术中肢体被动运动在脊柱外科俯卧位手术臂丛神经保护中的护理疗效  

Nursing effectiveness of limb passive movement in the protection of brachial plexus in prone position of spinal surgery

作　　者：乔伟 何国龙 杨浩[1] QIAO Wei;HE Guo-long;YANG Hao(Operating Room,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院手术室,武汉430030

出　　处：《骨科》2020年第4期329-332,共4页ORTHOPAEDICS

摘　　要：目的探讨术中肢体被动运动在俯卧位脊柱手术病人术中体位性臂丛神经损伤的干预效果和护理要点。方法选取2018年1月至12月在我院骨科实施俯卧位脊柱手术病人377例,术中采用双上肢尺神经体感诱发电位(somatosensory evoked potentials, SEP)监测,在病人上肢肌力电位下降时,给予肢体肌肉按摩、关节适度被动运动干预。观察术前、干预前和干预后病人上肢肌力电位的阈值和潜伏期变化情况。结果术中11例出现上肢肌力电位下降,其中7例(63.6%)行肢体被动运动干预40~70 min后上肢SEP恢复正常,恢复时间为(47.31±15.57)min;4例在3 h内恢复正常。手术前、干预前和干预后的潜伏期比较,差异无统计学意义(P=0.236)。手术前、干预前和干预后病人上肢肌力电位的阈值比较,差异有统计学意义(F=16.218,P<0.001),且干预后上肢尺神经阈值明显高于干预前,差异有统计学意义(P<0.05)。11例病人术后均未出现上肢功能障碍及其他臂丛神经损伤症状。结论基于神经电生理监测的术中肢体被动运动,有助于改善俯卧位脊柱手术病人术中上肢肌力下降,减少术中体位并发症,促进病人术后恢复。Objective To explore the intervention effectiveness and nursing points of limb passive movement in the protection of position brachial plexus injury in prone position of spinal surgery. Methods A total of 377 patients who underwent the spinal surgery in the prone position in Orthopedics Department of our Hospital during January 2018 to December 2018 were selected, the somatosensory evoked potentials(SEP) of the ulnar nerves in both upper limbs during the operation were recorded. When the muscle force potential of the upper limbs decreased, the passive movements of the limbs were done, including limb movement, muscle massage, joint movement and other measures. The changes of threshold and latency of upper limb myodynamic potential were observed pre-operation, pre-intervention and post-intervention. Results During the operation,11 patients experienced a decrease in upper limb myodynamic potential. Among them, 7 patients(63.6%)returned to normal SEP after 40 to 70 min of passive limb movement intervention, and the recovery time was(47.31±15.57) min;4 patients returned to normal within 3 h. There was no statistically significant difference in latency pre-operation, pre-intervention and post-intervention(P=0.236). The upper limb myodynamic potential threshold before surgery, before intervention and after intervention was compared, and the difference was statistically significant(F=16.218, P<0.001). The upper limb ulnar nerve threshold after intervention was significantly higher than before intervention(P<0.05). No upper limb dysfunction or other symptoms of brachial plexus injury occurred in 11 patients. Conclusion Based on neuroelectrophysiological monitoring,the intraoperative passive movement of limbs is helpful to improve the muscle strength of upper limbs of spinal surgery patients in prone position, reduce the complications caused by position in operation, and promote the recovery of patients after operation.

关 键 词：俯卧位 上肢体感诱发电位 护理干预 

分 类 号：R472.3[医药卫生—护理学]