骨水泥机械手与手推注射法经皮椎体成形术的护理观察

Nursing observation on percutaneous vertebroplasty via bone cement Manipulator and hand-push injection

目的 总结骨水泥机械手与手推注射法在经皮椎体成形术中的护理观察。方法 选择2014年10月～2015年11月我院45例PVP病例根据随机原则分为应用手推法注射22例和骨水泥机械手23例,观察手推注射法、骨水泥机械注射法术中骨水泥渗漏发生例数、骨水泥的注射总时间、操作者的X线下暴露时间、术后2 d进行疼痛视觉类比评分（VAS）,两种注射方法患者的心理、机体反应及医护患配合要点。结果 两组患者心身反应良好,术中均无骨水泥渗漏发生,注射总时间手推法（3.5±0.6）min,机械手（4.8±0.7）min,注射总时间差异有统计学意义（t=2.97,P〈0.05）;术者暴露时间手推法（4.8±0.8）min,机械手（1.9±0.4）min,t=15.48,两组术者暴露时间比较,差异有统计学意义（P〈0.05）;术后2 d疼痛视觉类比评分,手推法（2.2±1.2）,机械手（1.9±0.8）,差异无统计学意义（t=1.27,P〉0.05）。两组病例注射操作均达预期效果。手推法注射属于近台操作,对患者的心理支持较好;机械手注射属于遥控操作,有利于精准控制注射时间、剂量及注射过程监控观察。结论 做好医患沟通,医护配合,医护患三者协作,机械手代替传统手推法注射骨水泥符合医疗技术智能化的发展要求,也有利于减少术者的X线辐射剂量。医护患三方均能从中获益。

Objective To summarize the nursing observation on percutaneous vertebroplasty via bone cement manipula- tor and hand-push injection. Methods 45 PVP cases treated in our hospital from October 2014 to November 2015 were randomly treated by hand-push injection （22 eases） and manipulator （23 cases）. The incidence of bone cement leakage, total time of bone cement injection, exposure duration under X-ray of the operator, and visual analogue scale （VAS） at 2d after operation in hand-push injection group and manipulator group were observed. The psychological and physical reaction, and cooperation of doctors, nurses and patients were compared. Results The psychological and physical reac- tions of patients in two groups were favorable. There was no leakage of bone cement during operation. The overall time of injection was （3.5±0.6）rain in the hand-push injection group, and （4.8±0.7）min in the manipulator group. There was significant difference in injection time between two groups（t=2.97, P〈0.05）. The exposure duration was （4.8±0.8）min in the hand-push injection group, and （1.9±0.4）min in the manipulator group（t=15.48）, which showed significant difference between two groups （P〈0.05）. The VAS at 2d after operation was （2.2±1.2） in the hand-push injection group, and （1.9± 0.8） in the manipulator group （t=1.27）,which showed no significant difference （P〉0.05）. Expected effect was obtained in both groups after injection. Hand-push injection was a kind of close-table operation, providing better psychological support for patients; while manipulator was a kind of remote operation, having advantages in precise control of injection time and dose, and monitoring of injection process. Conclusion With good doctor-patient communication, and coopera- tion between doctor and nurse, application of manipulator instead of hand-push injection of bone cement conforms to the requirement of intelligentization of medical technology, and facilitate reduction of X-ray exposure, which benefits doctors, nurses and patients at same time.