不同手术体位对经皮肾镜取石手术患者术中舒适度及疼痛的影响

摘要

目的:探讨不同手术体位对经皮肾镜取石手术患者术中舒适度及疼痛的影响.方法:以2014年1月～2017年4月我院收治的300例上尿路结石患者为研究对象,依据其入院顺序随机等分为对照组和观察组,两组均行经皮肾镜取石手术,对照组实施传统俯卧位护理干预,观察组另实施斜仰卧位联合截石位护理干预,观察两组患者手术一般情况(手术时间、术中出血量、住院时间)、手术安全性[舒张压(DBP)、收缩压(SBP)、心率(HR)]、术中体位舒适度、疼痛评分、结石清除率及术后并发症发生率.结果:观察组患者手术时间、住院时间明显短于对照组,而术中出血量明显少于对照组(P<0.05).护理干预前两组患者SBP,DBP,HR指标相比较无统计学意义(P>0.05);体位干预后30 min仅对照组SBP,DBP较体位干预前明显降低,HR明显升高,并且护理干预后30 min对照组SBP,DBP,HR指标变化较观察组明显,差异有统计学意义(P<0.05).观察组术中舒适度明显高于对照组,而体位干预后观察组疼痛评分明显低于对照组,差异具有统计学意义(P<0.05).观察组患者结石清除率高于对照组,而术后并发症发生率明显低于对照组,差异具有统计学意义(P<0.05).结论:斜仰卧位联合截石位护理干预在经皮肾镜取石术治疗的患者中应用,不仅可有效缩短手术时间、住院时间,减少术中出血量,对患者呼吸循环系统影响轻微,并且提高结石清除率和术中舒适度并减轻疼痛和降低并发症发生率.%Objective:To explore the effects of intraoperative comfort and pain through different operative positions applied in percutaneous nephrolithotomy treatment which patients received. Methods:To select 300 cases of patients with upper urinary tract calculi cured in our hospital as abject of study from Jan-uary 2014 to April 2017, equally divided them into control group and observation group according to the order to be hospitalized. Two groups were given percutaneous nephrolithotomy operation. Control group were given traditional prone position nursing, while observation group were given oblique supine po-sition combining lithotomy position nursing intervention. Compared general situation in operation ( time of operation, intraoperative blood loss, length of stay) , operation safety [ diastolic blood pressure ( DBP) , systolic blood pressure ( SBP) , heart rate ( HR) ] , position comfort in operation, pain score, clearance rate of calculus and occurrence rate of complication after operation. Results:Patient's operation time and hospital stay of observation group were obviously shorter than that of control group, and intraoperative blood loss lesser than that of control group(P<0. 05). SBP, DBP and HR index of two groups had no statistical significance before nursing intervention(P>0. 05);SBP and DBP of control group after 30 min intervention were decreased obvi-ously comparing with accepting position intervention before, HR were obviously increased, and SBP, DBP and HR of control group after 30 min nursing in-tervention were more obvious than that of observation, difference had statistical significance(P<0. 05). Intro-operative comfort of observation group was higher than that of control group, however pain scores of observation group after intervention were obviously lower than that of control group, and difference was statistically significant(P<0. 05). Clearance rate of calculus of patients in observation group was higher than that of control group, at the same time, incidence of postoperative complication was lower than that of control group, and difference was statistically significant(P<0. 05). Conclusion:The appli-cation of oblique and supine position combining lithotomy position nursing intervention in percutaneous nephrolithotomy treatment which patients received not only can shorten operation time, length of stay, lessen intraoperative blood loss, influenced slightly on patient's respiratory system, but also improve clear-ance rate of calculus and intraoperative comfort, as well as lower the occurrence rate of complication.