骨水泥机械手与手推注射法经皮椎体成形术的护理观察
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摘要
目的总结骨水泥机械手与手推注射法在经皮椎体成形术中的护理观察。方法选择2014年10月~2015年11月我院45例PVP病例根据随机原则分为应用手推法注射22例和骨水泥机械手23例,观察手推注射法、骨水泥机械注射法术中骨水泥渗漏发生例数、骨水泥的注射总时间、操作者的X线下暴露时间、术后2 d进行疼痛视觉类比评分(VAS),两种注射方法患者的心理、机体反应及医护患配合要点。结果两组患者心身反应良好,术中均无骨水泥渗漏发生,注射总时间手推法(3.5±0.6)min,机械手(4.8±0.7)min,注射总时间差异有统计学意义(t=2.97,P<0.05);术者暴露时间手推法(4.8±0.8)min,机械手(1.9±0.4)min,t=15.48,两组术者暴露时间比较,差异有统计学意义(P<0.05);术后2 d疼痛视觉类比评分,手推法(2.2±1.2),机械手(1.9±0.8),差异无统计学意义(t=1.27,P>0.05)。两组病例注射操作均达预期效果。手推法注射属于近台操作,对患者的心理支持较好;机械手注射属于遥控操作,有利于精准控制注射时间、剂量及注射过程监控观察。结论做好医患沟通,医护配合,医护患三者协作,机械手代替传统手推法注射骨水泥符合医疗技术智能化的发展要求,也有利于减少术者的X线辐射剂量。医护患三方均能从中获益。
Objective To summarize the nursing observation on percutaneous vertebroplasty via bone cement manipulator and hand-push injection. Methods 45 PVP cases treated in our hospital from October 2014 to November 2015 were randomly treated by hand-push injection(22 cases) and manipulator(23 cases). The incidence of bone cement leakage,total time of bone cement injection, exposure duration under X-ray of the operator, and visual analogue scale(VAS) at 2 d after operation in hand-push injection group and manipulator group were observed. The psychological and physical reaction, and cooperation of doctors, nurses and patients were compared. Results The psychological and physical reactions of patients in two groups were favorable. There was no leakage of bone cement during operation. The overall time of injection was(3.5±0.6)min in the hand-push injection group, and(4.8±0.7)min in the manipulator group. There was significant difference in injection time between two groups(t=2.97, P<0.05). The exposure duration was(4.8±0.8)min in the hand-push injection group, and(1.9±0.4)min in the manipulator group(t=15.48), which showed significant difference between two groups(P<0.05). The VAS at 2d after operation was(2.2±1.2) in the hand-push injection group, and(1.9±0.8) in the manipulator group(t=1.27),which showed no significant difference(P>0.05). Expected effect was obtained in both groups after injection. Hand-push injection was a kind of close-table operation, providing better psychological support for patients; while manipulator was a kind of remote operation, having advantages in precise control of injection time and dose, and monitoring of injection process. Conclusion With good doctor-patient communication, and cooperation between doctor and nurse, application of manipulator instead of hand-push injection of bone cement conforms to the requirement of intelligentization of medical technology, and facilitate reduction of X-ray exposure, which benefits doctors, nurses and patients at same time.
Objective To summarize the nursing observation on percutaneous vertebroplasty via bone cement manipulator and hand-push injection. Methods 45 PVP cases treated in our hospital from October 2014 to November 2015 were randomly treated by hand-push injection(22 cases) and manipulator(23 cases). The incidence of bone cement leakage,total time of bone cement injection, exposure duration under X-ray of the operator, and visual analogue scale(VAS) at 2 d after operation in hand-push injection group and manipulator group were observed. The psychological and physical reaction, and cooperation of doctors, nurses and patients were compared. Results The psychological and physical reactions of patients in two groups were favorable. There was no leakage of bone cement during operation. The overall time of injection was(3.5±0.6)min in the hand-push injection group, and(4.8±0.7)min in the manipulator group. There was significant difference in injection time between two groups(t=2.97, P<0.05). The exposure duration was(4.8±0.8)min in the hand-push injection group, and(1.9±0.4)min in the manipulator group(t=15.48), which showed significant difference between two groups(P<0.05). The VAS at 2d after operation was(2.2±1.2) in the hand-push injection group, and(1.9±0.8) in the manipulator group(t=1.27),which showed no significant difference(P>0.05). Expected effect was obtained in both groups after injection. Hand-push injection was a kind of close-table operation, providing better psychological support for patients; while manipulator was a kind of remote operation, having advantages in precise control of injection time and dose, and monitoring of injection process. Conclusion With good doctor-patient communication, and cooperation between doctor and nurse, application of manipulator instead of hand-push injection of bone cement conforms to the requirement of intelligentization of medical technology, and facilitate reduction of X-ray exposure, which benefits doctors, nurses and patients at same time.
引文
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[13]李月玲.我国医务人员手卫生的影响因素及对策[J].中华医院感染学杂志,2007,8(14):201-202.
[14]邵国女,何小青,孔江明.精细化管理在基层医院介入室预防医院感染中的应用[J].中国现代医生,2015,53(5):108-110,114.
[15]彭小忠,陈明,武振国,等.经皮椎体成形102例中22例骨水泥渗漏原因[J].中国组织工程研究与临床康复,2011,15(8):1515-1518.
[16]郑召民.经皮椎体成形术要不要继续开展下去?[J].中国脊柱脊髓杂志,2010,20(6):444-445.
[17]兰宇斌.经皮椎体成形术治疗椎体压缩性骨折的中远期随访观察[J].中国实用医药,2016,11(1):55-56.
[18]邵国女,邵敏,朱胜玲,等.椎体骨质疏松性骨折经皮成形术后社区康复指导[J].中华现代护理杂志,2016,22(1):47-49.
[19]武汉,高中礼,吕中文,等.脊柱外科医生所受射线辐射危险及防护措施进展[J].中国骨伤,2009,22(11):874-876.
[20]王建儒,张奎渤,刘辉,等.经皮椎体后凸成形术术中不同辐射防护距离的对比研究[J].中国脊柱脊髓杂志,2014,24(5):417-421.
[21]李建哲,贾全章,陈阳,等.改良低辐射椎体成形术治疗骨质疏松性椎体压缩骨折的临床对比研究[J].中国矫形外科杂志,2014,22(4):365-368.
[2]刘寒笑,秦瑜.经皮椎体成形术的护理研究进展[J].医学信息,2014,27(4):184-185.
[3]潘丽芬,刘婉玲,张春燕,等.经皮椎体成形术治疗脊柱压缩性骨折的手术体位改进[J].中华护理杂志,2010,45(7):605-607.
[4]任中贤.经皮穿刺椎体成形术的护理[J].护理与康复,2006,5(1):34-35.
[5]叶丽洁,林丹,董晓琴.骨质疏松性椎体骨折患者经皮强化治疗的护理[J].护理与康复,2007,6(9):596-597.
[6]王达纯.经皮椎体成形术治疗椎体压缩骨折的临床护理研究[J].医学信息,2015,28(18):70-71.
[7]钱兆玲,唐婧,陈勤.经皮椎体成形术后高龄患者的护理分析[J].国际护理杂志,2016,35(2):206-208.
[8]王靓.舒适护理在胸腰段经皮椎体成形术中的应用[J].齐齐哈尔医学院学报,2015,36(19):2962-2963.
[9]魏营勃.俯卧位脊柱手术常见并发症的诱因及干预措施[J].世界最新医学信息文摘,2016,16(5):91.
[10]毛燕君,许秀芳,杨继金.介入治疗护理学[M].北京:人民军医出版社,2007:289-300.
[11]林学杨,张亮,高粱斌,等.经皮椎体成形手术体位对患者生命体征和血氧饱和度的影响[J].中国组织工程研究与临床康复,2011,15(30):5679-5683.
[12]邵卫东.手部卫生与医院感染[J].现代中西医结合杂志,2007,16(20):2953-2954.
[13]李月玲.我国医务人员手卫生的影响因素及对策[J].中华医院感染学杂志,2007,8(14):201-202.
[14]邵国女,何小青,孔江明.精细化管理在基层医院介入室预防医院感染中的应用[J].中国现代医生,2015,53(5):108-110,114.
[15]彭小忠,陈明,武振国,等.经皮椎体成形102例中22例骨水泥渗漏原因[J].中国组织工程研究与临床康复,2011,15(8):1515-1518.
[16]郑召民.经皮椎体成形术要不要继续开展下去?[J].中国脊柱脊髓杂志,2010,20(6):444-445.
[17]兰宇斌.经皮椎体成形术治疗椎体压缩性骨折的中远期随访观察[J].中国实用医药,2016,11(1):55-56.
[18]邵国女,邵敏,朱胜玲,等.椎体骨质疏松性骨折经皮成形术后社区康复指导[J].中华现代护理杂志,2016,22(1):47-49.
[19]武汉,高中礼,吕中文,等.脊柱外科医生所受射线辐射危险及防护措施进展[J].中国骨伤,2009,22(11):874-876.
[20]王建儒,张奎渤,刘辉,等.经皮椎体后凸成形术术中不同辐射防护距离的对比研究[J].中国脊柱脊髓杂志,2014,24(5):417-421.
[21]李建哲,贾全章,陈阳,等.改良低辐射椎体成形术治疗骨质疏松性椎体压缩骨折的临床对比研究[J].中国矫形外科杂志,2014,22(4):365-368.