胸腔镜下肺癌根治术的护理配合

Nursing coordination of lung resection under thoracoscopy

目的：探讨胸腔镜下行肺癌根治术的护理体会，为减少并发症、提高患者生活质量提供有益参考。方法选择胸外科2012年1—12月72例肺癌患者，采用随机数字表法分为干预组和对照组各36例。对照组采用常规护理方法，干预组在术前访视、手术介绍、放松训练、手术体位训练、手术室护理、术中护理和术后护理等方面开展细致化和人性化的护理工作。在患者入院后和术后7 d，采用欧洲癌症研究与治疗组织（ EORTC ）生活质量核心量表QLQ-C30对患者进行调查。结果干预组住院时间为（10．2±1．8）d，拔管时间为（56．3±7．6）h，对照组分别为（17．4±3．9）d，（64．9±8．1）h，两组比较差异有统计学意义（t值分别为－10．057，－4．646；P＜0．05）。干预组吻合口渗血发生率为0．0％，肺漏气发生率为2．8％，对照组分别为11．1％，8．3％，差异无统计学意义（χ2值分别为1．014，0．158；P＞0．05）。入院时两组患者的生活质量及症状评分差异无统计学意义（P＞0．05）。治疗后两组患者总体健康状况及功能维度中的情绪、认知、社会维度比较差异有统计学意义（ t值分别为2．109，2．547，2．047，2．141；P＜0．05）。结论在胸腔镜下行肺癌根治术的围术期进行良好的护理配合，可以减少并发症的发生，对患者的康复至关重要。

Objective To discuss the nursing care experience of lung resection under thoracoscopy in order to provide a useful reference for reducing complications and improving quality of life for patients. Methods Totals of 72 patients with lung cancer were selected from January to December 2012 and divided into the intervention group and the control group, with 36 patients in each. The control group used conventional care methods, and the intervention group had more detailed and humane care in the perspectives of preoperative visiting, operative reports, relaxation training, postural training, operating room care, surgery care, postoperative care and so on. After admission and 7 days after surgery, the Quality of Life Scale-C30 （ QLQ- C30） was used to carry out the investigation. Results The hospital stay of patients in the intervention group was （ 10.2±1.8） days, the extubation time was （56.3 ±7.6） hours, which were significantly lower than （ 17.4±3.9） days and （64.9±8.1 ） hours in the control group （ t = - 10. 057, - 4. 646, respectively; P 〈 0.05 ）. The rates of anastomotic bleeding and pulmonary air leaks were O. 0% and 2.8% in the intervention group and 11.1% ,8.3% in the control group, respectively, which had no statistically significant differences （X2 = 1. 014,0. 158, respectively;P〉0.05）. The quality of life and symptom scores of two groups in the time of admission had no statistically significant differences. After the treatment, the overall health status, role, emotion, cognition, society of patients in the intervention group and control group were statistically significant （ t = 2. 109, 2. 547, 2. 047, 2. 141, respectively; P 〈 0.05 ）. Conclusions Good nursing care in the periods of lung resection under thoracoscopy can reduce the rate of complications which is critical to patients ＇ recovery.