膝关节联合麻醉术后平卧时间与方法的对比研究  

Study for the time of horizontal position and time for patients after knee joint operation under combined spinal epidural anesthesia

作　　者：王欣[1] 韩咲 李亚红[1] 张晓乐[1] 腾爽 

机构地区：[1]北京大学第三医院,北京100191

出　　处：《护士进修杂志》2016年第17期1544-1547,共4页Journal of Nurses Training

摘　　要：目的研究膝关节联合麻醉术后平卧的具体时间、方法以及不同起点计时对患者不良反应和舒适度的影响。方法选取北京市某三级甲等医院运动医学病房联合麻醉下膝关节手术患者420例,按照病房不同将其分为对照组和观察组,每组各210例。其中,观察组又按房间不同分为A组70例、B组70例、C组70例。对照组自患者回到病房后作为起点去枕平卧6 h;观察A组为麻醉拔出硬膜外导管后作为起点去枕平卧6 h,观察B组为麻醉拔出硬膜外导管后作为起点去枕平卧4 h,观察C组为麻醉拔出硬膜外导管后作为起点低枕平卧4 h。采用访谈法和观察法了解两组患者术后不良反应与不舒适情况。结果两组患者尿潴留发生情况差异有统计学意义(P<0.05),对照组更容易发生尿潴留;两组腰背酸痛情况差异有统计学意义(P<0.05),对照组更容易引起腰背酸痛;其他术后不良反应发生率差异无统计学意义;观察组组内比较不良反应的发生率差异无统计学意义(P>0.05);观察组患者坐起前舒适度高于对照组,并且观察组组内舒适度为C组高于A组和B组(P<0.05),但A组和B组间舒适度差异无统计学意义(P>0.05)。结论以麻醉拔管时间作为术后平卧的起点,并适当缩短平卧时间至4 h,采用低枕平卧的方式,不会增加不良反应的发生率,且可提高患者的舒适度。Objective To study the specific time and compare the difference of adverse reactions and comfort degree between two group patients with different beginnings of ＂ horizontal position＂ after knee joint operation under combined spinal epidural anesthesia（ CSEA）. Methods A total of 420 patients from sports medicine ward of a third-grade class hospital in Beijing undergoing knee joint operation under CSEA were selected and divided into two groups,210 cases in each group.The observation group were divided into group A,group B and group C according to the ward,each group has 70 cases. Patients in control group kept 6 hours＇ horizontal position from the time returned to their ward. Patients in observation group A kept 6 hours＇ pillow-free horizontal position from the time after anesthesia extubation,group B kept 4 hours pillow-free horizontal position,and group C kept 4 hours low-pillow horizontal position. By adopting face-to-face interview and observation method,both post-operative adverse reactions and discomforts of the two group patients were compared. Results There were statistical significant difference in terms of uroschesis between the observation group and the control group（ P 〈 0. 05）.There was no statistical difference in terms of the other postoperative adverse reaction between the two groups（ P〉 0. 05）.However,the discomfort degree of observation group cases was lower than that of control group,and the group C was higher than the group A and group B. Conclusion To begin with extubation of anesthesia as the low-pillow horizontal position counting does not increase adverse reactions of patients and could bring patients more comfort.

关 键 词：联合麻醉 膝关节术后 平卧 舒适度 护理 

分 类 号：R473.6[医药卫生—护理学] R687.4[医药卫生—临床医学]