胸腔镜下肺癌根治手术的护理体会

Nursing care for thoracoscopic resection for lung cancer

目的探讨关于胸腔镜下治疗肺癌的术前、术中、术后护理方法及其效果。方法选取49例于2012年11月—2014年6月在温州医科大学附属第一医院接受胸腔镜肺癌根治术的患者为研究对象,对患者围手术期进行系统的护理,记录患者手术完成时间、术中出血量、输血量、吸氧时间、拔管时间、住院时间、术后出现并发症情况。结果患者共计49名,经医生和护理人员在手术前、手术中、手术后的治疗和护理,所有患者成功完成手术。平均手术时间为(140±35)min;术后平均吸氧时间为(62.0±10.1)h;胸腔引流管平均拔管时间为(68.0±8.2)h;平均住院时间为(11.5±3.2)d;术中平均失血量为(241±33)ml,1例接受800 ml输血治疗。术后出现并发症8例(16.3%),其中胸腔漏气2例、肺部感染2例、肺不张1例、肺水肿1例、出血1例,1例术后8 d出现呼吸功能衰竭,术后5个月死亡,其余48名患者均痊愈。结论通过对行胸腔镜下肺癌根治术患者系统科学的护理,包括术前教育、围手术期功能训练与准备、术中医护人员密切配合、术后病情监测和康复指导,能够提高手术成功率、缩短住院时间、降低术后并发症,是一种值得推广的护理方法;为了能够使患者获得胸腔镜技术最好的治疗效果,护理人员应当加强学习,在实践工作中不断总结护理经验,为患者提供科学、可靠、优质的护理服务,减轻患者病痛,提高生活质量。

Objective To evaluate the effect of systematic nursing care on the lung cancer patients undergoing video-as- sisted thoracoseopic surgery（VATS）. Methods 49 lung cancer patients underwent VATS in our hospital from January 2009 to January 2011 were enrolled into the study. The systematic perioperative numing care was carried out. The opera- tion time, volume of bleeding, amount of blood transfusion, mechanical ventilator time, time to chest tube extubation, length of stay ,incidence of complications were documented. Results The operations were successful in all 49 cases with an av- erage time of （ 140 ± 35 ） min. The average mechanical ventilator time was （ 62.0 ± 10.1 ） h; time to chest tube extubation was （ 68.0 ± 8.2 ） h, average length of stay was （ 11.5 ± 3.2 ） d, average blood loss was （ 241 ± 33 ） ml. 800 ml of blood was intra-operatively transfused in one case. 8 cases were with postoperative complications （ 16.3% ） ,including 2 cases of aer- othorax ,2 cases of pulmonary infection, 1 case of pulmonary ateleetasis, 1 case of pulmonary edema, 1 case of hemorrhage, 1 case of respiratory failure at d8 after the surgery who died 5 months later. Other 48 patients were cured. Conclusion The systematic nursing care for the lung cancer patients underwent VATS can improve the surgical success rate, shorten the hospitalization time ,reduce the incidence of postoperative complications, which can be applied clinically. The nurses should learn more and summary the experience, and provide science, reliable, high quality nursing service for patients, re- lieve their pain, and improve their quality of life.