改良手术体位对胸腔镜肺切除术后患者疼痛和运动的影响  

Effect of modified surgical position on pain and exercise after thoracoscopy pneumonectomy

作　　者：薛菊琴 戴莉[1] 韩瑶华 赵青[1] 张辉[1] XUE Ju-qin;DAI Li;HAN Yao-hua;ZHAO Qing;ZHANG Hui(Shanghai Chest Hospital,Shanghai Jiaotong University,Shanghai 200030,China)

机构地区：[1]上海市胸科医院,上海交通大学附属胸科医院,上海200030

出　　处：《临床肺科杂志》2020年第8期1163-1166,共4页Journal of Clinical Pulmonary Medicine

摘　　要：目的探讨侧卧位时两种不同的手臂摆放方式对于胸腔镜肺切除患者术后疼痛以及手臂活动度的影响。方法本实验采用前瞻性随机对照研究,选取2018年6月至9月在上海市胸科医院单个医疗组中行胸腔镜肺切除术患者200例,根据随机数字分组法分为对照组和研究组,对照组为常规90℃侧卧位摆放100例(健侧手臂置于手架上,患侧手臂外展固定于搁手架上),研究组采用改良后的90℃侧卧位摆放100例(侧卧位+双手自然抱枕法,健侧手臂自然弯曲放于头侧,术侧手臂自然放于健侧手臂的上方,双臂之间垫软枕),比较两组患者手术时间、术后24 h患者疼痛以及患者手臂活动度等各项指标。结果与对照组相比,研究组患者术后手臂疼痛更轻(无痛:70%vs 82%,轻度:16%vs 16%,中度:2%vs 1%,重度:6%vs 1%,剧痛:6%vs 0,χ^2=10.85,P=0.028)、患者术后手臂活动度更大(能摸头的:93%vs 100%,χ^2=7.254,P=0.007,能摸对侧腋窝的:87%vs 96%,χ^2=5.207,P=0.023,能绕过头摸对侧耳朵的:82%vs 94%,χ^2=6.818,P=0.009)。结论侧卧位+双手自然抱枕法手臂摆放明显优于传统的常规侧卧位摆放,可以避免损伤臂丛神经,减轻患者术后手臂的疼痛感,改善患者术后手臂活动度,从而提高患者的舒适度。Objective To investigate the effect of two different arm placement methods on postoperative pain and arm mobility in lateral decubitus position. Methods A prospective randomized controlled study was conducted in 200 patients undergoing thoracoscopic lung resection in Shanghai Chest Hospital from June to September 2018. According to the random lottery grouping method, they were divided into the control group and the study group. The control group consisted of 100 patients who were placed in the traditional lateral decubitus position( the arm of operative side was abducted and fixed on the shelf,and the contralateral arm was placed on the bracket). 100 patients in the study group were placed in the modified lateral decubitus position( two arms naturally flexed with a pillow between them). The operation time,pain score on postoperative day 1 and arm mobility were compared between the two groups. Results Compared with the control group,the arm pain was less severe in the study group( Painless: 70%vs 82%,mild: 16% vs 16%,moderate: 2% vs 1%,severe: 6 % vs 1%,extremely severe: 6% vs 0,χ^2= 10. 85,P = 0. 028). The arm mobility was better in the study group( touching head 93% vs 100%,χ^2= 7. 254,P = 0. 007,touching contralateral axilla,87% vs 96%,χ^2= 5. 207,P = 0. 023,touching contralateral ear,82 % vs 94%,χ^2=6. 818,P = 0. 009). Conclusion The modified arm placement method( lateral decubitus position + two hands naturally holding pillow) is superior to the traditional methods,which can avoid injuring brachial plexus nerve,relieve the arm pain,improve the arm mobility after operation,and thus improve the comfort of patients.

关 键 词：胸腔镜手术 肺切除术 体位 疼痛 

分 类 号：R655.3[医药卫生—外科学]