CT引导下经皮胸交感射频联合无水乙醇注射治疗手汗症的护理  

Nursing care of patients with primary palmar hyperhidrosis treated by CT guided percutaneous thoracic sympathetic nerve radiofrequency thermocoagulation combined with absolute ethanol injection

作　　者：廖雨萍 张达颖[2,3] 王志剑 曾飞[2,3] 余波 刘韦辰 万露 魏建梅 LIAO Yuping;ZHANG Daying;WANG Zhijian;ZENG Fei;YU Bo;LIU Weichen;WAN Lu;WEI Jianmei(School of Nursing,Nanchang University,Nanchang 330006,China;Department of Pain Medicine,The First Affiliated Hospital of Nanchang University,Nanchang 330006,China;Key Laboratory of Neuropathic Pain(the First Affiliated Hospital of Nanchang University),Healthcare Commission of Jiangxi Province,Nanchang 330006,China)

机构地区：[1]南昌大学护理学院,南昌330006 [2]南昌大学第一附属医院疼痛科,南昌330006 [3]江西省卫生健康神经性疼痛重点实验室,南昌330006

出　　处：《中国疼痛医学杂志》2022年第12期927-932,共6页Chinese Journal of Pain Medicine

基　　金：国家临床重点专科建设项目[国卫办医函(2013)544号]。

摘　　要：目的:探讨CT引导下经皮穿刺胸交感神经射频热凝术联合无水乙醇注射术治疗原发性手汗症的围手术期护理方法。方法:对2020年10月1日至2022年8月30日疼痛科收治的40例在CT引导下行经皮穿刺胸交感神经射频热凝术联合无水乙醇注射术治疗的原发性手汗症病人进行规范化术前、术中、术后护理。结果:40例病人均顺利完成手术,其中37例症状缓解、2例原发性手汗症(primary palmar hyperhidrosis,PPH)分级为轻度、1例分级为中度;术后病人手掌皮肤平均温度由33.1±0.4℃升高至35.9±0.4℃,手指末梢灌注指数(perfusion index,PI)由0.9±0.1升高至4.8±0.5,差异均有统计学意义(P<0.001);术后出现1例胸闷、8例胸背部疼痛、3例代偿性多汗、1例霍纳综合征,经及时有效处理后症状均得以缓解;进行疼痛护理管理后病人焦虑评分、抑郁评分、睡眠评分及满意度评分均较护理前明显改善。结论:术前做好病情评估、心理护理、完善相关术前准备;术中做好手术配合;术后密切观察病人病情、做好伤口护理、疼痛护理管理、并发症防范及出院指导能有效保证手术效果,使病人得到更好地恢复,并改善其就医体验。Objective:To explore the perioperative nursing methods for CT-guided percutaneous thoracic sympathetic radiofrequency thermocoagulation combined with absolute ethanol injection during the treatment of primary palmar hyperhidrosis.Methods:From October 1,2020 to August 30,2022,40 patients with primary palmar hyperhidrosis who were treated by CT guided percutaneous transthoracic sympathetic radiofrequency thermocoagulation combined with absolute ethanol injection were given standardized preoperative,intraoperative and postoperative nursing care.Results:All the 40 patients successfully completed the operation,of which 37 cases were relieved,2 cases of primary palmer hyperhidrosis(PPH)were graded as mild,and 1 case was graded as moderate.The mean temperature of palm skin increased from 33.1±0.4℃to 35.9±0.4℃,and the perfusion index(PI)of finger increased from 0.9±0.1 to 4.8±0.5(P<0.001).There were 1 patient of chest tightness,8 of chest and back pain,3 of compensatory hyperhidrosis and 1 of Horner syndrome after operation,and the symptoms were relieved after timely and effective treatment.Anxiety score,depression score,sleep score and satisfaction score were significantly improved after nursing.Conclusion:Preoperative disease assessment,psychological care,improvement of the relevant preoperative preparation;intraoperative surgical cooperation;postoperative close observation of the patient's condition,good wound care,pain care management,complication prevention and discharge guidance can effectively ensure the surgical effect,so that patients can get better recovery and improve their medical experience.

关 键 词：原发性手汗症 胸交感神经射频热凝术 无水乙醇注射术 围手术期护理 

分 类 号：R473.75[医药卫生—护理学]