预防性围术期麻醉管理在心脏手术患者护理中的应用
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摘要
目的:探讨预防性围术期麻醉管理在心脏手术患者护理中的应用效果。方法:将230例心脏手术患者随机分为研究组132例和对照组98例,对照组采用常规护理措施,研究组在对照组基础上实施预防性围术期麻醉管理,比较两组患者术前(T0)、手术开始时(T1)、术毕时(T2)生命体征相关指标,于T0、术后24 h(T3)检测两组患者心肌损伤标志物水平,观察两组术后并发症发生情况,评估护理质量。结果:研究组手术时间、失血量、术后住院时间、总并发症发生率均小于对照组(P <0. 05); T0～T2时,两组心率、平均动脉压、体温组间效应,时间点效应及组间与时间点交互效应比较差异均有统计学意义(P <0. 05); T1、T2时,研究组心率、平均动脉压、体温均高于对照组(P <0. 05); T3时,两组血清肌钙蛋白-I、CK-MB水平均较T0时升高,且研究组低于对照组(P <0. 05);研究组服务质量量表(SERVQUAL)各维度评分均高于对照组(P <0. 05)。结论:预防性围术期麻醉管理应用于心脏手术患者,有助于维持患者血流动力学稳定,减轻其心肌损伤,降低术后并发症发生率,可显著提升护理质量。
Objective: to explore the effect of preventive perioperative anesthesia management in the nursing of patients with cardiac surgery. Methods: A total of 230 patients with cardiac surgery were randomly divided into research group with 132 cases and control group of98 cases. The control group used conventional nursing intervention,and perioperative preventive anesthesia management was applied in the research group on the basis of the control group. The vital signs were compared before operation( T0),at the time of operation beginning( T1) and after operation( T2) between the two groups. The levels of myocardial injury markers were compared before operation( T0),and24 hours after operation( T3). Postoperative complications were observed and nursing quality were assessed in the two groups. Results: The operative time,blood loss,postoperative hospitalization time and total complication rate in the research group were all lower than those in the control group( P < 0. 05). At T0 ～ T2,the heart rate,mean arterial pressure,body temperature effect of the two groups,time point effect,and intergroup interaction effect were compared between the two groups. There were statistically significant differences( P < 0. 05).At T1 and T2,the heart rate,average arterial pressure and body temperature of the research group were all higher than those of the control group( P < 0. 05). At T3,serum troponin I and CK-MB levels in both groups were higher than those at T0,and the levels in the research group were lower than those in the control group( P < 0. 05). The score of service quality scale( SERVQUAL) of the research group was higher than that of the control group in all dimensions( P < 0. 05). Conclusion: Prophylactic perioperative anesthesia management in patients with cardiac surgery is helpful to maintain the hemodynamic stability of patients,reduce their myocardial injury,reduce the incidence of postoperative complications,and significantly improve the quality of care.
Objective: to explore the effect of preventive perioperative anesthesia management in the nursing of patients with cardiac surgery. Methods: A total of 230 patients with cardiac surgery were randomly divided into research group with 132 cases and control group of98 cases. The control group used conventional nursing intervention,and perioperative preventive anesthesia management was applied in the research group on the basis of the control group. The vital signs were compared before operation( T0),at the time of operation beginning( T1) and after operation( T2) between the two groups. The levels of myocardial injury markers were compared before operation( T0),and24 hours after operation( T3). Postoperative complications were observed and nursing quality were assessed in the two groups. Results: The operative time,blood loss,postoperative hospitalization time and total complication rate in the research group were all lower than those in the control group( P < 0. 05). At T0 ～ T2,the heart rate,mean arterial pressure,body temperature effect of the two groups,time point effect,and intergroup interaction effect were compared between the two groups. There were statistically significant differences( P < 0. 05).At T1 and T2,the heart rate,average arterial pressure and body temperature of the research group were all higher than those of the control group( P < 0. 05). At T3,serum troponin I and CK-MB levels in both groups were higher than those at T0,and the levels in the research group were lower than those in the control group( P < 0. 05). The score of service quality scale( SERVQUAL) of the research group was higher than that of the control group in all dimensions( P < 0. 05). Conclusion: Prophylactic perioperative anesthesia management in patients with cardiac surgery is helpful to maintain the hemodynamic stability of patients,reduce their myocardial injury,reduce the incidence of postoperative complications,and significantly improve the quality of care.
引文
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[10]黎敏.快通道麻醉心脏手术患者术后护理分析[J].国际心血管病杂志,2017,44(1):252.
[11]吕红.综合保温措施在心脏外科手术围术期的应用[J].护士进修杂志,2015,30(8):739-741.
[12]许娜. ICU心脏体外循环术后患者预见性护理的效果研究[J].中国急救医学,2016,36(1):320-321.
[2]陈娟,石敏.综合护理干预对体外循环心脏手术后ICU综合征的预防作用[J].实用临床医药杂志,2015,19(23):217-218.
[3] Fedosiuk RN,Shchupachynska LO. Hypertrophic cardiomyopathy:an intraoperative death case analysis and substantiation of the standards of perioperative anesthetic management in a non-cardiosurgery clinic[J]. Wiad Lek,2018,71(2pt2):425-435.
[4]李丽,叶文琴,赵明利.应用Servqual量表评价影响护理服务质量的相关因素调查[J].护理研究,2013,27(19):1946-1948.
[5]郑瑾. ICU护士术前访视对心脏搭桥术后患者心理应激反应及负性情绪的影响[J].齐鲁护理杂志,2016,22(6):78-80.
[6]宋磊军,魏金聚,刘爱英.快通道心脏麻醉用于心脏手术的临床观察[J].中国药房,2016,27(14):1975-1978.
[7]韩盖宇,卢嫦青,张燕,等.腔镜心脏外科手术的巡回护理[J].护士进修杂志,2017,32(7):661-663.
[8] Kowalczyk M,Nestorowicz A,Stachurska K,et al. Myasthenia gravis:a careful perioperative anesthetic management of coronary artery bypass grafting[J]. J Neurosci Nurs,2015,47(3):161-165.
[9]高文婷.快速康复外科理念在心脏外科手术护理中的应用[J].护士进修杂志,2015,10(2):175-177.
[10]黎敏.快通道麻醉心脏手术患者术后护理分析[J].国际心血管病杂志,2017,44(1):252.
[11]吕红.综合保温措施在心脏外科手术围术期的应用[J].护士进修杂志,2015,30(8):739-741.
[12]许娜. ICU心脏体外循环术后患者预见性护理的效果研究[J].中国急救医学,2016,36(1):320-321.