改良体位对乳腺手术过程及效果的影响

Influence of improved posture during breast surgery on the implementation process and effect of the operation

目的分析改良体位对乳腺手术过程及效果的影响。方法选择2019年1月至2021年1月接受乳腺手术治疗的86例患者作为研究对象,按数表法将其分为对照组与观察组,每组43例。对照组患者在手术治疗过程中采取常规仰卧位;观察组患者则将腋窝抬高,使腋后线、头顶部均与床边缘对齐,医护人员在手术操作过程中适当调整操作位置、方式。对2组手术实施过程中的相关指标(手术时间、术中出血量、无影灯调节次数)、术后并发症发生率、肩关节活动度及其达标率进行比较。结果对照组的手术时间长于观察组(t=3.340,P<0.05),其术中出血量、无影灯调节次数均多于观察组(t=2.752、t=3.263,P<0.05);对照组术后并发症发生率高于观察组,肩关节活动度达标率低于观察组(χ^(2)=5.460、χ^(2)=4.914,P<0.05);2组术后1天肩关节活动度无明显差异(P>0.05),术后2个月,对照组肩关节的前屈、外旋、内收、内旋、外展、后伸的活动度均小于观察组(t=2.985、t=2.760、t=3.506、t=2.988、t=3.630、t=2.246,P<0.05)。结论对于采用乳腺手术治疗者,术中对其进行改良体位指导可以缩短手术时间,减少术中出血量及无影灯调节次数,并降低术后并发症发生率,有利于患者肩关节功能的恢复。

Objective To analyze the influence of improved posture during breast surgery on the implementation process and effect of the operation.Methods A total of 86 patients who received breast surgery in our hospital from January 2019 to January 2021 were selected as the research objects.They were randomly divided into the control group and the observation group according to the table method,with 43 cases in each group.Patients in the control group were guided to take the conventional supine position during the surgical treatment.In the observation group,the armpit of the patient was raised so that the posterioRaxillary line and the top of the head were aligned with the edge of the bed,and the medical staff properly adjusted the operation position and mode during the operation.The operation-related indexes(operation time,blood loss during operation,adjustment times of shadowless lamp),postoperative complication rate,shoulder joint mobility and compliance rate were compared between the two groups.Results The operation time of the control group was significantly longeRthan that of the observation group(t=3.340,P<0.05),and the amount of bleeding and adjustment times of shadowless lamp were more than those of the observation group(t=2.752 and t=3.263,respectively;P<0.05).The incidence of postoperative complications in the control group was significantly higher than that of the observation group,while the standard rate of shoulder joint mobility was significantly lower than that of the observation group(χ^(2)=5.460 andχ^(2)=4.914,respectively;P<0.05).There was no significant difference in the range of motion between the two groups on the first day after operation(P>0.05).Two months after operation,the range of motion of shoulder flexion,external rotation,adduction,internal rotation,abduction and extension in the control group was significantly smalleRthan that of the observation group(t=2.985,2.760,3.506,2.988,3.630 and 2.246,respectively;P<0.05).Conclusion Intraoperative guidance of the improved posture during breast operation can shorten the operation time,and reduce the amount of intraoperative bleeding,adjustment times of shadowless lamp and the incidence of postoperative complications,which is beneficial to the recovery of shoulder joint function.