体位管理对子宫内膜异位症患者腹腔镜术后康复效果的影响
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摘要
目的:观察术后体位管理对子宫内膜异位症患者腹腔镜术后康复效果的影响。方法:将150例子宫内膜异位症行腹腔镜手术并置放盆腔引流管的患者采用随机数字表法随机分为对照组和试验组,各75例。对照组进行常规护理,试验组在对照组基础上实施体位管理。干预后比较两组患者的疼痛视觉模拟评分(visual analogue scale,VAS)、伤口感染、腹胀发生情况、首次肛门排气时间、首次下床活动时间、引流管置管时间及术后住院时间。结果:干预后试验组术后6、12、24、48 h的VAS评分均低于对照组,差异均有统计学意义(P<0.05)。试验组伤口感染率(5.3%)和腹胀发生率(13.3%)均低于对照组(17.3%、34.7%),差异均有统计学意义(P<0.01)。试验组首次肛门排气时间、首次下床活动时间、引流管置管时间及术后住院时间均短于对照组(P<0.01)。结论:体位管理能有效减轻子宫内膜异位症患者腹腔镜术后疼痛程度,减少伤口感染的发生,促进患者胃肠功能的恢复,缩短引流时间,加速患者术后康复。
Objective:To evaluate the effect of postural management on the rehabilitation of patients with endometriosis after laparoscopic surgery.Method:A total of 150 patients with endometriosis after laparoscopic surgery and pelvic drainage tube placement were randomly divided into control group and experimental group by random number table method,75 cases in each group.The control group was given routine nursing,and the experimental group was given postural management on the basis of the control group.After the intervention,the visual analogue scale(VAS)score,wound infection,abdominal distension,time of first anal exhaust,time of first movement out of bed,time of drainage tube placement and postoperative hospitalization time were compared between the two groups.Result:After the intervention,the VAS scores of the experimental group at 6,12,24,48 h after the surgery were lower than those of the control group,and the pain gradually decreased,the differences were statistically significant(P<0.05).The wound infection rate(5.3%)and abdominal distention rate(13.3%)in the experimental group were lower than 17.3%,34.7% in the control group,the differences were statistically significant(P<0.01).The time of first anal exhaust,time of first movement out of bed,time of drainage tube placement and postoperative hospitalization time in the experimental group were lower than those in the control group(P<0.01).Conclusion:Postural management can effectively relieve the pain of patients with endometriosis after laparoscopic surgery,reduce the incidence of wound infection,promote the recovery of gastrointestinal function,shorten the time of drainage,accelerate postoperative rehabilitation.
Objective:To evaluate the effect of postural management on the rehabilitation of patients with endometriosis after laparoscopic surgery.Method:A total of 150 patients with endometriosis after laparoscopic surgery and pelvic drainage tube placement were randomly divided into control group and experimental group by random number table method,75 cases in each group.The control group was given routine nursing,and the experimental group was given postural management on the basis of the control group.After the intervention,the visual analogue scale(VAS)score,wound infection,abdominal distension,time of first anal exhaust,time of first movement out of bed,time of drainage tube placement and postoperative hospitalization time were compared between the two groups.Result:After the intervention,the VAS scores of the experimental group at 6,12,24,48 h after the surgery were lower than those of the control group,and the pain gradually decreased,the differences were statistically significant(P<0.05).The wound infection rate(5.3%)and abdominal distention rate(13.3%)in the experimental group were lower than 17.3%,34.7% in the control group,the differences were statistically significant(P<0.01).The time of first anal exhaust,time of first movement out of bed,time of drainage tube placement and postoperative hospitalization time in the experimental group were lower than those in the control group(P<0.01).Conclusion:Postural management can effectively relieve the pain of patients with endometriosis after laparoscopic surgery,reduce the incidence of wound infection,promote the recovery of gastrointestinal function,shorten the time of drainage,accelerate postoperative rehabilitation.
引文
[1]景兰凯,尼华,李华.子宫内膜异位症相关恶变的研究近况[J].国际妇产科学杂志,2018,45(2):175-179.
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[4]何玲,刘志洪,姚远,等.妇科腹腔镜手术放置腹腔引流在快速流程模式中的应用[J].实用妇产科杂志,2011,27(5):361-364.
[5]熊光福.腹腔引流的合理应用及管理[J].中国医学创新,2008,5(34):142-143.
[6]李石英,胡元媛.阶梯式健康教育对妇科腹部术后留置腹腔引流管患者舒适度的干预[J].当代护士(学术版),2011,18(9):160-162.
[7]吴科,李雨聪,唐郢.腹腔镜根治性子宫切除联合盆腔淋巴清扫术后是否放置引流对盆腔淋巴囊肿的影响[J].中国微创外科杂志,2016,16(12):1089-1091,1095.
[8]中华医学会妇产科学分会子宫内膜异位症协作组.子宫内膜异位症的诊治指南[J].中华妇产科杂志,2015,50(3):161-169.
[9]吕小青,王晓兰,周芳,等.76例深部浸润型子宫内膜异位症手术患者的护理[J].护理学报,2015,22(12):63-65.
[10]Wickstr?m K,Edelstam G.Minimal clinically important difference for pain on the VAS scale and the relation to quality of life in women with endometriosis[J].Sex Reprod Healthc,2017(13):35-40.
[11]曾诚,徐嘉宁,周应芳,等.腹腔镜手术治疗阴道子宫内膜异位症43例疗效分析[J].中国微创外科杂志,2014,14(4):289-292.
[12]陈芸,张铭,丁焱.体位干预对妇科腹腔镜术后腹腔引流量的影响[J].中华护理杂志,2010,45(4):314-316.
[13]林金芳,冯缵冲,丁爱华.实用妇科内镜学[M].上海:复旦大学出版社,2001:77.
[14]高国丽,王生锋.社外科护理技术实训[M].武汉:华中科技大学出版,2014:48.
[15]崔建春,李立,荣大庆,等.腹腔镜手术中腹腔冲洗引流的原则和方法[J].腹腔镜外科杂志,2006,11(2):109-110.
[16]王萍萍,林珍珍,周海英,等.体位干预对妇科腹腔镜患者术后胃肠蠕动功能影响的效果分析[J].当代医学,2015,21(26):98-99.
[17]Jorgensen J O,Gillies R B,Hunt D R,et al.A simple and effective way to reduce postoperative pain after laparoscopic cholecystectomy[J].Aust N Z J Surg,1995,65(7):466-469.
[18]孙美农,王娜卿.体位干预对妇科腹腔镜术后患者非切口疼痛的影响[J].中国病案,2016,17(1):95-96.
[19]王学花,付明媚,宋丹.体位干预对妇科腹腔镜术后腹腔引流效果影响的Meta分析[J].中国老年保健医学,2014,12(1):25-27.
[20]郝娜.护理体位干预对妇产科腹腔镜术后引流的效果分析[J].中国医药指南,2018,16(1):214-215.
[2]Wang K C,Chang W H,Lee W L,et al.An increased risk of epithelial ovarian cancer in Taiwanese women with a new surgicopathological diagnosis of endometriosis[J].BMC Cancer,2014(14):831.
[3]赵赫,张军.手术前评估子宫内膜异位症严重程度的研究进展[J].中华妇产科杂志,2018,53(10):721-724.
[4]何玲,刘志洪,姚远,等.妇科腹腔镜手术放置腹腔引流在快速流程模式中的应用[J].实用妇产科杂志,2011,27(5):361-364.
[5]熊光福.腹腔引流的合理应用及管理[J].中国医学创新,2008,5(34):142-143.
[6]李石英,胡元媛.阶梯式健康教育对妇科腹部术后留置腹腔引流管患者舒适度的干预[J].当代护士(学术版),2011,18(9):160-162.
[7]吴科,李雨聪,唐郢.腹腔镜根治性子宫切除联合盆腔淋巴清扫术后是否放置引流对盆腔淋巴囊肿的影响[J].中国微创外科杂志,2016,16(12):1089-1091,1095.
[8]中华医学会妇产科学分会子宫内膜异位症协作组.子宫内膜异位症的诊治指南[J].中华妇产科杂志,2015,50(3):161-169.
[9]吕小青,王晓兰,周芳,等.76例深部浸润型子宫内膜异位症手术患者的护理[J].护理学报,2015,22(12):63-65.
[10]Wickstr?m K,Edelstam G.Minimal clinically important difference for pain on the VAS scale and the relation to quality of life in women with endometriosis[J].Sex Reprod Healthc,2017(13):35-40.
[11]曾诚,徐嘉宁,周应芳,等.腹腔镜手术治疗阴道子宫内膜异位症43例疗效分析[J].中国微创外科杂志,2014,14(4):289-292.
[12]陈芸,张铭,丁焱.体位干预对妇科腹腔镜术后腹腔引流量的影响[J].中华护理杂志,2010,45(4):314-316.
[13]林金芳,冯缵冲,丁爱华.实用妇科内镜学[M].上海:复旦大学出版社,2001:77.
[14]高国丽,王生锋.社外科护理技术实训[M].武汉:华中科技大学出版,2014:48.
[15]崔建春,李立,荣大庆,等.腹腔镜手术中腹腔冲洗引流的原则和方法[J].腹腔镜外科杂志,2006,11(2):109-110.
[16]王萍萍,林珍珍,周海英,等.体位干预对妇科腹腔镜患者术后胃肠蠕动功能影响的效果分析[J].当代医学,2015,21(26):98-99.
[17]Jorgensen J O,Gillies R B,Hunt D R,et al.A simple and effective way to reduce postoperative pain after laparoscopic cholecystectomy[J].Aust N Z J Surg,1995,65(7):466-469.
[18]孙美农,王娜卿.体位干预对妇科腹腔镜术后患者非切口疼痛的影响[J].中国病案,2016,17(1):95-96.
[19]王学花,付明媚,宋丹.体位干预对妇科腹腔镜术后腹腔引流效果影响的Meta分析[J].中国老年保健医学,2014,12(1):25-27.
[20]郝娜.护理体位干预对妇产科腹腔镜术后引流的效果分析[J].中国医药指南,2018,16(1):214-215.