机器人手术护理管理初探

Nursing management on robotic surgeries

以达芬奇机器人系统为代表的微创外科技术的出现改变了以往的手术常规格局,颠覆了传统外科观念。结合机器人手术系统和医院手术室的特点,本护理团队以手术护理小组的形式在术前对每位患者制定操作流程,并对术中出现的护理问题进行记录,在术后对术前制定的护理操作流程进行讨论、修改,这样周而复始,不断对护理操作流程进行改进,直至制定出护理常规。针对后期机器人系统24h不停机的运行模式,本护理团队采用了“导师制”的培训和考核模式,保证了带教质量;结合护理实践,本护理团队设计了头高足低位上胸部抬高斜坡垫和侧卧位上肢分隔约束袋的体位安置方式,但临床使用效果有待进一步验证。在细节管理方面,本团队采用每日记录护理问题、每周进行讨论的方式,针对出现的相关护理问题进行总结分析,及时修订护理配合常规以保障手术的安全运行。

The emergence of minimally invasive surgical technology represented by Da Vinci robotic surgical system has changed the conventional surgery and traditional surgical concept. Operative procedures is made by our nursing team before surgery based on characteristics of robotic surgery system and operating room. Intraoperative nursing problems are recorded and operative procedures made for each patient are discussed and adjusted before surgery. Nursing procedures are continuously discussed and adjusted for nursing process optimization until the nursing routine is formed. Considering the 24 h non-stop operation mode of robotic surgical system in the later period, the nursing team adopted our training and assessment mode of “mentor system”to guarantee the teaching quality. The upper chest elevation with slope pad and the lateral upper limb separating-restraint bag under dorsal elevated position is designed by our nursing team and good results achieved, but the clinical effect needs to be further studied. In terms of management, nursing problems are recorded daily and discussed every week. The safety and effectiveness of robotic surgery is guaranteed by timely summarizing relevant nursing problems and adjusting the nursing procedures.