腺样体肥大两种手术方式术后护理的临床观察

Clinical Observation and Postoperative Nursing of Two Methods of Adenoidectomy

目的总结123例腺样体肥大患者的两种不同手术方式的术中、术后的护理观察,来评价两种手术方式的特点。方法对123例患者按照时间段分别采用两种不同的手术方式进行治疗,其中2016年11月8日至2017年9月22日的时间段采取传统的腺样体刮除术28例(传统组);2017年9月23日至2019年12月28日采用鼻内镜下腺样体等离子消融术95例(等离子组);统计两组手术的治疗效果、腺样体残留率、手术时间、手术时出血量、术后出血和疼痛的并发症等。比较两种手术方法的优缺点。结果传统组的手术有效率为100%,等离子组的手术有效率为100%;手术残留率传统组为64.29%,等离子组为0%;手术时间的比较上传统组与等离子组无差异;术中出血量传统组较多,平均约23.52ML,等离子组出血很少,平均约2.23 ML。术后出血传统组1例,量约2~11 ML,仅一例应用膨胀海绵填塞。等离子组术后出血3例,局部滴药停止,未用填塞。术后疼痛评分,传统组疼痛评分为3~6分,等离子组为1~3分。结论在2017年以前我们没有等离子手术器械,只能用传统的手术方法,在2017年9月23日引进等离子手术器械后采用等离子腺样体消融术,传统方法因为残留率高、出血量多、术后疼痛重的问题已经摒弃。等离子腺样体消融术手术时间略短、出血少或基本不出血、术后疼痛轻,但价格略贵,因为手术的优点,得到患者家长的好评。

Objective To summarize the nursing observation of 123 patients with adenoid hypertrophy during and after operation who underwent two different operation methods,and to evaluate the characteristics of the two operation methods.Methods 123 patients were treated with two different surgical.Methods according to the time period,among which 28 patients were treated with traditional adenoidectomy from November 8,2016 to September 22,2017(the traditional group);95 patients were treated with adenoidectomy under nasal endoscope from September 23,2017 to December 28,2019(the plasma group);the therapeutic effect and adenoid residual rates,operation time,amount of bleeding during operation,complications of bleeding and pain after operation,of the two group were statistically analyzed.The advantages and disadvantages of the two methods were compared.Results The efficacy of the traditional operation group was 100%,the efficacy of the plasma operation group was 100%;the operation residual rate of the traditional group was 64.29%,the plasma group was 0%;the operation time between the traditional group and the plasma group had no difference;the amount of intraoperative bleeding in the traditional group was more,with an average of about 23.52 ml,while the plasma group had little bleeding,with an average of about 2.23ml.In the traditional group,only one case was applied with expanded sponge.In the plasma group,1 cases suffered bleeding,which was controlled by nasal administration,and no packing was used.The postoperative pain score was 3-6 in the traditional group and 1-3 in the plasma group.Conclusions Before 2017,we didn’t have plasma surgical instruments,so we can only use traditional surgical methods.After the introduction of plasma surgical instruments on September 23,2017,the traditional methods have been abandoned because of the problems of high residual rate,large amount of bleeding and severe postoperative pain.The operation time of plasma adenoidectomy is a little shorter,with little or no bleeding,and the postoperative pain is light,but the price is a little expensive.Because of the advantages of the operation,it is well received by the parents of the patients.