改良侧卧位拉肩方法在颅脑手术中的临床应用  

Clinical application of modified lateral decubitus position shoulder stretching method in craniocerebral surgery

作　　者：吴丽珍[1] 柯雅娟[1] 陈运完[1] 邢芳坛[1] 陈燕曼 张超才 WU Lizhen;KE Yajuan;CHEN Yunwan;XING Fangtan;CHEN Yanman;ZHANG Chaocai(Operating Room,Hainan Provincial People's Hospital,Haikou 570100,China)

机构地区：[1]海南省人民医院手术室,海南海口570100

出　　处：《中国现代医生》2020年第20期151-154,共4页China Modern Doctor

摘　　要：目的探讨改良侧卧位拉肩方法在颅脑手术中的临床应用,以降低体位摆置不当引起的并发症。方法选取我院2018年1~12月100例神经外科侧卧手术体位患者作为研究对象,将其随机分为观察组和对照组两组,每组50例,对照组常规侧卧位后采用自制拉肩带固定患侧肩峰处并交叉打结于腋下,两侧固定带固定于两侧的床缘;观察组常规侧卧位后采用透气胶布根据患者体型大小裁剪合适宽度粘贴于患侧肩峰处,向患者腹侧膝下牵拉固定于一侧床缘上,并于手术中合理降低医疗器械行为压力,比较两组皮肤发生压力性损伤情况,术后手臂麻木、术后肢体疼痛、体位摆置时间、体位移动、手术团队满意度等情况并进行效果评价。结果观察组患者术中压力性损伤、患侧手臂麻木及肢体术后72 h疼痛发生率等并发症明显低于对照组(P<0.05);观察组体位摆置时间、体位移动率明显优于对照组(P<0.05);观察组医务人员对手术体位满意度调查明显高于对照组(P<0.05)。结论与对照组相比,改良侧卧拉肩方法应用于神经外科侧卧手术的优势更显著,不仅为手术医生提供良好的操作空间,有效预防并发症的发生,还能缓解术后疼痛,促进手术患者快速康复,值得推广。Objective To explore the clinical application of modified lateral decubitus position shoulder stretching method in craniocerebral surgery,to reduce the complications caused by improper positioning.Methods 100 neurosurgery patients with lateral decubitus position from January to December 2018 in our hospital were taken as the research object.They were randomly divided into the observation group and the control group,with 50 cases in each group.After the control group's conventional lateral decubitus position,the self-made shoulder stretching strap was fixed to the acromion of the affected side and cross-knotted under the armpit.The two sides were fixed to the bed edge on both sides.After the observation group's conventional lateral decubitus position,breathable adhesive tape was cut according to the patient's size and pasted at the acromion of the affected side.The tape was pulled to the patient's ventral knee and fixed on the side of the bed.And the behavioral pressure of medical devices reasonably during the operation was reduced.The stress skin damage,effect evaluation including postoperative limb numbness,postoperative limb pain,posture placement time,posture movement and surgical team satisfaction between two groups were compared.Results Complications such as intraoperative pressure damage,numbness of the affected limb,and pain incidence at 72 hours after limb surgery were significantly lower in the observation group than those in the control group(P<0.05).The posture placement time and posture movement rate in the observation group were significantly better than those in the control group(P<0.05).The medical staff's satisfaction with surgical posture in the observation group was significantly higher than that in the control group(P<0.05).Conclusion Compared with those of the control group,the advantages of the modified lateral shoulder stretching method for neurosurgical lateral surgery are more obvious.It not only provides a good operating space for the surgeon,effectively prevents the occurrence of complic

关 键 词：拉肩方法 颅脑手术 侧卧体位 并发症 

分 类 号：R473.6[医药卫生—护理学]