肠瘘术后患者应用不同卧位的效果观察  

Influences of different lying positions in patients after intestinal fistula surgery

作　　者：江方正 李洁[2] 王敏 吴楠 薛阳阳 叶向红 赵允召 任建安 童智慧 李维勤 Jiang Fangzheng;Li Jie;Wang Min;Wu Nan;Xue Yangyang;Ye Xianghong;Zhao Yunzhao;Ren Jian'an;Tong Zhihui;Li Weiqin(Intensive Care Unit of General Surgery 7th,Intensive Care Center,General Hospital of Eastern Theater Command,,Nanjing 210002,China;School of Nursing,Nanjing University of Chinese Medicine,Nanjing 210029,China)

机构地区：[1]东部战区总医院重症医学中心普通外科7ICU,南京210002 [2]南京中医药大学护理学院,210029

出　　处：《中华现代护理杂志》2020年第35期4868-4872,共5页Chinese Journal of Modern Nursing

基　　金：江苏省科技项目(BE2015685);军事医学创新工程(18CXZ040)。

摘　　要：目的探讨肠瘘术后拔除气管插管患者6 h内采取不同卧位对生命体征和舒适度的影响。方法采用便利抽样法,选取2018年10月—2019年6月东部战区总医院重症医学中心肠瘘全麻术后患者150例为研究对象,等待患者麻醉清醒后拔除气管插管,正常经鼻自主呼吸后进行卧位更换。将患者随机分为5组,每组30例。A组为平卧位;B组为床头抬高15°卧位;C组为床头抬高30°卧位;D组为床头抬高45°卧位;E组为床头抬高15~45°卧位,开始将床头摇至15°,2 h后将床头摇至30°,再2 h后将床头摇至45°。5组患者卧位固定后,在患者主诉不适时或体位自行改变。比较5组卧位坚持时间、不舒症状和腹部切口疼痛程度。结果肠瘘术后拔除气管插管患者6 h内15°卧位与30°卧位坚持时间较长,分别为(72.27±12.41)min和(69.37±9.10)min,5种不同卧位坚持时间比较差异有统计学意义(P<0.01)。B、C组患者腰部疼痛人数较少,切口无痛患者较多,5组患者比较差异有统计学意义(P<0.05)。结论肠瘘术后拔除气管插管经鼻正常自主呼吸患者,术后6 h内采取15°、30°卧位可延长患者坚持卧位时间,减少腹部切口疼痛、腰部酸痛发生率,且减少头晕、恶心呕吐发生概率。Objective To explore the influences of different lying positions on vital signs and comforts in patients with tracheal intubation removed after intestinal fistula surgery.Methods From October 2018 to June 2019,convenience sampling was used to select 150 patients with intestinal fistula surgery after general anesthesia in Intensive Care Unit of the General Hospital of Eastern Theater Command were selected as the research object.After waiting for the patient to wake up from anesthesia,the tracheal intubation was removed,and the lying position was changed after normal spontaneous breathing through the nose.Patients were randomly divided into 5 groups,30 cases in each group.Group A was in the supine position;group B was in the lying position with the head of the bed raised by 15°;group C was in the lying position with the head of the bed raised by 30°;group D was in the lying position with the head of the bed raised by 45°;group E was in the lying position with the head of the bed raised by 15°to 45°.At the beginning,the head of the bed was shaken to 15°;and after two hours,the head of the bed was shaken to 30°,and after another two hours,the head of the bed was shaken to 45°.After 5 groups of patients fixed the angle of the lying position,when the patient complained of discomfort or the body position changed spontaneously,the patient changed the lying position.The duration of the lying position,uncomfortable symptoms and pain degree of abdominal incision were compared among 5 groups.Results Patients with tracheal intubation removed after intestinal fistula surgery had a longer persistence in the 15°and 30°lying positions within 6 hours,respectively(72.27±12.41)min and(69.37±9.10)min.There were statistically significant differences in the persistence time of 5 different lying positions(P<0.01).The number of patients in group B and C with waist pain was less,and there were more patients with painless incisions,and there were statistically significant differences among 5 groups(P<0.05).Conclusions Among pat

关 键 词：肠瘘 体位 腹部手术 全麻 术后 舒适度 

分 类 号：R473.6[医药卫生—护理学]