全麻鼻内镜下行鼻窦开放术后早期改良卧位的效果观察

Study on effects of early improved decubitus of general anesthesia downlink sinus endoscope operation

目的：探讨全麻鼻内镜下行鼻窦开放术后早期改良卧位的效果。方法选取2014年9月至2015年5月在我院鼻科收治的鼻窦开放术患者106例,采用随机数字表法分为对照组54例和实验组52例。对照组采用我院鼻科全麻鼻内镜下鼻窦开放术后卧位,即全麻术后去枕平卧4h后改半卧位；实验组采用术后早期半卧位,即全麻术后评估后（患者意识清楚,能够正确回答问题）给予床头抬高40度。比较两组患者术前及术后4h内血压、心率、呼吸、血氧饱和度情况,以及术后4h鼻腔血性分泌物渗出量、伤口疼痛及总体不适感情况。结果两组患者术后4 h内的平均收缩压、舒张压、心率、呼吸、血氧饱和度比较,差异均无统计学意义（t值分别为-1.834,-0.071,-0.144,-0.813,-0.818, P〉0.05）；两组患者术后4 h 伤口疼痛状况比较,差异无统计学意义（Z=-0.572,P〉0.05）；实验组患者术后4 h鼻腔血性分泌物渗出量明显优于对照组,差异有统计学意义（Z=-2.014,P〈0.05）；实验组患者术后4 h总体不适感较对照组明显减轻,差异有统计学意义（Z=-2.270,P〈0.05）。结论全麻鼻内镜下行鼻窦开放术后患者采用早期半卧位,对患者术后的收缩压、舒张压、心率、呼吸、血氧饱和度、鼻腔伤口疼痛无明显影响,有利于患者术后鼻腔分泌物排出、降低患者总体不适感、提高护理质量,增加了患者舒适度。

Objective To discuss the effects of early improved decubius of general anesthesia downlink sinus endoscope operation. Methods A total of 106 cases of patients who received nasal sinus open surgery in a certain hospital in Beijing from September 2014 to May 2015 were randomly divided into a control group and an experimental group according to the random number table method, 54 cases in the control group and 52 cases in the experimental group. The control group adopted recumbent position after general open nasal endoscopic sinus surgery of our hospital （ changing to semirecumbent position after 4 hours＇ prostration without pillow）. The experimental group adopted semirecumbent position at the early stage after surgery （ the head of bed was elevated for 40 degrees after the postoperative evaluation for general anesthesia, patients with clear consciousness are able to correctly answer questions ） . The blood pressure, heart rate, breathing and blood oxygen saturation of the two groups 4 hours before and after the operation were compared. The nasal hemorrhagic secretions seepage quantity, wound pain and general discomfort of the two groups 4 hours after operation were compared. Results There were no statistical significances in terms of the comparison of the mean systolic pressure, diastolic blood pressure, heart rate, breathing and bl0od oxygen saturation of the two groups 4 hours after operation （t value respectively -1. 834, -0. 071, -0. 144, -0. 813, -0. 818, P〉0. 05）. There were no statis- tical significances in terms of the wound pain condition 4 hours after operation （Z=-0. 572, P〉0.05）. The seepage quantity of nasal bloody secretions of the experimental group 4 hours after operation was better than that of the control group, and the difference was statistically significant （Z =-2. 014, P〈0.05）. The discomfort of the experimental group＇s patients 4 hours after operation was obviously reduced compared with the control group, and the difference was statistically significant （ Z = - 2. 270, P 〈 0. 05 ） . Conclusions The early improved decubitus of general anesthesia downlink sinus endoscope operation proved no obvious effect On patients＇ systolic pressure, diastolic blood pressure, heart rate, breathing, blood oxygen Saturation and nasal wound pain, but it is helpful for discharging the nasal secretions, reducing overall discomfort of patients, increasing patients＇ comfort and improving the quality of nursing.