综合护理干预在全麻显微支撑喉镜下声带息肉摘除患者中的应用

The nursing of patients with vocal cord polyps removed by microscopically supported laryngoscope

目的 探讨全麻显微支撑喉镜下声带息肉摘除术患者在围术期行不同护理模式对治疗效果的影响.方法 选取2012年6月～2017年1月该院拟行全麻显微支撑喉镜下声带息肉摘除术患者56例,依据护理模式的不同分为治疗组和对照组,各28例.对照组采用常规护理模式,治疗组在对照组的基础上采用综合护理干预模式.比较护理干预后两组的手术疗效,采用简易应对方式问卷量表（SCSQ）记录并比较两组患者治疗期间应对方式的转变,采用睡眠自评量表（SRSS）评价两组患者护理干预前后的睡眠质量,采用多维嗓音分析程序系统评价并比较两组患者嗓音声学参数变化,统计并比较两组患者术后并发症的发生情况.结果 治疗组的有效率为92.86％显著高于对照组的71.43％,差异有统计学意义（P〈0.05）;声带息肉消失时间和声带充血肥厚减轻时间均显著短于对照组（P〈0.05或P〈0.01）.护理干预前,两组患者的SCSQ、SRSS评分比较,差异均无统计学意义（均P〉0.05）;护理干预后,两组积极应对方式评分显著升高（P〈0.05或P〈0.01）,消极应对方式评分和SRSS评分均显著下降（P〈0.01）,差异有统计学意义（均P〈0.05或P〈0.01）.护理干预前,两组的嗓音声学参数比较,差异无统计学意义（P〉0.05）;护理干预后,两组的jitter percent、shimmer percent及NHR均显著低于干预前（均P〈0.05或P〈0.01）,且治疗组显著低于对照组（P〈0.05或P〈0.01）.治疗组的并发症发生率为10.71％显著低于对照组的35.71％（P〈0.05）.结论 采用综合护理干预可显著提高行全麻显微支撑喉镜下声带息肉摘除术患者的积极配合度,有助于提高手术疗效,并能进一步改善患者的睡眠质量和嗓音学参数,且并发症少.

Objective To observe the effect of different nursing modes on the therapeutic effect during periop- erative period of patients with vocal cord polyps under laryngoscopy. Methods A total of 56 patients who were planned to have vocal cord polypectomy under general anesthesia self-retaining laryngoscope from June 2012 to January 2017 were selected. The selected patients were divided into treatment group and control group （28 cases each） according to the difference of nursing mode. The control group adopted the routine nursing mode, and the treatment group adopted the comprehensive nursing intervention mode on the basis of the control group. The curative effect of the two groups after nursing intervention was observed and compared. The simple coping style questionnaire （SCSQ） was used to record and compare the changes of coping styles between the two groups. The sleep quality of the two groups was evaluated by the sleep self-rating scale （SRSS）. Multidimensional voice analysis was used to evaluate and compare the acoustic parame- ters of the two groups. The postoperative complications of the two groups were compared. Results The effective rate of the treatment group, 92. 86%, was significantly higher than that of the control group of 71. 43%, and the difference was statistically significant （P〈0. 05）. The time of disappearance of vocal cord polyps and the loss of hypertrophy of the vocal cords were significantly shorter than those of the control group （P〈0. 05 or P〈0. 01 ）. Before nursing inter- vention, the SCSQ and SRSS scores of the two groups were not statistically significant （P〉0. 05）. After nursing inter- vention, the two groups were significantly increased in coping style （P〈0. 05 or P〈0. 01 ）. Both negative coping style and SRSS score significantly decreased （P〈0. 01 ）, and the difference was statistically significant （P〈0. 05 or P〈 0.01 ）. There was no significant difference in acoustic parameters between the two groups before nursing intervention （P〉0. 05 ）. After intervention, the jitter percent, shimmer percent and NHR of both groups were significantly lower than before intervention （P〈0. 05 or P〈0. 01 ）. The treatment group was significantly lower than the contt＇ol group （P〈 0. 05 or P〈0. 01 ）. The complication occurrence rate of treatment was I0. 71%, which was significantly lower than control group that was 35.71% （P〈0. 05）. Conclusions The application of comprehensive nursing intervention can obviously improve the positive degree of adaptability for the patients who have vocal cord polypectomy under general an- esthesia self-retaining laryngoscope, which is more conducive to improve surgical treatment. In addition, it can further improve the sleep quality and voice parameter of patients. Moreover, the complications are fewer, which is worth hav- ing clinical application.