围术期标准化肢体锻炼对胸腔镜肺叶切除患者术后上肢功能恢复、疼痛的影响

Effects of perioperative standardized limb exercises on functional recovery and pain in the upper limbs of patients undergoing thoracoscopic pneumonectomy

目的探讨围术期标准化肢体锻炼在胸腔镜肺叶切除患者术后上肢功能恢复、疼痛等各方面指标的影响。方法选取清远市人民医院2019年4—11月共79例进行胸腔镜肺叶切除手术的患者,采用回顾性研究前后对照的方法,2019年4—7月入院的患者为对照组(n=36),2019年8—11月入院的患者为干预组(n=43),对照组按常规护理措施进行护理,干预组在常规护理的基础上实施标准化围术期肢体锻炼,分别比较两组患者术前1 d、术后当日、拔管日、出院日的肩关节外展、后伸及疼痛评分情况,并观察记录。结果两组患者术前1 d肩关节外展(P=0.153)、后伸(P=0.697)、疼痛评分(P=0.084)情况,差异无统计学意义(P>0.05);术后当日、拔管日、出院日的肩关节外展、后伸情况,干预组优于对照组,疼痛评分干预组明显低于对照组,差异有统计学意义(P<0.05)。结论对胸腔镜肺叶切除患者围术期实施标准化肢体功能锻炼,有助于患者患侧肢体术后活动度的恢复,可减轻患者术后肩关节疼痛,值得临床推广。

Objective To investigate the effects of perioperative standardized limb exercises on various indicators of functional recovery and pain in the upper limbs of patients undergoing thoracoscopic pneumonectomy.Methods A total of 79 patients who underwent thoracoscopic pneumonectomy in Qingyuan People's Hospital from April to November 2019 were selected as the study subjects.Based on a retrospective study of before-and-after controls,patients admitted from April to July 2019 were selected as the control group(n=36)and patients admitted from August to November 2019 were selected as the intervention group(n=43).The control group received conventional nursing,while the intervention group received standardized perioperative limb exercises on the basis of conventional nursing.The shoulder abduction,posterior extension and pain scores of patients in both groups were compared 1 day before the operation,on the day of operation,the day of extubation and the day of discharge,respectively,and the comparison results were observed and recorded.Results There were no statistically significant differences between the two groups in shoulder abduction(P=0.153),posterior extension(P=0.697),and pain scores(P=0.084)1 day before the operation(P>0.05).The conditions of shoulder abduction and posterior extension on the day of operation,the day of extubation,and the day of discharge were better in the intervention group than those in the control group,and the pain scores was significantly lower in the intervention group than those in the control group,all with statistically significant differences(P<0.05).Conclusion For patients undergoing thoracoscopic pneumonectomy,the implementation of standardized limb functional exercises in the perioperative period is helpful for the recovery of the mobility of the affected limb and the reduction of shoulder pai n after operation,which is worth promoting clinically.