无充气腋窝入路腔镜甲状腺手术患者肩颈功能锻炼方案构建及应用  

Construction and application of a shoulder and neck function exercise program for patients undergoing endoscopic thyroidectomy by a gasless unilateral axillary approach

作　　者：王慧慧 殷德涛[1] 齐宝珍 朱春华 董淑敏 郑元[2] Wang Huihui;Yin Detao;Qi Baozhen;Zhu Chunhua;Dong Shumin;Zheng Yuan(First Department of Thyroid Surgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;General Party Branch of the Second Surgical Department,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院甲状腺外一科,郑州450052 [2]郑州大学第一附属医院外二党总支,郑州450052

出　　处：《中华现代护理杂志》2025年第10期1321-1328,共8页Chinese Journal of Modern Nursing

基　　金：2022年度河南省医学重点(培育)学科(外科护理学);2023年郑州大学第一附属医院护理科研专项(HLKY2023014)。

摘　　要：目的构建无充气腋窝入路腔镜甲状腺手术患者肩颈功能锻炼方案,并探讨其应用效果。方法通过文献回顾构建无充气腋窝入路腔镜甲状腺手术患者肩颈功能锻炼方案初稿,对20名专家进行2轮专家函询,结合预试验结果确定方案终稿。采用便利抽样法,选取2023年9月—2024年1月在郑州大学第一附属医院甲状腺外科行无充气腋窝入路腔镜甲状腺手术的98例患者为研究对象,将2023年9—12月的患者设为对照组,2023年10月—2024年1月的患者设为试验组,各49例。对照组实施常规护理,试验组在对照组基础上接受本研究制订的肩颈功能锻炼方案。干预后1周、1个月、3个月比较两组患者的肩关节功能评价量表评分、胸壁入路区麻木发生情况以及癌症患者生命质量量表评分。结果2轮专家函询有效问卷回收率分别为85.00%(17/20)和94.12%(16/17),函询专家的熟悉程度系数为0.938,判断依据系数为0.891,权威系数为0.915。第2轮函询各条目重要性评分的变异系数为0.096~0.190、肯德尔和谐系数为0.155(P<0.01)。最终形成的无充气腋窝入路腔镜甲状腺患者肩颈功能锻炼方案,包括3个一级条目、5个二级条目和13个三级条目。干预后1周,两组胸壁入路区麻木发生情况比较,差异有统计学意义(P<0.05)。干预后1个月,两组肩关节功能评分、胸壁入路区麻木发生情况及生命质量评分比较,差异均有统计学意义(P<0.05)。干预后3个月,两组肩关节功能评分、生命质量评分比较,差异均有统计学意义(P<0.05)。结论本研究构建的无充气腋窝入路腔镜甲状腺手术肩颈功能锻炼方案具有一定的科学性和可行性,能够改善腋窝入路腔镜甲状腺手术患者的肩颈功能,减轻胸壁入路区麻木情况,提高患者术后生活质量。Objective To construct a shoulder and neck functional exercise program for patients undergoing endoscopic thyroidectomy by a gasless unilateral axillary approach and to explore its effectiveness.Methods The first draft of the shoulder and neck functional exercise program for patients undergoing endoscopic thyroidectomy by a gasless unilateral axillary approach was constructed through literature review,and two rounds of expert consultation were conducted with 20 experts to determine the final draft of the program with the results of the pretest.A total of 98 patients who underwent endoscopic thyroidectomy by a gasless unilateral axillary approach in the Department of Thyroid Surgery of the First Affiliated Hospital of Zhengzhou University from September 2023 to January 2024 were selected for the study using the convenience sampling method.Patients from September to December 2023 were set up as control group and patients from October 2023 to January 2024 were set up as experimental group,with 49 patients in each group.Control group implemented routine nursing,and experimental group received the shoulder and neck functional exercise program developed in this study on the basis of control group.Constant-Murley Score score,occurrence of numbness in the chest wall access area,and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire scores in cancer patients were compared between the two groups at one week,one month,and three months post-intervention.Results In the two rounds of expert consultation,the effective questionnaire recovery rates were 85.00%(17/20)and 94.12%(16/17),and the coefficient of the expert familiarity was 0.938,the coefficient of basis of judgment was 0.891,and the coefficient of authority was 0.915.The coefficients of variation for the importance ratings of the entries in the second round of consultation were 0.096 to 0.190 and Kendall's harmony coefficient was 0.155(P<0.01).The shoulder and neck function exercise program for patients undergoing endoscopic thyroid

关 键 词：康复锻炼 甲状腺切除术 肩颈功能 生活质量 德尔菲法 

分 类 号：R73[医药卫生—肿瘤]