手术体位护理对女性甲状腺切除术生理功能及舒适度影响

Influence of surgical body position nursing care on physiological function and comfort in women treated by modified transthoracic endoscopic thyroidectomy

目的围术期改良手术体位护理方案对经胸乳径路腔镜女性甲状腺切除术患者生理功能及舒适度的影响。方法行腔镜下甲状腺切除术的女性患者90例为研究对象，数字表法随机分为对照组和研究组，各45例。对照组采取常规仰卧位；研究组实施围手术期改良手术体位方案，包括术前2d适应性体位训练、术中改良截石位联合应用头部u型垫与楔型肩背垫、术后及时体位指导等；手术时间为切开皮肤至缝合皮肤结束截止；术中监护仪分别在气管插管后气腹前（T0）、气腹后体位改变前（T1）、体位改变后20min（T2）连续监测HR、SBP、DBP、SpO2、Ppeak、PETCO，等参数值；术后72h回访采用本院自制调查问卷评价术后身体及四肢舒适度并记录相关不良反应。结果T2时研究组SBP、DBP、Ppeak、PETCO2分别为（95．6±7．6）mmHg（1mmHg=0．133kPa）、（61．5±8．1）mmHg、（15．2±1．3）cmH2O（1cmH20=0．098kPa）、（32．0±1．6）mmHg，明显低于对照组（111．8±12．7）mmHg、（72．6±10．3）mmHg、（20．8±5．5）cmH2O、（34．8±3．5）mmHg，SpO2为（95．2±2．3）％，高于对照组的（90．8±2．0）％，差异均有统计学意义（均P〈0．05），且气腹后SBP、DBP、HR、Ppeak、PETCO2各项差值的变化均小于对照组，但差异均无统计学意义（均P〉0．05）。研究组手术时间平均为（66．08±14．37）min，明显短于对照组的（86．28±25．12）min，且术后总舒适率100．0％，不良反应发生率为0，分别较对照组的51．1％、46．7％有明显优势。结论女性经胸乳径路腔镜甲状腺切除，通过术前评估、体位改良放置、个体垫特异性使用及术后细节健康指导等环节监控，有效缩短手术进程，使术中肢体处于功能位，将对呼吸循环等生理功能的影响降至最低，避免伤口愈合不良，保证术中及术后安全舒适，提高术后生存质量，利于康复，值得进一步推广。

Objective To explore the influence of modified perioperative body position nursing care plan on physiological function and comfort in women treated by transthoracic endoscopic thyroidectomy. Methods 90 women treated by thyroidectomy were selected as study objects and were randomly divided into a control group and a study group, 45 for each group. The control group took regular supine position. The study group took modified perioperative body position plan： doing preoperative adaptive position training 2 days before operation, took modified lithotomy position and using u-shaped head pad and wedge shoulder pad during operation, and timely position guidance after operation. The operation time started from skin incision to skin suture. After endotracheal intubation and before pneumoperitoneum （ T0 ） , after pneumoperitoneum and before position change （ T1 ） , and 20 min after position change （ T2 ） , the HR, SBE DBE SpO2, Ppeak, and PETCO2 were continuously monitored, of parameter values. Self-made questionnaires was used to evaluate the postoperative body and limb comfort and the related adverse reactions were record. Results At T2, the SBP, DBP, Ppeak, and PETCO2 were obviously lower, the SpO2 was higher, and the operation time was shorter in the study group than in the control group [ （ 95.6±7.6 ） mmHg （ 1 mmHg = 0.133 kPa ） vs. （ 111.8±12.7 ） mmHg, （ 61.5±8.1 ） mmHg vs. （ 72.6±10.3 ） mmHg, （ 15.2±1.3 ） cmH2O （1 cm H2O=0.098 kPa） vs. （ 20.8±5.5 ） cmH2O, （ 32.0±1.6 ） mmHg vs. （ 34.8±3.5 ）mmHg, （ 95.2±2.3 ）% vs. （ 90.8±2.0 ）%, and （ 66.08±14.37 ） vs. （ 86.28±25.12 ）] （ P 〈 0.05 ）. The total comfort rate and the incidence of adverse reactions were 100.0% and 0 in the study group and were 51.1% and 46.7% in the control group. Conclusions For women treated by modified transthoracic endoscopic thyroidectomy, preoperative evaluation, modified position, individual pad specific use, and postoperative health guidance can effectively shorten the operation process, make mtraoperative body in functional position, minimize the influence on physiological function, such as respiratory cycle, avoid poor wound healing, ensure intra- and post-operative safety and comfort, and improve postoperative survival quality and is conducive to rehabilitation, so it is worth being further generalized.