免气腹腹腔镜胆囊切除术围手术期的护理干预和疗效观察

目的探讨围手术期护理干预对免气腹腹腔镜胆囊切除术疗效的影响。方法将80例患胆囊结石、胆囊息肉或胆囊炎患者分成免气腹腹腔镜胆囊切除术(A组,n=40)和二氧化碳气腹腹腔镜胆囊切除术(B组,n=40),全程护理干预下观察并记录两组手术时间、术后切孔感染、术后肩部疼痛;术前和手术30 min及手术结束10 min PaCO2、PetCO2、Paw、pH;术前术后IL-6、PT;术后下床活动时间、术后胃肠功能恢复时间、术后并发症、术后住院时间、住院费用等指标。结果 80例手术全部成功,B组术后6例肩部疼痛,A组无肩部疼痛;B组手术30 min及手术结束10 min PaCO2、PetCO2、Paw均高于A组,而pH降低;B组术后24 h IL-6高于A组、PT低于A组(P0.01);B组住院费用比A组高(均P0.05)。结论科学严谨、全程规范而具针对性的围手术期护理干预是提高免气腹腹腔镜胆囊切除术成功率、减少术后并发症、促进患者康复的重要保障。

Nursing intervention and therapeutic effect observation of gasless laparoscopic cholecystectomy during perioperative period

Objective To explore effect of perioperative nursing intervention on gasless laparoscopic cholecystectomy. Methods 80 patients with gallbladder stones, gallbladder polyps, or eholecystitis were divided into two groups： gasless laparoscopic cholecystectomy （group A, n = 40 ） or carbon dioxide pneumoperitoneum laparoscopic cholecystectomy （group B, n = 40）. Patients received whole course nursing intervention, and were observed and recorded the operation time, incision infection after operation, postoperative shoulder pain; PaCO2, PetCO2, Paw, and pH at before operation, 30 minutes after the start of operation, 10 minutes after operation; IL-6 and PT before and after operation, postoperative activity time, postoperative gastrointestinal function recovery time, postoperative complications, postoperative hospitalization time, cost of hospitalization index, etc. Results Operation was successfully completed in 80 cases. Postoperative shoulder pain occurred only in 6 case of group B （P 〈 0.05）. Compared with group A, IL-6 of 24 h,PaCO2, PetCO2 at 30 min after operation start and 10 min after operation end, Paw, and hospitalization cost were higher, pH and PT were lower （ all P 〈 0. 05 ）. Conclusion Scientific and rigorous nursing intervention can provide important assurance for enhancing the success rate of suspending gasless laparoseopic cholecystectomy ,reducing its complication, and promoting postoperative rehabilitation.