comprehensive nursing interventions on preventing conjunctival edema caused by Trendelenburg position in gynecological laparoscopic surgery. Methods Totally 240 patients undergoing gynecological laparoscopic surgery were selected and divided into the observation group(n=120) and the control group(n=120) according to the random number table. Trendelenburg position was adopted in the gynecological laparoscopic surgery. Patients in the control group were given routine care, and those in the observation group were given comprehensive nursing interventions. The intraocular pressure was assessed during the surgery, and the incidence of conjunctival edema as compared between two groups. Results There was no significant difference in surgical field exposure between the two groups(P>0.05). The intraocular pressure of the observation group was lower than that of the control group at 5 and30 minutes after taking Trendelenburg position, 1 hour after surgery onset and time-point of tube withdrawal, respectively(P<0.01). The incidence of conjunctival edema was lower in the observation group than that in the control group(4.17% vs. 12.50%, P<0.05). The incidence rates of postoperative lower limb pain and shoulder pain were lower in the observation group than those in the control group(P<0.05). Conclusion Comprehensive nursing interventions can effectively prevent conjunctival edema caused by Trendelenburg position in gynecological laparoscopic surgery.
引文
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[9] 王宇,李胜云,孙立群,等.改进头低足高“人字形”截石位在老年妇科腹腔镜手术中的效果观察[J].中国实用护理杂志,2017,33(21):1622-1626.
[10] 王薇,奚春花.妇科腹腔镜头低位对手术患者眼压的影响及护理措施[J].中华现代护理杂志,2017,23(17):2283-2286.
[11] 缪月琴.术中不同体位对妇科腹腔镜患者眼压的影响[J].国际护理学杂志,2016,15(18):2590-2592.
[12] 吴文利.医用水凝胶眼疗贴在全麻俯卧位眼部保护中的应用[J].蚌埠医学院学报,2016,41(11):1534-1535.
[13] 易旦冰,丁建林,曾娜芬,等.妇科腹腔镜手术患者围术期眼压的变化及护理[J].海南医学,2014,25(2):306-308.
[14] 祁涛,丁正年.腹腔镜手术CO_2气腹及体位改变对眼内压的影响[J].临床麻醉学杂志,2009,25(5):398-400.
[2] 邵彦,胡博杰,刘巨平,等.23G玻璃体切割术后视力及眼内压影响因素的多元线性回归分析[J].国际眼科杂志,2011,11(11):1925-1927.
[3] MARTI M,WALTON R,BONI C,et al.INCREASED INTRAOCULAR PRESSURE IS A RISK FACTOR FOR UNEXPLAINED VISUAL LOSS DURING SILICONE OIL ENDOTAMPONADE[J].Retina,2017,37(12):2334-2340.
[4] 周路阳,蒋忠.腹腔镜前列腺癌根治术患者术中眼内压升高的多因素分析[J].临床麻醉学杂志,2013,29(4):331-333.
[5] 左艳霞,秦寿泽.腹腔镜手术与眼内压变化的研究现状与进展[J].河北医科大学学报,2016,37(6):740-744.
[6] 余庭霞,马小玲,钱益勇.白内障手术患者眼内炎的危险因素分析[J].中华医院感染学杂志,2014(15):3824-3826.
[7] QUARANTA L,KATSANOS A,RUSSO A,et al.24-hour Intraocular Pressure and Ocular Perfusion Pressure in Glaucoma[J].Surv Ophthalmol,2013,58(1):26-41.
[8] 陈雪莉,刘冬华.人工气腹及体位对下腹部腔镜手术患者眼压及呼吸循环功能的影响[J].护士进修杂志,2016,31(16):1517-1519.
[9] 王宇,李胜云,孙立群,等.改进头低足高“人字形”截石位在老年妇科腹腔镜手术中的效果观察[J].中国实用护理杂志,2017,33(21):1622-1626.
[10] 王薇,奚春花.妇科腹腔镜头低位对手术患者眼压的影响及护理措施[J].中华现代护理杂志,2017,23(17):2283-2286.
[11] 缪月琴.术中不同体位对妇科腹腔镜患者眼压的影响[J].国际护理学杂志,2016,15(18):2590-2592.
[12] 吴文利.医用水凝胶眼疗贴在全麻俯卧位眼部保护中的应用[J].蚌埠医学院学报,2016,41(11):1534-1535.
[13] 易旦冰,丁建林,曾娜芬,等.妇科腹腔镜手术患者围术期眼压的变化及护理[J].海南医学,2014,25(2):306-308.
[14] 祁涛,丁正年.腹腔镜手术CO_2气腹及体位改变对眼内压的影响[J].临床麻醉学杂志,2009,25(5):398-400.