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腹腔镜胃癌手术后保温措施的应用效果
发布时间:2020-01-13

  摘    要: 目的:探索术后保温对胃癌患者行腹腔镜胃大部切除术后快速康复的影响。方法:将2015年1月至2018年10月间在宁波市医疗中心李惠利医院行腹腔镜胃大部切除的66例患者随机分为对照组和实验组。对照组采用常规围手术期护理,麻醉复苏及回病房途中常规保暖措施;实验组采用常规围手术期护理,麻醉复苏及回病房途中采用一系列保暖措施。观察2组患者术后0.5、1、2、3、5、7 h的血压、心率、耳温、术后拔管时间、进食/排气时间、术后住院时间及胃瘫发生率。结果:与对照组比,实验组患者术后耳温提高、心率减慢;术后进食/排气时间提前,住院时间缩短(P<0.05),术后胃瘫率降低(P<0.05)。结论:胃癌患者行腹腔镜胃大部切除术后保温可以缩短术后住院时间,加速患者术后康复。

  关键词:赢发彩票代理 胃癌; 围手术期; 保温; 快速康复; 腹腔镜;

  Abstract: Objective: To investigate the effect of heat preservation on rapid recovery of patients with gastric cancer after laparoscopic surgery. Methods: A total of 66 patients, who undertook laparoscopic subtotal gastrectomy in Ningbo Medical Treatment Centre Lihuili Hospital from January 2015 to October 2018, were randomly divided into the control group and the experimental group. The patients in the control group adopted routine perioperative nursing and the experimental group patients were kept warm during postoperative period. The two groups were statistically analyzed in terms of blood pressure, heart rate, ear temperature during the study, and postoperative extubation time, eating and anus exhaust time and postoperative hospitalization time. Results: Compared with the control group, the experimental group patients had higher ear temperature, slower heart rate, earlier eating time, shorter postoperative hospitalization and lower postoperative gastroplegia rate, with statistical difference between the two groups(P<0.05). Conclusion: The postoperative temperature control for laparoscopic subtotal gastrectomy patients with gastric carcinoma could effectively shorten the time of hospitalization with sooner postoperative recovery.

  Keyword: gastric cancer; perioperative period; heat preservation; rapid recovery; laparoscopy;

  FUQIANGJINGWEIAISHOUSHUSHI,YOUYUMAZUIYIZHI、SHOUSHUSHIDISHIWEN、SHIWENYETISHUZHU、SHOUSHUYINGJI、QIFUSHIQITIJIAOHUANJISHIWENSHUICHONGXIDENGYINSUYINGXIANG,HUANZHEYIFASHENGDITIWENXIANXIANG。DITIWENYIYOUFAJITININGXUEGONGNENGZHANGAI,DAOZHIWEISHOUSHUQISHIXUELIANGJISHUXUELIANGZENGJIA,SHISHUBUQIEKOUYUHESHIJIANYANZHANG,ZENGJIASHOUSHUBUWEIGANRAN(surgical site infection,SSI)DEFASHENGLV,DUIHUANZHESHUHOUHUIFUJIWEIBULI[1]。YOUYANJIU[2,3]FAXIANSHUZHONGDITIWENFASHENGLVYUEWEI60%,DANJINXINGTIWENJIANCEDEZHIZHAN19.4%,DUIHUANZHECAIQUJIJIBAONUANCUOSHIDEZHAN38.5%。KEJIAN,WULUNSHISHUZHONGHAISHISHUHOU,DUIYUHUANZHETIWENDEYOUXIAOKONGZHIWANGWANGBEIHULVE。YOUYANJIUZHICHU,WEIBUSHOUSHUZHONGDEDITIWENSHIHUANZHESHUSHIDUJIANGDI,YANZHANGZHUYUANTIANSHU,ZENGJIAYILIAOFEIYONG,JIAZHONGHUANZHEJINGJIFUDAN[4]。ZAISHIJIANGUOCHENGZHONG,WOMENZHONGSHISHUZHONGDEBAOWEN,RANERDUIYUSHOUSHUHOUDEBAOWENQUEWANGWANGHUSHI。WOKEWEIJIANSHAOHUANZHESHUHOUDITIWEN,CUJINHUANZHESHUHOUKUAISUKANGFUZHIDINGLESHUHOUDEBAOWENCUOSHI,TONGGUOSHIJIANQUDELEMANYIDEXIAOGUO。

  1 、资料和方法

  1.1、 一般资料

  将2015年1月至2018年12月间在宁波市医疗中心李惠利医院由同一位外科医师进行腹腔镜胃大部切除(包括近端及远端)的66例患者,随机分为实验组与对照组,每组33例。纳入标准:(1)患者心肺功能良好,能够耐受全身麻醉和腹腔镜手术;(2)经过宣教能够完全配合护理工作;(3)术前耳温(Thermo Scan PRO 4000,美国)为36.5~37.5℃。排除标准:(1)合并其他严重疾病的;(2)术后死亡或因并发症需再次手术的。所有患者进行入院宣教,并签署知情同意书,本研究获得宁波市医疗中心李惠利医院伦理委员会的审核批准。
 

腹腔镜胃癌手术后保温措施的应用效果
 

  1.2、 方法

  1.2.1、 对照组:

  JINXINGRUYUANJIANKANGXUANJIAO,GAOZHIHUANZHEWEIEXINGZHONGLIUXIANGGUANZHISHIJISHOUSHUQIXIANGGUANGONGZUONEIRONG,CHONGFENDEDAOHUANZHEJIJIASHUDEXINRENYUPEIHE。SHUQIANBUJINXINGCHANGDAOZHUNBEI,SHUQIAN6 hJINSHI,YUSHUQIAN2 hKOUFU10%PUTAOTANG500 mL,BUZHIBIWEIGUAN,SHUQIANJINGDIKANGSHENGSU(JIARU100 mL 0.9%LVHUANARONGYEZHONG)。SHUZHONGSHIYONGDUANXIAOJINGMAIMAZUIJI,SHIYONGQUANSHENMAZUIDEFANGSHI,MAZUIKAISHIHOUJIKAISHICHONGQISHIBAOWENTANDEJIAWEN。SHIYONG5KONGFAFUQIANGJINGWEIDABUQIECHUSHU,SHUZHONGCHONGXISHISHIYONGYUXIANJIAREDEYETI(ZAIJIAWENXIANGZHONGJIAWENZHI37℃)。RUOSHUZHONGCHUXIANTIWENBODONG,BUCAIQUCHANGGUICHULI。SHUHOUWENHEKOUFANGZHIFUQIANGYINLIUGUAN1GEN,MAZUIHUIFUQIZAIFUSUSHICAIYONGCHANGGUIHULI,JISHIWENYETISHUYEJIBUCAIYONGMAOTANBAOWEN。

  1.2.2、 实验组:

赢发彩票代理   CHULEYUDUIZHAOZUXIANGTONGDECHANGGUIHULIWAI,WOMENCAIQUDESHUZHONGBAOWENCUOSHIHAIYOUSHUZHONGSHUYEQIANHUOCHONGXIFUQIANGYONGDE0.9%LVHUANARONGYEHUOZHEZHENGLIUSHUIZAIJIAWENXIANGZHONGJIAWEN。ZAISHISHIMAZUI、SHOUSHUKAISHIHOU,MEIGE15 minCEERWEN1CI,ZUOHAOJILU,BINGGENJUHUANZHEDETIWENBIANHUASUISHIDIAOZHENGCUOSHI,QUEBAOHUANZHEDETIWENZAI36℃YISHANG,JUTIFANGFAWEI:(1)TIGAOFUQIANGCHONGXISHIDECHONGXIYEWENDUZHI37℃;(2)TIGAOCHONGQISHIBAOWENTANDEWENDUZHI37℃;(3)BIYAOSHIJIANYIWAIKEYISHIZANTINGSHOUSHU,DAITIWENHUIFUZHENGCHANGHOUZAIJIXUSHOUSHU。TONGSHIGUANCHAHUANZHEDEQUANSHENZHUANGKUANGJIZHITIDEPIFUWENDU,TEBIESHISIZHIDEMOSHAOXUEYUN。SHOUSHUJIESHUHOUJIXUJIANGCHONGQISHIBAOWENTANDIANZAIZHUANYUNCHUANGXIA,HUANZHEFANHUIBINGFANGHOU,JIXUPEIHEBINGFANGHUSHI,SHIYONGJIAWENGUODEYETIDUIHUANZHEJINXINGSHUYE,QUEBAOJIANGHUANZHEBAOWENZHISHUHOU8 h。GUANCHABINGJILU2ZUHUANZHESHUHOU0.5、1、2、3、5、7 hDEXUEYA、XINLV、ERWENJISHUHOUBAGUANSHIJIAN、JINSHI/PAIQISHIJIAN、SHUHOUZHUYUANSHIJIANJIWEITANFASHENGLV。

  1.3、 统计学处理方法

  CAIYONGSPSS20.0RUANJIANJINXINGFENXI。JILIANGZILIAOYIBIAOSHI,2ZUBIJIAOCAIYONGtJIANYAN;DENGJIZILIAODEZUJIANBIJIAOCAIYONGZHIHEJIANYAN,JISHUZILIAOZUJIANBIJIAOCAIYONGχ2JIANYAN。P<0.05WEICHAYIYOUTONGJIXUEYIYI。

  2、 结果

  2.1 、2组患者一般资料比较

  2ZUHUANZHEZAINIANLING、BMI、XINGBIEGOUCHENG、ERWEN、XINLVDENGRENKOUXUETEZHENGJIBENTEZHENGFANGMIANBIJIAO,CHAYIWUTONGJIXUEYIYI(P>0.05),JIANBIAO1。

  2.2、 2组术后指标比较

赢发彩票代理   SHIYANZUHUANZHESHUHOU0.5、1、2、3 hDEPINGJUNERWENYUDUIZHAOZUBIJUNJIAOGAO,CHAYIYOUTONGJIXUEYIYI(P<0.05);SHUHOU0.5、1、2、3 hSHIYANZUXINLVJIAODUIZHAOZUDI,CHAYIYOUTONGJIXUEYIYI(P<0.05)。JIANBIAO2。SHIYANZUHUANZHEJINSHI/PAIQISHIJIANJIAODUIZHAOZUTIQIAN,BAGUANSHIJIANHEZHUYUANSHIJIANJUNJIAODUIZHAOZUSUODUAN,WEITANFASHENGLVDI,CHAYIJUNYOUTONGJIXUEYIYI(P<0.05),JIANBIAO3。

  3 、讨论

  DITIWENSHIZUZHIQIGUANDAIXIELVJIANGDI,KEDUIZUZHIQIBAOHUZUOYONG;DANLINGYIFANGMIAN,DITIWENYIZHIMIANYIGONGNENG,DAOZHININGXUEJIZHIWENLUANDENG,YOUQISHIJIANGDIJITIGEXITONGGONGNENG,KESHIXUNHUANXITONGWAIZHOUXUEGUANZULIZENGJIA,YINQIFEIXUEGUANZULIZENGGAO,XINDONGGUOSU,XUEYAXIAJIANG,XINZANGCHUANDAOZUZHIDENGYANZHONGBINGFAZHENG[5]。SHUZHONG、SHUHOUDITIWENXIANXIANGYIJINGZHUJIANYINQILINCHUANGYIHURENYUANDEZHONGSHI。TONGGUOSHOUSHUQIANHESHOUSHUGUOCHENGZHONGKONGZHITIBIAOHETIQIANGSANRE,CAIQUDUOZHONGHULICUOSHIYINGZAOCONGTINEIDAOTIWAIWENNUANSHUSHIDENEIWAIHUANJING,KEYOUXIAOFANGZHIHUANZHESHUZHONGDITIWEN。YOUYANJIU[6]ZHICHU,RUOSHINEIWENDUJIAODI,KONGQIDUILIU、REFUSHEZENGJIAJIQUANMAHOUHUANZHEXUEGUANKUOZHANG,ZEDAOZHIRELIANGKUAISUZAIFENBUDAOZHOUWEICONGERYOUFAHEXINTIWENDEXIAJIANG,GUSHIWENSHISHUZHONG、SHUHOUDITIWENFASHENGDEDULIWEIXIANYINSU。YOUXUEZHEZHICHU[7,8],SHUHOUBAOWENKEYOUXIAOJIANGDIYINGJIFANYING,CUSHIHUANZHESHUHOUJINKUAISUXING,JIANSHAOYINDITIWENSUOZAOCHENGDEHANZHAN、ZAODONGDEFASHENG,JIANGDILEYANGHAO,JIANSHAODIXUEYANGZHENGDEFASHENG,SHIXINLVQUYUWENDING,JIANSHAOXINZANGSUNHAIHEXINDONGGUOSUDEFASHENG。

  表1 2组患者一般情况比较(每组n=33)
表1 2组患者一般情况比较(每组n=33)

  表2 2组患者术后耳温及心率比较(每组n=33)
表2 2组患者术后耳温及心率比较(每组n=33)

  表3 2组患者手术后指标比较(每组n=33)
表3 2组患者手术后指标比较(每组n=33)

赢发彩票代理   CONGBENYANJIUJIEGUOLAIKAN,YUDUIZHAOZUBI,SHIYANZUHUANZHESHUZHONGXUEYASHENGGAO、XINLVJIANGDI、JINSHISHIJIANTIQIAN、GANGMENPAIQISHIJIANTIQIAN、SHUHOUBAGUANSHIJIANHESHUHOUZHUYUANSHIJIANSUODUAN。XIANYOUYANJIUBIAOMINGSHUZHONGHUANZHEDETIWENHUIMINGXIANXIAJIANG[9],LIANGAIQUNDENG[10]ZHICHU,CAIQUCHONGQISHINUANFENGTANJIASHUIXUNHUANWENTANYIBAOWENCUOSHINENGWEICHISHOUSHUQUANGUOCHENGTIWEN、XINLV、XUEYAXIANGDUIPINGWEN,YOULIYUWAIKESHOUSHUDESHUNLIJINXING,SUIRANYUWOMENDEBAOWENFANGFABUJINXIANGTONG,DANJIEGUOYUWOMENDEYANJIUSHIYIZHIDE。XIANGDUIYUQITABAOWENCUOSHI,CHONGQISHIBAOWENTANGENGSHIHEWEIHUANZHETIGONGBAOWENBAOZHANG[11]。HUMEIDENG[12]YANJIUFAXIAN,DUIFUQIANGJINGWEIAIGENZHISHOUSHUHUANZHECAIQUSHUZHONGBAOWENCUOSHI,NENGGOUJIANSHAOSHOUSHUBUWEIGANRANDEFASHENG,CUJINSHUHOUKANGFU,TAMENDEYANJIUJIEGUOYUWOMENDEJIBENYIZHI,LINGWAIWOMENFAXIAN,ZHUZHONGSHUHOUDEBAOWENKEYIJIANGDIFUQIANGJINGWEIAISHUHOUDEWEITANFASHENGLV。

赢发彩票代理   SHUZHONG、SHUHOUDITIWENDEFANGZHIYIJINGDEDAOLEYUELAIYUEDUOLINCHUANGGONGZUOZHEDEZHONGSHI,BENCIYANJIUCONGFUQIANGJINGWEIDABUQIECHUSHUCHUFA,ZHENGSHILESHUZHONG、SHUHOUBAOWENKEYISHIHUANZHEZONGTIYUHOUDEDAOSHOUYI,ZHEIYEFUHELEDANGXIAKUAISUKANGFUWAIKEDECHAOLIU。RANER,CICIYANJIUZHISHIJUXIANYUFUQIANGJINGWEIZHONGLIUSHOUSHU,WEILAIXUYAOGENGDUODESUIJIDUIZHAOYANJIUYIJINXINGDASHUJUFENXIBINGSHISHUHOUBAOWENDEDAOJINYIBUDETUIGUANG。

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