胸腔镜下肺癌根治术患者围麻醉期舒适化医疗程序的探讨  

Investigation of the Soochow University model of comfortable medical procedures during peri-anesthesia period for patients undergoing radical resection of lung cancer through thoracoscope

作　　者：陆香红[1] 嵇富海[1] 刘思兰[1] 常小兰[1] 潘爱芬[1] 蒋芳琴[1] 张新梅[1] Lu Xianghong;Ji Fuhai;Liu Silan;Chang Xiaolan;Pan Aifen;Jiang Fangqin;Zhang Xinmei(Department of Anesthesiology,the First Affiliated Hospital of Soochow University,Suzhou 215006,China)

机构地区：[1]苏州大学附属第一医院总院麻醉手术科,苏州215006

出　　处：《中华老年医学杂志》2020年第4期424-429,共6页Chinese Journal of Geriatrics

基　　金：国家自然科学基金(81471835);江苏省医学创新团队(CXTDA2017043);苏州市科研基金(LCZX201603)。

摘　　要：目的:构建胸腔镜下肺癌根治术患者围麻醉期舒适化医疗程序的苏州大学模式。方法:随机对照研究,选择2018年苏州大学附属第一医院全麻下行胸腔镜下肺癌根治术的手术患者共860例,采用随机数字表法分为常规组(C组,430例)和舒适化组(S组,430例),分别给予围麻醉期常规服务或舒适化服务。记录拔管后5 min(T1)、出麻醉术后恢复室(PACU)时(T2)、术后1 h(T3)、术后6 h(T4)、术后12 h(T5)、术后24 h(T6)、术后2 d(T7)和术后3 d(T8)两组患者的疼痛评分(VAS)、镇静评分(RASS)和口渴评分(TAS),并分别观察T2、T6和T8时患者术后咽喉痛视觉模拟(POST)、恶心呕吐(PONV)、尿路刺激感(CRBD)、口渴和低体温的发生率;同时,在T6和T8完成患者舒适度评分(PCQ)和围麻醉期满意度问卷的调查。结果:T2C组和S组POST(48.6%和16.2%)、PONV(24.9%和13.0%)、CRBD(78.8%和20.9%)和口渴(74.9%和20.0%),C组T2时的发生率均高于S组(均P<0.05);C组的舒适度得分和满意度得分、T6(3.14±1.04)分和(4.92±1.42)分、(2.67±0.89)分和(3.30±1.01)分、T8(3.84±1.83)分和(5.05±1.77)分、(2.74±0.84)分和(3.26±1.06)分,均低于S组(均P<0.05)。结论:成功构建了胸腔镜下肺癌根治术患者围麻醉期舒适化医疗程序的苏州大学模式,降低了患者围麻醉期并发症的发生率,提高了患者围麻醉期的舒适度和满意度。Objective To construct a Soochow University model of comfortable medical procedures during peri-anesthesia period for patients undergoing radical resection of lung cancer through thoracoscope.Methods In this prospective study,eight hundreds and sixty patients undergoing radical resection of lung cancer through thoracoscope were enrolled in our hospital in 2018.During peri-anesthesia period,the 860 patients were randomly(by the random number table method)divided into the control group(the group C receiving routine medical procedures,n=430)and the comfort group(the group S receiving the comfortable medical procedures of Soochow University model,n=430).The scores of Visual Analogue Scale(VAS),Richmond Agitation-Sedation Scale(RASS),and Thirsty Analogue Scale(TAS)were recorded at 5 min after extubation(T1),at out of the post-anesthesia care unit(T2),at 1 h(T3),6 h(T4),12 h(T5),24 h(T6),2 d(T7)and 3 d after surgery(T8)in two groups.The incidences of postoperative sore throat(POST),nausea and vomiting(PONV),catheter-related bladder discomfort(CRBD),thirst and hypothermia were recorded at T2,T6 and T8,respectively.Meanwhile,the peri-anesthesia comfort questionnaire(PCQ)and peri-anesthesia satisfaction questionnaire(PSO)were completed at T6 and T8.Results The incidences of POST(48.6%vs.16.2%),PONV(24.9%vs.13.0%),CRBD(78.8%vs.20.9%)and thirst(74.9%vs.20.0%)were higher in the group C than in the group S at T2(P<0.05).The comfort score and satisfaction score were lower in the group C than in the group S at T6(3.14±1.04 vs.4.92±1.42,2.67±0.89 vs.3.30±1.01)and at T8(3.84±1.83 vs.5.05±1.77,2.74±0.84 vs.3.26±1.06)(P<0.05).Conclusions The Soochow University model of comfortable medical procedures during peri-anesthesia period for patients undergoing radical resection of lung cancer through thoracoscope has been successfully constructed,and this model can reduce the incidence of complications,and improve the comfort and satisfaction during peri-anesthesia period.

关 键 词：肺肿瘤 麻醉 舒适化医疗 

分 类 号：R734[医药卫生—肿瘤] R614[医药卫生—临床医学]