集束化护理在支撑喉镜CO_2激光显微手术后的应用

Application of Cluster Nursing after Laryngoscope-Aided CO_2 Laser Microsurgery

目的探讨集束化护理在支撑喉镜CO_2激光显微术治疗后的疗效。方法回顾性分析2013年8月到2017年12月,早期声门型喉癌患者132例的临床资料,根据术后护理方法的不同分为两组,对照组患者采取常规护理方法;观察组患者在常规护理的基础上联合集束化护理,每组患者各66例,所有患者均给予支撑喉镜CO_2激光显微手术联合普米克令舒雾化吸入治疗,激光治疗功率3～5 W。两组护理观察时间为14 d,记录两组患者围期手术指标和并发症发生情况。术前1 d与术后14 d,采用频闪喉镜检査进行嗓音声学检查;术后3个月,以中国版头颈部癌生命质量评估量表对患者的生活质量进行评定,比较两种患者的临床疗效。结果 132患者顺利完成治疗,两组患者手术时间、术中出血量比较差异无统计学意义(P>0.05),观察组术后住院时间显著少于对照组(P<0.05)。观察组并发症发生率为4.5%,对照组为19.7%,两组比较差异具有统计学意义(P<0.05)。两组患者术后14 d基频和基频微扰值显著高于术前,观察组的升高幅度低于对照组(P <0.05)。术后3个月,观察组患者生存质量高于对照组(P<0.05)。结论在普米克令舒雾化吸入联合支撑喉镜CO_2激光显微手术治疗喉癌术后应用集束化护理,可加快患者的康复速度,降低并发症发生率,增强其嗓音功能,提升患者生活质量,此护理方法值得临床推广。

To investigate the application of cluster nursing after laryngoscope-aided CO2 laser microsurgery.Methods A retrospective study was made on 132 patients of early glottic carcinoma given pulmicort respules inhalation plus laryngoscope-aided CO2 laser microsurgery from Aug.2013 to Dec.2017.They were selected randomly and divided into the observation group(66 patients)and control group(66 patients)by postoperative nursing methods.The patients in the control group were given routine nursing after the operation,and those in the observation group cluster nursing in addition to routine nursing.The observation on the effect of the nursing lasted for 14 d for both groups.Results The treatment was completed successfully on all the patients.No significant difference in operative time or intraoperative blood loss was observed between the two groups(P>0.05).The postoperative hospitalization time in the observation group was significantly less than that in the control group(P<0.05).The postoperative 14 d incidence of complications such as dyspnea,mucous edema and functional impairment was 4.5%in the observation group and 19.7%in the control group,indicating a difference that was statistically significance(P<0.05).For both groups,the FO and Jitter values on the 14 th day after the operation were significantly higher than those on the day before the operation,but the increased values in the observation group were less than those of the control group(P<0.05).Three months after the operation,the physiological,social and familial,emotional,functional scores and health status of the observation group were significantly higher than those of the control group(P<0.05).Conclusions Postoperative cluster nursing will promote the rehabilitation of the patients given pulmicort respules inhalation plus laryngoscope-aided CO2 laser microsurgery,reduce incidences of various complications and improve their voice functions and living quality.