1例子宫肌瘤电切并发TURPS的围术期护理  

Perioperative nursing of a case of hysteromyoma resection complicated with TURPS

作　　者：吴菁[1] WU Jing(Operating Room,Tianjin Central Obstetrics and Gynecology Hospital,Tianjin 300600,China)

机构地区：[1]天津市中心妇产科医院手术室,天津300600

出　　处：《中国城乡企业卫生》2021年第10期164-166,共3页Chinese Journal of Urban and Rural Enterprise Hygiene

摘　　要：目的探讨1例宫腔镜下子宫肌瘤切除术患者并发TURPS的发生原因,以降低TURPS的发生率。方法总结手术配合及护理、并发TURPS后的处置,拟定预防、应对风险发生的预案。术前积极完善手术准备,对易发生风险的患者进行风险等级评估,护理人员应提高防风险等级的意识,做好各项准备工作,积极配合手术,减少严重不良后果的发生。密切观察患者生命体征变化,监测尿量、膨宫液体的入量、血钠浓度等指标,纠正循环血量异常及电解质紊乱等。结果对电切手术>20 min,子宫肌瘤比较大,直径>5 cm,手术创面比较大,有开放的血窦,出血>200 ml的患者应高度警惕,做好发生TURPS的准备。医务人员在术中密切观察该患者病情变化,在短时间内及时处置,终止了TURPS的发展,未造成严重不良后果。结论应对TURPS发生的危险,器械护士和巡回护士应对发生TURPS的危险有充分的评估和认识,积极完善术前准备,将膨宫压力控制在合理的范围内,充分暴露手术视野,缩短手术时间,提高手术效率,保证手术顺利进行。Objective To explore the causes of a case of patient undergoing hysteroscopic myomectomy complicated with TURPS,in order to reduce the incidence rate of TURPS. Methods To summarize surgical cooperation,nursing and treatment after TURPS,and formulate plans to prevent and deal with risks. Before operation,to actively improve the operation preparation,and evaluate the risk level of patients prone to risk.Nurses should improve the awareness of risk prevention level,make various preparations,and actively cooperate with the operation to reduce the occurrence of serious adverse consequences. To closely observe the changes of vital signs,monitor the urine volume,the amount of uterine distention fluid,blood sodium concentration and other indicators,and correct the abnormal circulating blood volume and electrolyte disorder. Results Patients with electrosurgical resection more than 20 min,large hysteromyoma,diameter more than 5 cm,large surgical wound,open blood sinus and bleeding more than 200 ml should be highly vigilant and prepare for TURPS. The medical staff closely observed the changes of the patient’s condition during the operation and timely handled it in a short time,which terminated the development of TURPS without serious adverse consequences. Conclusion In response to the risk of TURPS,instrument nurses and itinerant nurses should fully evaluate and understand the risk of TURPS,actively improve preoperative preparation,control the uterine distention pressure within a reasonable range,fully expose the surgical vision,shorten the operation time,improve the operation efficiency and ensure the smooth progress of the operation.

关 键 词：宫腔镜 子宫肌瘤 经尿道前列腺电切综合征 围术期护理 

分 类 号：R248.3[医药卫生—中医临床基础]