肺癌胸腔镜手术围麻醉期安全护理路径的编制和实证研究

发布时间：2018-01-07 13:18

本文关键词：肺癌胸腔镜手术围麻醉期安全护理路径的编制和实证研究　出处：《青岛大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的制定肺癌胸腔镜手术患者围麻醉期安全护理路径文本,评价肺癌胸腔镜手术患者围麻醉期安全护理路径的实施效果。方法本研究分两阶段进行:本研究分两阶段进行:(1)参考麻醉科护理常规及大量文献,通过咨询临床专家及临床医务人员,设计并编制肺癌胸腔镜手术患者围麻醉期安全护理路径表和临床实施流程。通过三轮预实验的实施,最终确定肺癌胸腔镜手术围麻醉期安全护理路径。(2)选取肺癌胸腔镜手术患者120例,随机分为干预组和对照组各60例。两组患者在年龄、性别和ASA分级、临床分期、手术时间等一般资料上的差异无统计学意义(P0.05)。对照组采用常规围麻醉期护理,干预组按照肺癌胸腔镜手术患者围麻醉期安全护理路径进行护理。以焦虑水平、躁动发生次数、镇痛评分、舒适度评分、操作时间和住院时间为评价指标,评价肺癌胸腔镜手术围麻醉期安全护理路径的应用效果。结果1.完成肺癌胸腔镜手术围麻醉期安全护理路径的文本编制和实施流程的规定。文本由患者入院基本信息和围麻醉期安全护理路径表格2个部分组成,其中安全护理路径表格包括麻醉前一日、麻醉日和麻醉后24-48小时。2.数据分析显示,干预组患者术前30分钟平均焦虑评分(HAD评分)为11.83±2.34,而对照组为17.55±2.73。干预组明显比对照组低(t=12.312,P0.001),两组比较差异有统计学意义。干预组患者躁动发生6例,躁动发生百分率为10.00%,对照组术后躁动发生17例,躁动发生百分率为28.33%,两组比较差异明显,有统计学意义(c2=6.508,P0.01)。干预组患者平均镇痛评分(VAS评分)为4.18±1.50,对照组为4.82±1.10,两组比较差异有统计学意义(t=2.638,P=0.009)。干预组患者术后平均舒适度评分(PCQ评分)为100.92±14.47,对照组为87.58±11.85,干预组患者平均舒适度评分明显比对照组高(t=-5.524,P0.001)。干预组患者术后平均麻醉插管操作时间为7.50±2.05分钟,对照组为9.73±2.33分钟,干预组患者平均麻醉插管操作时间明显比对照组缩短(t=5.582,P0.001)。干预组患者术后平均住院日是9.22±1.54天,对照组为11.62±1.43天,干预组患者住院时间比对照组明显缩短,差异有统计学意义(t=8.8500,P0.001)。结论肺癌胸腔镜手术围麻醉期安全护理路径的构建为肺癌胸腔镜手术患者围麻醉期安全护理提供规范方法。此安全护理路径的应用能减轻患者焦虑程度及躁动发生并降低疼痛程度,能提高患者舒适程度,并能缩短麻醉诱导插管操作时间和术后住院时间。
[Abstract]:Objective to establish lung cancer patients with thoracoscopic surgery perioperative safety nursing path text, to evaluate the effect of thoracoscopic surgery in patients with lung cancer perioperative nursing safety pathway. Methods this study is divided into two stages: the study is divided into two stages: (1) Department of Anesthesiology nursing routine and reference literature, through consulting experts and clinical the clinical medical personnel, design and preparation of thoracoscopic surgery patients with lung cancer perioperative safety and clinical nursing path table implementation process. Through the implementation of three pre experiment, and ultimately determine the lung cancer thoracoscopic surgery perioperative safety nursing path. (2) a total of 120 cases of lung cancer patients with thoracoscopic surgery, were randomly divided into intervention group and control 60 cases in each group. The two groups in age, gender and ASA classification, clinical stage, there was no significant difference in general data operation time (P0.05). The control group received conventional perioperative nursing, stem The pre group nursing in patients with lung cancer according to thoracoscopic surgery perioperative nursing safety path. To the level of anxiety, restlessness times, pain scores, comfort score, operation time and hospitalization time as the evaluation index, evaluation of thoracoscopic lung surgery application effect of anesthesia nursing safety pathway. Results 1. complete perioperative safety the nursing path for lung cancer thoracoscopic surgery text preparation and implementation of process regulations. Text by the patients basic information and perioperative safety nursing path table is composed of 2 parts, including safety nursing path table including anesthesia the day before anesthesia, and anesthesia after 24-48 hours.2. data analysis showed that the patients in the intervention group before 30 min average anxiety score (HAD score) was 11.83 + 2.34, while the control group was 17.55 + 2.73. group was significantly lower than the control group (t=12.312, P0.001), there was significant difference between two groups. Patients in the intervention group the incidence of agitation in 6 cases, the incidence of agitation was 10%, the control group on postoperative agitation in 17 cases, the incidence of agitation was 28.33%, the difference between the two groups was statistically significant (c2=6.508, P0.01). The average intervention analgesia group score (VAS score) was 4.18 + 1.50, 4.82 in the control group. 1.10, there was significant difference between two groups (t=2.638, P=0.009). The patients in the intervention group after the average score (PCQ score) was 100.92 + 14.47, 11.85 + 87.58 in the control group, patients in the intervention group the average score is significantly higher than the control group (t=-5.524, P0.001). The patients in the intervention group after the average intubation operation time was 7.50 + 2.05 minutes, the control group was 9.73 + 2.33 minutes, patients in the intervention group the average intubation time was significantly shorter than the control group (t=5.582, P0.001). The patients in the intervention group after the average hospitalization days was 9.22 + 1.54 days, the control group was 11.62 Within 1.43 days, the intervention group hospitalization time was significantly shorter than the control group, the difference was statistically significant (t=8.8500, P0.001). The perioperative nursing path construction safety conclusion lung cancer thoracoscopic surgery with standard methods for lung cancer patients with thoracoscopic surgery perioperative nursing safety of anesthesia. Application of the safety nursing pathway can reduce the anxiety degree of patients and the incidence of agitation and reduce pain, improve patients comfort degree, and can shorten the hospitalization time of anesthesia induction and intubation operation time and postoperative.

【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R473.73

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