应用人体工程学原则关注腹腔镜手术中的护理问题

Using Ergonomic Principle to Focus on Nursing Problems in Laparoscopic Surgery

人体工程学是研究"人-机-环境"系统中人、机和环境三大要素之间的关系,为系统中的人的效能、健康问题提供理论与方法的学科,被应用到外科尤其是微创腔镜手术中。微创腔镜手术配合中,在效果效率与手术者安全舒适之间建立一个可接受的平衡是手术护士必须思考的问题。腹腔镜手术中有关人体工程学的护理问题包括:显示器位置。手术间的腔镜主机的位置很多时候是固定不变的,很大程度上决定了手术医生的身体姿势。有时候由于助手的遮挡,医生不得不身体前倾来观察显示器。同时监视器高度不可调节(仪器车上固定),所以不能适应不同外科医生的需要。腹腔镜手术医生工作姿势不当会导致疲劳。在进行腔镜手术时,手术医生直立在患者前面,头部向前弯曲微微点头,头部和颈部长时间弯曲会带来颈部肌肉紧张和疼痛,因此这是我们应该关注的问题。为了完成切开、抽吸和冲洗等操作,主刀医生不仅要掌握、定位手术器械,还需要同时配合脚踏开关使得医生不得不在单腿站立的姿势下完成手术。腹腔镜手术室内的一些布局不符合人体工程学的原则,手术护士关注到腹腔镜手术间工程学问题,兼顾手术医生的操作舒适性,提高手术效率。

Ergonomics is a discipline which studies the relations between human, machine and environment. The purpose of this discipline is to provide theories and methods for effectiveness, health problems happened to human in the“human-machine-environment” system. This discipline is applied to surgery especially to minimally invasive endoscopic surgery. To establish a balance between the efficiency, effectiveness of operation and the safe and comfort of patients in the cooperation of minimally invasive endoscopic surgery is a problem that operating nurses must think about. The nursing problems related to laparoscopic surgery include the position of display. Most often, the position of endoscopic host computer was is fixed and largely determined determines the body posture of operating surgeon. Sometimes, the operating surgeon has to lean forward to observe the display because the assistant obstructs the view of the surgeon. At the same time, the height of monitor is unadjustabl（fixed on instrument truck）, so it cannot meet the needs of different surgeons. Improper body posture of operating surgeon can result in fatigue. During the operation, the operating surgeon stands upright in front of the patient, with his head bending forward and nodding slightly. However, the long time bending of head and neck may result in muscular tension and pain. So, this is a problem we need to focus on. In order to complete incision, aspiration and irrigation, the operating surgeon not only need needs to grasp and position surgical instruments, but also need needs to coordinate with foot switch, which makes the surgeon complete the operation, standing on one leg. Some layouts of laparoscopic operation room don’t conform to ergonomic principle. Operating nurses have focused on ergonomics problems of laparoscopic operation room and given consideration to operation comfort, improved operation efficiency.