单切口胸膜腔镜检查术的护理
Nursing in Primary Surgical Pleuroscopy

作者: 杨彩玲 , 王 丽 , 孟军会 , 党 莹 :西安交通大学医学院第一附属医院,西安;

关键词: 单切口胸膜腔镜检查护理Primary Surgical Pleuroscopy Nursing

摘要:
【目的】探讨不明原因胸腔积液患者在不需要麻醉科医师监护和特殊供氧条件下,应用传统局部麻醉方式基础上和小剂量咪达唑仑–芬太尼静脉复合麻醉行单切口胸膜腔镜检查护理要点。【方法】对50例患者检查前由责任护士做好健康宣教、心理护理,协助患者备好常规检查、备药;人工气胸等;术前30 min常规2%利多卡因5~8 ml + 0.1%肾上腺素0.2~0.3 ml浸润局部麻醉,在此基础上依据患者年龄、体重、基础疾病遵医嘱应用小剂量咪达唑仑2~3 mg、芬太尼1 ug/kg静脉注射镇静镇痛;术中给予吸氧、生命体征、血氧饱和度监测,保持呼吸道通畅;术后胸腔闭式引流护理,加强复张性肺水肿、疼痛、发热、胸腔出血、胸腔漏气及皮下气肿等并发症的观察及护理。【结果】50例患者均一次成功完成单切口胸膜腔镜检查,无严重并发症病例,确诊恶性肿瘤30例、慢性炎症12例,结核5例,未明确诊断3例,术后恢复良好。【结论】对不明原因胸腔积液患者应用传统局部浸润麻醉方式和小剂量咪达唑仑–芬太尼静脉复合麻醉行单切口胸膜腔镜检查安全、检查阳性率高,护理上检查前做好患者健康宣教及心理护理,术中严密观察患者神志、心率、呼吸、血氧饱和度,及时清理呼吸道分泌物,保持清理呼吸道通畅,术后做好胸腔闭式引流护理及疼痛、发热、皮下气肿、复张性肺水肿等等并发症的观察与护理,全程精心护理与单切口胸膜腔镜检查成功密切相关。

Abstract:
[Objective] To investigate unexplained pleural effusion in patients without the need for anes- thesiologists care and domiciliary oxygen; to apply traditional methods based on local anesthesia and a small dose of midazolam-fentanyl intravenous injection for primary surgical pleuroscopy. [Methods] 50 patients were examined by nurses for routine aspect of health education, psychological counseling, patient preparation, maintenance drug and pleuroscopy set. 30 minutes prior to the pleuroscopy, local anesthesia was provided with 2% lidocaine (5 - 8 ml) + 0.1% adrenaline solution (0.2 - 0.3 ml); based on the patient’s age, weight and underlying disease a small dose of midazolam 2 - 3 mg, fentanyl 1 ug/kg intravenous injection was given as analgesia. Thoracic drainage care, prevention of re-expansion pulmonary edema, pain, fever, pleural hemorrhage, pleural air leaks, subcutaneous emphysema and other possible complications were taken care of intra-operatively; oxygen supplementation, monitoring of vital signs and oxygen saturation, maintenance of airway patency was continuously done. [Results] 50 patients suc- cessfully underwent primary surgical pleuroscopy, 30 cases were diagnosed with malignancy, 12 cases of chronic inflammation, 5 cases of tuberculosis, and 3 cases with uncertain diagnosis. None of the patients had post pleuroscopy complication. [Conclusion] Patients with unexplained pleural effusion should undergo primary surgical pleuroscopy using the traditional methods of local anesthesia and a small dose of midazolam-fentanyl intravenous injection. The aspect of nursing includes health education, psychological counseling, patient preparation; maintenance drug and pleuroscopy set check. Intra-operative monitoring of heart rate, respiratory rate, oxygen satura- tion, suction of respiratory secretions, maintaining airway patency followed by good postopera- tive care and thoracic drainage reduces the complications of pain, fever, subcutaneous emphy- sema, swelling, re-expansion pulmonary edema. Proper nursing care and the outcome of primary surgical pleuroscopy are closely related.

文章引用: 杨彩玲 , 王 丽 , 孟军会 , 党 莹 (2014) 单切口胸膜腔镜检查术的护理。 护理学, 3, 56-60. doi: 10.12677/NS.2014.33012

参考文献

[1] 杜召云, 成义仁, 刘继兰, 等 (1997) 护理心理学. 中国医药科技出版社, 北京, 149-155.

[2] 刘桐林, 丁伟 (2001) 胸部疾病电视胸腔镜诊断治疗学. 天津科技翻译出版公司, 天津, 68-75.

[3] 许世英, 施伟 (2008) 电视胸腔镜手术治疗脓胸的围手术期护理. 护理与康复, 2, 130-131.

[4] 陈正贤 (2004) 介入性肺病学. 人民卫生出版社, 北京, 270.

[5] Viskum, K. and Enk, B. (1981) Complications of thoracoscopy. Poumoncoeur, 37, 25-28.

分享
Top