保留盆腔神经子宫广泛性切除术患者早期康复护理探讨

Early rehabilitation and nursing of patients undergoing nerve-sparing radical hysterectomy

目的:初步探讨保留盆腔神经的子宫广泛性切除术配合早期多种膀胱功能康复锻炼对促进患者早期自主排尿的护理效果。方法:选择2009-2011年间收治Ib1-IIa期子宫颈癌进行手术的患者共61例,其中28例行保留盆腔神经子宫广泛性切除术(Nerve-sparing Radical Hysterectomy,NSRH),33例行传统的子宫广泛性切除术(Nerve-sparing Radical Hysterectomy,RH)。RH组进行常规护理,NSRH组除常规护理外,实施早期盆底肌功能锻炼、术后持续膀胱冲洗结合间断性夹管刺激膀胱容量反射的冲洗方法、下肢功能锻炼及自主排尿训练,观察NSRH和RH术后对膀胱功能恢复的影响。结果:NSRH组术后留置膀胱造瘘管时间为(12.4±5.2)d,与RH组(22.4±9.7)d差异有统计学意义(P<0.05)。术后3周随访患者排尿满意度,NSRH组为100%,RH组为54.5%,差异均有统计学意义(P<0.05)。结论:保留盆腔神经子宫广泛性切除术配合早期多种膀胱功能锻炼,能促进膀胱功能的早期恢复、提高排尿满意度、降低并发症的发生率。

Objective To Preliminarily explore the nursing effect of nerve--sparing radical hysterectomy combined with various exercises of bladder function on the stimulation of early automatic micturition of the patients. Methods Sixty--one patients with Ibl--IIa--stage cervical carcinoma admitted to hospital from 2009 to 2011 were selected,28 un- dergoing nerve--sparing radical hysterectomy （NSRH）,33 undergoing conventional radical hysterectomy （RH）. Rou- tine nursing was conducted for both groups,while early functional exercise of pelvic floor muscles, postoperative con- tinual bladder irrigation combined with intermittent clip pipe stimulating bladder capacity reflection,lower limb function exercise and automatic mieturition training were also taken in NSRH group. Effects of NSRH and RH on postoperative recovery of bladder were observed. Results Indwelling bladder fistula after operation in NSRH group was （12.4±5.2） d, which was statistically different from that in R H group （22.4±9.7）d. Three weeks after the operation the patients were followed up in mieturition satisfaction, which was 100 % for NSRH group and 54.5 % for RH group,with a statistical difference. Conclusion NSRH combined with various exercises of bladder function can promote the early recovery of bladder function,improve urination satisfaction and reduce the incidence of complications.