中西医结合疼痛护理在日间腹腔镜胆囊切除术围手术期中的研究

目的:探讨中西医结合疼痛护理在日间腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)围手术期中的应用价值。方法:对2017年11月—2018年5月146例行日间LC手术患者实施中西医结合疼痛护理措施(实验组),并与同期住院行常规LC术患者127例(对照组)进行对比,分析对比两组患者术后疼痛评分、术后使用阿片类镇痛药例数、护理满意度评分等。结果:实验组术后各时间点疼痛评分及阿片类药物使用例数明显低于对照组(P0.05),护理满意度评分明显高于对照组(P0.05)。结论:在日间LC术围手术期中实施中西医结合疼痛护理可明显降低患者疼痛程度,促进患者快速康复,增加患者护理满意度。     

腹腔镜胆囊切除术快速康复外科护理效果观察

目的探讨腹腔镜胆囊切除术(LC)快速康复外科护理的效果。方法随机将2016-05—2018-06间在新野县人民医院接受LC的84例患者分为2组,各42例。观察组实施快速康复外科护理。对照组行常规护理。结果观察组术后恢复效果、疼痛评分、并发症发生率均优于对照组,差异有统计学意义(P0.05)。结论对LC患者采取快速康复外科护理,可减轻患者疼痛,降低术后并发症发生率,缩短住院时间,促进术后恢复,提高患者的生活质量。     

精准护理在混合痔围手术期患者中的应用效果观察

目的:观察精准护理在混合痔围手术期患者中的应用效果。方法:将70例行混合痔手术患者随机分为对照组和观察组,每组35例。对照组患者采用常规护理,观察组患者在对照组基础上采用精准护理,比较2组患者的疗效,术后首次排便时间、住院天数,术后当天、术后1周疼痛评分以及护理满意度。结果:观察组患者总有效率明显高于对照组(P<0.05);观察组患者术后首次排便时间、住院天数均短于对照组(P<0.05),术后当天、术后1周疼痛评分均低于对照组(P<0.05);观察组患者护理满意度明显高于对照组(P<0.05)。结论:将精准护理应用于混合痔围手术期患者,可提高治疗有效率和护理满意度,缩短术后首次排便时间、住院天数,减轻疼痛,值得临床推广应用。     

人性化护理在腹腔镜下胆囊切除术中的体会

目的总结人性化护理在腹腔镜下胆囊切除术(LC)中临床应用的体会。方法将拟接受LC的130例患者随机分为观察组和对照组,每组65例。对照组患者按照传统给予常规护理,观察组患者在对照组的基础给予人性化护理。比较两组患者术前焦虑程度、术后疼痛程度、护理满意度、平均住院时间以及术后并发症情况。结果患者术前焦虑程度、术后疼痛程度、护理服务满意度比较,观察组均明显优于对照组(P0.05)。观察组平均住院时间明显短于对照组,观察组患者术后并发症情况明显少于对照组,两组差异均有统计学意义(P0.05)。结论人性化护理在LC中可有效缓解患者术前焦虑,减轻术后疼痛和减少术后并发症的发生率,促进患者康复,缩短住院时间,提高患者满意度。     

舒适护理在腹腔镜胆囊切除术中的应用效果分析

目的探讨舒适护理在腹腔镜胆囊切除术(LC)中的应用效果。方法将160例LC患者随机分为2组,每组80例。对照组实施常规护理,观察组在对照组基础上应用舒适护理。观察2组手术时间、术后并发症发生率、住院时间及患者和家属对护理工作的满意度。结果 2组手术时间差异无统计学意义(P0.05);观察组术后并发症发生率低于对照组,住院时间短于对照组,对护理工作满意度高于对照组,差异均有统计学意义(P0.05)。结论对LC患者实施舒适护理,可降低术后并发症的发生率,缩短住院时间,提高患者及家属对护理工作的满意度。     

比较脐缘三孔法和常规三孔法腹腔镜胆囊切除术的效果

目的比较脐缘三孔法和常规三孔法腹腔镜胆囊切除术(LC)的效果。方法选取2016-01—2018-12间在睢县人民医院接受LC治疗的100例慢性结石性胆囊炎患者,随机分为2组,各50例。对照组行常规三孔法手术,观察组行脐缘三孔法手术。结果全部患者均成功完成LC。观察组中3例因胆囊三角严重粘连改为常规三孔法施术。对照组手术时间长于观察组,差异有统计学意义(P0.05)。2组术中出血量差异无统计学意义(P0.05)。观察组术后切口疼痛评分、需要镇痛例数、住院时间及对腹壁切口的满意度评分等指标均优于对照组,差异有统计学意义(P0.05)。结论脐缘三孔法LC的手术时间长于常规三孔法LC。但其术后切口疼痛评分、需要镇痛例数、术后住院时间及对腹壁切口的满意度评分等指标均优于常规三孔法LC。     

改良式简易封闭负压引流技术联合全面护理在断肢再植患者术后创面修复中的应用

目的:探讨改良式简易封闭负压引流技术联合全面护理在断肢再植患者术后创面修复中的应用。方法:选取2018年1月-2020年6月于笔者医院收治的284例断肢再植手术患者作为研究对象,采用单双号法将284例患者随机分为观察组(142例)和对照组(142例)。两组均行断肢再植手术治疗,对照组术后采用常规封闭负压引流技术联合全面护理,观察组采用改良式简单封闭负压引流技术联合全面护理。对比两组创面愈合时间、敷料维持时间、住院时间和住院费用,护理前后疼痛视觉模拟评分(Visualanaloguescale,VAS),护理期间的术后并发症发生率以及患者护理满意度。结果:护理后,观察组VAS评分、创面愈合时间、住院时间和住院费用均低于对照组,敷料维持时间高于对照组,差异有统计学意义(P0.05)。观察组对护理技术、护理态度、护理方式和健康教育方面满意度以及护理总满意度评分均明显高于对照组,差异有统计学意义(P0.05)。护理期间,观察组并发症发生率3.52%低于对照组的9.86%,差异有统计学意义(P0.05)。结论:改良式简易封闭负压引流技术联合全面护理在断肢再植患者术后创面修复中的应用,可减少术后并发症的发生,加快创面愈合,并缓解患者疼痛,减少住院时间和费用,提升患者的临床护理满意度。     

腹腔镜胆囊切除术后整体护理体会

目的探讨腹腔镜胆囊切除术(LC)的术后整体护理措施。方法随机将100例行LC的胆囊结石患者分为2组,各50例。对照组术后采取常规护理,观察组术后实施整体护理措施。对比2组患者的护理效果。结果观察组患者的术后下床活动时间、住院时间较对照组明显缩短,VAS评分及术后并发症发生率较对照组低,差异均有统计学意义(P0.05)。结论对LC患者术后采取整体护理措施,可促进患者术后康复,效果显著。     

舒适护理在皮肤激光美容治疗中的应用效果分析

目的:探讨舒适护理在皮肤激光美容治疗中的应用效果。方法:选取2016年1月-2017年1月在本院行皮肤激光美容治疗的患者82例,随机分为观察组和对照组,每组41例。对照组给予常规护理干预,观察组在对照组基础上实施舒适护理干预,比较两组患者焦虑自评量表(Self—Rating Anxiety Scale,SAS)评分、不良反应发生率及术后满意度等指标。结果:观察组患者SAS评分和不良反应发生率明显低于对照组,差异有统计学意义(P0.05);观察组患者满意度明显高于对照组,差异有统计学意义(P0.05)。结论:皮肤激光美容治疗中应用舒适护理可有效缓解患者焦虑情绪,降低不良反应发生率,提高患者护理满意度,效果显著,值得推广应用。     

中西医结合加速康复护理在腹腔镜胆囊切除术围术期的应用

目的:探讨中西医结合加速康复护理在腹腔镜胆囊切除术后患者中的应用价值。方法:380例腹腔镜胆囊切除术患者,分为常规护理组(对照组)和中西医结合加速康复护理组(观察组),回顾性分析对比各组术后肛门排气时间、疼痛评分、术后住院时间及术后住院费用等临床资料。结果:观察组术后排气时间(20.4±4.6)h,明显短于对照组(29.6±8.7)h,术后疼痛评分(2.6±1.0),显著低于对照组(3.8±1.6),观察组术后住院时间(3.4±1.6)d,显著低于对照组(3.9±2.6)d,术后住院费用(8400±2700)元,明显少于对照组(11600±4200)元。结论:应用中西医结合快速康复护理能明显促进腹腔镜胆囊切除术患者的术后康复,降低医疗费用。     

Randomized clinical trial of open versus laparoscopic cholecystectomy in the treatment of acute cholecystitis

BACKGROUND: The aim of this prospective trial was to determine whether surgical approach (open versus laparoscopic) had an impact on morbidity and postoperative recovery after cholecystectomy for acute cholecystitis. METHODS: Seventy patients who met the criteria for acute cholecystitis were randomized to open or laparoscopic cholecystectomy. The type of operation was unknown to the patient and all hospital staff involved in the postoperative care. RESULTS: The two groups were similar with respect to demographic and clinical characteristics. There were no significant differences in rate of postoperative complications, pain score at discharge and sick leave. In eight patients a laparoscopic procedure was converted to open cholecystectomy. Median operating time was 90 (range 30-155) and 80 (range 50-170) min in the laparoscopic and open groups respectively (P = 0.040). The direct medical costs were equivalent in the two groups. Although median postoperative hospital stay was 2 days in each group, it was significantly shorter in the laparoscopic group (P = 0.011). CONCLUSION: Cholecystectomy for acute cholecystitis can be performed by either laparoscopic or open techniques without any major clinically relevant differences in postoperative outcome. Both techniques offer low morbidity and rapid postoperative recovery.     

单切口免钛夹腹腔镜胆囊切除术

目的 探讨单切口免钛夹腹腔镜胆囊切除术治疗胆囊良性疾病的可行性及安全性.方法 按患者意愿对1890例胆囊良性疾病患者中的1016例采用脐部单切口免钛夹腹腔镜胆囊切除术(单切口组),实际完成1001例,与同期完成的874例两孔法免钛夹腹腔镜胆囊切除术患者进行比较,采用t检验和x2比较两组的手术时间、术中出血量、术后恢复等情况.结果 单切口组1016例仅15例因胆囊壶腹部炎症严重改为传统的四孔法切除,其余1001例均顺利完成单切口下LC术.两孔法组完成腹腔镜胆囊切除术874例.两组均无胆漏、胆道损伤及手术死亡等严重的手术并发症.单切口组与两孔法组的手术时间无差异[(34.5±5.2)min与(32.0±7.4)min,t=0.063,P=0.526]、术中出血量无差异[(56.5±17.8) ml与(55.2±15.9)ml,t=0.812,P=0.425]、术后住院时间无差异[(3.1±0.8)d与(3.2±O.7)d,t=1.073,P=0.326],而单切口组切口疼痛轻于两孔法组(P=0.000).结论 单切口免钛夹腹腔镜胆囊切除术安全性好,创伤更小,更美观.[关健词]胆囊切除术,腹腔镜;单切口;钛夹     

Reduced length of stay and convalescence in laparoscopic vs open sigmoid resection with traditional care: a double blinded randomized clinical trial

Aim The effect of a laparoscopic technique without a multi‐modal rehabilitation programme but with traditional postoperative care was studied in a blinded randomized trial regarding nursing time, hospital stay, pain, fatigue, need for sleep and return to normal daily activities. Method Eighteen patients with sigmoid cancer were randomly assigned to laparoscopic (n = 10) and open (n = 8) colonic resection in a double blinded trial. Length of hospital stay, fulfilment of discharge criteria, need for nursing care (information given to the patient, physical care and indirect care) and postoperative pain were recorded. Furthermore, the patients filled out a questionnaire regarding fatigue, need for sleep and return to daily activities 14 and 30 days postoperatively. Results The laparoscopic technique reduced length of hospital stay from 7 to 4.5 days (P = 0.006), although both groups met the discharge criteria on the third postoperative day. There were no significant differences in total need for nursing time during hospitalization between the two groups (P = 0.328). The laparoscopic group had less pain 24 hours after operation (P = 0.040), and reported less fatigue and reduced need for sleep during the day 30 days after surgery when compared with open surgery (P = 0.033 and P = 0.036, respectively). Furthermore, the laparoscopic group returned significantly faster to normal daily activities after surgery (P = 0.023). Conclusion Laparoscopic surgery per se reduced hospital stay, pain and convalescence compared with open surgery in patients undergoing colonic resection.These effects were obtained without a fast track programme and without an increase in nursing staff on the general surgical ward.     

Transvaginal cholecystectomy is associated with reduced pain and decreased analgetic requirements compared to laparoscopic cholecystectomy

BACKGROUND: Natural orifice transluminal endoscopic surgery (NOTES) is regarded as less invasive than laparoscopic surgery. However, the assumed advantages of NOTES – such as reduced pain and faster recovery of patients should be verified. METHODS: In this prospective controlled study 30 women undergoing transvaginal cholecystectomy (TV-ChE) were compared with 30 women undergoing conventional laparoscopic cholecystectomy (LAP-ChE). RESULTS: Compared to the LAP-ChE group, the women of the TV-ChE group reported less postoperative pain and less analgesic consumption. Both the duration of stay in the recovery room and the hospital stay were shorter in the TV-ChE group. After a follow-up of 3 months none of the patients of the TV-ChE group complained of dyspareunia or other colpotomy-related complications. CONCLUSIONS: TV-ChE is a safe and less invasive surgical technique. Compared to LAP-ChE there are some advantages such as less need for analgesics, faster mobilization, more comfortable recovery and shorter hospital stay.     

罗伊适应模式在腹腔镜下治疗疝患儿临床应用

目的探讨罗伊适应模式（RAM）应用于腹腔镜下疝手术治疗患儿的临床效果。 方法暨南大学附属第一医院自2016年4月至2017年4月收治的60例疝患儿,按照随机数字表法分为对照组和试验组试验组,每组30例。对照组患儿采用腹腔镜下疝修补术治疗的常规护理,试验组患儿在对照组基础上给予RAM进行护理。比较2组患儿的手术时间、下床活动时间、住院时间、并发症的发生情况及家属的护理满意度。 结果试验组患儿的手术治疗时间、下床活动时间、住院时间均显著少于对照组。试验组患儿中发生切口愈合不良1例、出现腹部牵拉痛1例;对照组患儿中发生切口感染2例、切口愈合不良3例、腹部牵拉痛4例、尿潴留3例。试验组患儿的不良反应发生率（6.67%）显著低于对照组（40.00%）,试验组患儿家属的护理总满意度（96.67%）显著高于对照组（70.00%）,差异具有统计学意义（P<0.05）。 结论腹腔镜下疝修补术治疗患儿围手术期采用RAM护理措施,可缩短手术时间、促进早期恢复、减少并发症发生,提高患儿家属的护理满意度。     

无痛理念对泌尿外科门诊手术患者术后疼痛及满意度的影响

［摘要］ 目的 探讨无痛理念对泌尿外科门诊手术患者术后疼痛及满意度的影响。方法 将2017年1月至2019年1月广东医科大学附属医院门诊部100例泌尿外科门诊手术患者作为研究对象,根据就诊单双顺序分为对照组与观察组（均n=50）,对照组给予常规护理,观察组在对照组基础上实施无痛理念护理,比较两组术后疼痛情况、术后2 h舒适度、术后留院时间和满意度。结果 观察组术后30 min数字评价量表（NRS）评分与对照组无显著差异（P>0.05）,术后1 h、术后1.5 h和术后2 h NRS评分均低于对照组（P<0.05）;观察组术后2 h生理舒适评分、心理舒适评分和舒适度总分均显著高于对照组（P<0.05）;观察组术后满意度高于对照组（P<0.05）;观察组术后留院时间短于对照组（P<0.05）。结论 无痛理念可减轻泌尿外科门诊手术患者术后疼痛,提高舒适度和患者满意度。     

腹腔镜与传统开腹手术治疗胆总管结石的临床应用比较

目的比较腹腔镜胆囊切除＋胆总管切开探查取石术和传统开腹胆囊切除＋胆总管切开探查取石术的临床效果和医疗费用。方法55例胆总管结石患者分两组,A组25例行腹腔镜胆囊切除＋胆总管切开取石术;B组30例行传统开腹胆囊切除＋胆总管切开取石术。统计手术时间,术后开始下床活动时间,术后胃肠功能恢复时间,术后住院时间,术后并发症和总住院费用。结果两组患者都顺利完成手术,术后两组各有1例患者胆道造影残留结石,两组手术时间无显著差异,A组患者术后下床活动时间、胃肠功能恢复时间较B组患者早,术后A组住院时间较B组短,住院费用A组较B组增多。结论腹腔镜胆总管切开取石术完全能达到传统开腹胆道切开取石术的效果,并具有创伤小,痛苦少,恢复快的优点,是治疗胆总管结石的理想手术方式之一。     

Course of postoperative pain in laparoscopic cholecystectomy under multimodal anesthesia-analgesia in ambulatory care

OBJECTIVE: To evaluate the evolution of postoperative pain and convalescence in a group of patients undergoing elective laparoscopic cholecystectomy under a multimodal anesthesia-analgesia treatment protocol. MATERIAL AND METHOD: Eighty-four consecutive patients undergoing elective laparoscopic cholecystectomy were given intramuscular ketoprofen during induction, anesthesia, with minimal use of opioids, and intraperitoneal irrigation with bupivacaine. We assessed the rate of conversion to hospitalization, hospital stay in hours, duration of the pain-free interval, oral analgesics per day at home, and intensity of postoperative pain and physical activity daily on a visual analog scale. RESULTS: The procedures were carried out on an outpatient basis in 90.5% of the cases, and the mean postoperative hospital stay was 7.2 +/- 0.9 hours. Eight patients required an overnight stay. No postoperative analgesics were required by 27.3% of the patients. Patients requiring analgesics had pain-free intervals lasting 17.3 +/- 11.8 hours after discharge. On the third day after surgery 80% had used no analgesics and over 75% had no pain or only minor pain. On the fourth postoperative day 50% were able to perform activities of daily living without help, and 50% returned to work on the eleventh day after surgery. CONCLUSIONS: The multimodal analgesia-anesthesia treatment proposed allows a high percentage of laparoscopic cholecystectomies to be performed on an outpatients basis. The protocol provides good control of postoperative pain and nausea and rapid return to habitual activity.     

Ambulatory and admitted laparoscopic cholecystectomy patients have comparable outcomes but different functional health status

BACKGROUND: Laparoscopic cholecystectomy is frequently an ambulatory procedure, but some patients are best admitted for a brief hospital stay. In this study, we compared the functional health status, symptoms, and outcomes of patients undergoing ambulatory elective laparoscopic cholecystectomy to those with brief hospital admission. The purpose was to assess patient satisfaction and to identify factors that might assist in selecting patients for ambulatory vs short-stay operations. METHODS: A total of 140 patients scheduled for elective cholecystectomy completed the SF-36 health survey and provided additional information regarding symptoms preoperatively, at 2 months, and at 6 months after operation. RESULTS: All patients had symptomatic gallstones; 76 were admitted to the hospital, and 64 were ambulatory. Admitted patients reported more emotional role limitations on preoperative SF-36. They also reported symptoms of depression more often. Patients in both groups were equally relieved of symptoms of pain, nausea, vomiting, and tenderness. Satisfaction with care was similar for both groups; however, at 2 and 6 months, admitted patients continued to report significantly poorer functional health status than ambulatory patients. CONCLUSION: A reliable, reproducible measure of functional health status, such as the SF-36, may be useful for identifying patients who are appropriate for short-stay hospital admission after laparoscopic cholecystectomy as part of a decision process that tries to optimize outcomes while utilizing resources efficiently.