腹腔镜下肾部分切除术后基于风险分级的不同体位干预方法的多中心临床对照研究

目的 探讨腹腔镜下肾部分切除术后基于风险分级的不同体位干预方法.方法 纳入100例行肾部分切除术的患者进行多中心临床对照研究,观察组根据风险分级(DH分级)制定个体化的卧床方案,对照组术后采用传统卧床方式,采用VAS评分评估疼痛发生情况、睡眠影响、躯体不适感及不良心理状态,观察严重出血、压疮、肺部感染、下肢深静脉血栓形成、肾下垂等术后并发症的发生率.结果 观察组患者术后舒适状况评价明显高于对照组.两组患者无需外科干预的出血和肾下垂的发生;肺部感染、下肢深静脉血栓形成、压疮等并发症差异有统计学意义(P<0.05);下床时间和出院时间,对照组低于观察组.结论 基于风险分级(DH分级)的腹腔镜下肾部分切除术后患者的体位管理方法可有效维持患者术后的舒适度,同时可有效控制术后并发症的发生,加速患者术后康复.

Objective To investigate the different position management based on the risk classification after laparoscopic partial nephrectomy.Methods 100 patients who underwent partial nephrectomy at four tertiary A-level hospitals in Zhejiang Province were included in this multi-center study.According to the risk classification,individualized bed rest programs and postural interventions were developed in observation group.Traditional bed rest programs were developed in control group.Visual analogue scales(VAS),used to assess the patient’s postoperative 3-day pain status,sleep impact,physical discomfort,and unhealthy mental status,were recorded.The incidence of postoperative complications such as severe hemorrhage requiring surgical intervention,pressure sores,pulmonary infections,deep venous thrombosis of lower extremities and nephroptosis were observed.Results The postoperative comfort status of the observation group were significantly better than that of the control group.There was no significant difference in the incidence of active hemorrhage between the two groups(P>0.05).There were significant differences in the incidence of pulmonary infection,deep vein thrombosis(DVT)and pressure sores between the two groups(P<0.05),and the control group was significantly higher than that of the observation group.There was no nephroptosis observed in both groups.Conclusion The postoperative position management of laparoscopic partial nephrectomy based on risk classification(DH classification)can effectively maintain postoperative patient comfort.The occurrence of postoperative complications such as severe hemorrhage,pulmonary infections,deep vein thrombosis,pressure ulcers,and renal ptosis can be effectively controlled.Accelerating postoperative rehabilitation can provide the basis for clinical nursing decisions of patients after laparoscopic partial nephrectomy.