腰椎髓核摘除病人术前禁食禁水及舒适度的分析

The Effects of Preoperative Fasting and Water Deprivation on Comfort of Patients Undergoing Percutaneous Lumbar Discectomy

目的研究腰椎管开窗减压及髓核摘除术前实际禁食禁水时间及其对机体舒适的影响。方法采用方便抽样选择120例病人,调查术前实际禁食禁水时间、术前口渴、焦虑、饥饿主观评分,以及术中有无恶心、呕吐及误吸。结果(1)实际禁食时间中位数为13h,四分位间距为10h,长于常规要求(禁食12h),差别有统计学意义(Wilcoxon检验,W=1540.00,P<0.01)。实际禁水时间中位数为4h,四分位间距为8h,长于常规要求(禁水4h),差别有统计学意义(Wilcoxon检验,W=946.00,P<0.01)。均未发生术中误吸。(2)120例病人均存在不同程度的不适,70%口渴评分>4分,44%感觉饥饿,90%出现明显焦虑。禁水与焦虑之间呈正相关,rS=0.25,P=0.00。术前不当禁水可能比不当禁食更容易导致机体不适。结论术前过度延长禁食、禁水时间可以导致机体舒适的改变,禁水对于舒适的影响更为明显。护士应正确指导和督促病人按要求禁水,以减少过度禁水引起的机体不适。

Objective To investigate the effects of preoperative fasting and water deprivation on comfort of patients undergoing pereutaneous lumbar diseeetomy. Methods One hundred and twenty patients who undergoing elective surgery of percutaneous lumbar discectomy were selected in our hospital by convenient sampling. The patients were investigated about their duration of fasting, thirst, anxiety, hunger before operation, and nausea, vomiting and mistaken aspiration during operation. Results （1）The median of practical fasting duration was 13 h, with the spacing 10 h, which was significantly longer than the routine duration （fasting for 12 h） by Wilcoxon test, W=1 540.00, P〈0.01）. The median of water deprivation duration was 4 h, with the spacing 8 h, which was significantly longer than the routine duration （fasting for 4 h） by Wilcoxon test, W=946.00, P〈0.01）. No mistaken aspiration was found. （2）Discomfort was found in all the patients in different degree： 70% of them were graded more than 4 in thirsty; 90% developed obvious anxiety. Water deprivation was positive related to anxiety （n=0.25, P=-0.00）. Improper water deprivation might be easier to cause body discomfort than improper fasting before operation. Conclusion The prolonged fasting and water deprivation can lead to changes of body＇s comfort, and the latter had larger influence on comfort. Nurses should instruct correctly and supervise patients on water deprivation in line with the requirements to avoid the body＇s discomfort resulting from over-duration of water deprivation.