吳彩玲
[摘要]目的 探討改良護(hù)理干預(yù)在經(jīng)臍單孔腹腔鏡下精索靜脈曲張(VC)術(shù)后患者中的應(yīng)用效果。方法 選取2017年7月~2018年7月我院收住的VC手術(shù)60例患者,以簡(jiǎn)單化隨機(jī)分組法分為對(duì)照組和觀察組,每組各30例。對(duì)照組選擇常規(guī)方式,觀察組加用改良護(hù)理方式,比較兩組護(hù)理總有效率、精子密度、有效精子數(shù)、精子活力指數(shù)、傷口愈合時(shí)間、住院時(shí)間、焦慮自評(píng)量表(SAS)分值。結(jié)果 觀察組護(hù)理總有效率(93.33%)高于對(duì)照組(80.00%),并發(fā)癥總發(fā)生率(10.00%)低于對(duì)照組(26.67%),差異均有統(tǒng)計(jì)學(xué)意義(P<0.05);觀察組精子密度為(102.41±11.74)× 106/ml、有效精子數(shù)為(43.52±10.02)×106/ml、精子活力指數(shù)為(30.06±1.31)%,對(duì)照組精子密度為(83.56±10.31)×106/ml、有效精子數(shù)為(36.89±10.14)×106/ml、精子活力指數(shù)為(24.65±1.27)%,觀察組各項(xiàng)指標(biāo)高于對(duì)照組,差異均有統(tǒng)計(jì)學(xué)意義(P<0.05);觀察組傷口愈合時(shí)間為(3.38±1.42)d,住院時(shí)間為(4.05±1.26)d,對(duì)照組傷口愈合時(shí)間為(5.27±2.05)d,住院時(shí)間為(6.89±1.52)d,觀察組傷口愈合時(shí)間與住院時(shí)間短于對(duì)照組,差異均有統(tǒng)計(jì)學(xué)意義(P<0.05);觀察組SAS評(píng)分為(15.06±2.08)分,對(duì)照組SAS評(píng)分為(29.01±5.14)分,觀察組SAS評(píng)分低于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(P<0.05)。結(jié)論 經(jīng)臍單孔腹腔鏡下VC術(shù)給予改良式護(hù)理干預(yù),能有效輔助治療效果提高,加速患者康復(fù)并緩解負(fù)面情緒,有較滿意的臨床效果。
[關(guān)鍵詞]改良護(hù)理;經(jīng)臍單孔腹腔鏡;精索靜脈曲張術(shù);前瞻性研究
[中圖分類(lèi)號(hào)] R473.6? ? ? ? ? [文獻(xiàn)標(biāo)識(shí)碼] A? ? ? ? ? [文章編號(hào)] 1674-4721(2020)6(c)-0230-03
Application effect of improved nursing intervention on patients with varicocele after transumbilical single-site laparoscopic surgery
WU Cai-ling
Department of General Surgery, Fuzhou First People′s Hospital, Jiangxi Province, Fuzhou? ?344000, China
[Abstract] Objective To explore the application effect of improved nursing intervention on patients with varicocele (VC) performed with transumbilical single-site laparoscopic surgery. Methods A total of 60 patients with VC for surgeries who were admitted to our hospital from July 2017 to July 2018 were selected. They were divided into observation group and control group by simplified randomized method. The conventional nursing was conducted in the control group and the improved nursing was added in the observation group. The total effective rate of nursing, sperm density, effective sperm number, sperm vitality index, wound healing time, hospital stay, and self-rating anxiety scale (SAS) score of the two groups were compared. Results The total effective rate of nursing in the observation group was 93.33%, higher than that of the control group, accounting for 80.00%, the total incidence of complications was 10.00% in the observation group, lower than that of the control group for 26.67%, with statistical differences (P<0.05). In the observation group, the sperm density was (102.41±11.74)×106/ml, effective sperm number was (43.52±10.02)×106/ml, sperm vitality index was (30.06±1.31)%; in the control group, the sperm density was (83.56±10.31)×106/ml, effective sperm number was (36.89± 0.14)×106/ml, sperm vitality index was (24.65±1.27)%; all indicators in the observation group were higher than those of the control group, with statistical differences (P<0.05). In the observation group, the wound healing time and hospital stay were (3.38±1.42) d and (4.05±1.26) d. In the control group, the wound healing time and hospital stay were (5.27±2.05) d and (6.89±1.52) d. The wound healing time and hospital stay of the observation group were shorter than those of the control group, with statistical differences (P<0.05). The SAS score of the observation group was (15.06±2.08) points, and the SAS score of the control group was (29.01±5.14) points. The SAS score of the observation group was lower than that of the control group, with statistical difference (P<0.05). Conclusion Modified nursing intervention on VC patients after transumbilical single-site laparoscopic surgery can effectively improve the therapeutic effect, accelerate the rehabilitation of patients and alleviate their negative sentiment. It has a satisfactory clinical effect.
[Key words] Improved nursing; Transumbilical single-site laparoscopy; Varicocele; Prospective study
精索靜脈曲張(VC)是臨床導(dǎo)致男性不育常見(jiàn)疾病之一,根據(jù)臨床研究顯示,在男性不育群體中,19%~41%患者為VC,嚴(yán)重影響男性患者的生活質(zhì)量[1]。在當(dāng)前的臨床中,針對(duì)VC的治療,最主要的治療方式是手術(shù)。而在醫(yī)學(xué)技術(shù)持續(xù)性發(fā)展支持下,腹腔鏡手術(shù)方式在VC治療中的應(yīng)用逐漸深入。腹腔鏡術(shù)有微創(chuàng)、高效優(yōu)點(diǎn),在患者接受度方面有明顯優(yōu)勢(shì)。但在圍術(shù)期很多患者可能存在抑郁及焦慮負(fù)面情緒,要通過(guò)科學(xué)合理的護(hù)理干預(yù),改善患者負(fù)面情緒,并提高患者臨床護(hù)理質(zhì)量[2-4]。為研究改良護(hù)理干預(yù)對(duì)經(jīng)臍單孔腹腔鏡下VC術(shù)患者影響,通過(guò)我院不同護(hù)理干預(yù)的效果比較,探討科學(xué)有效的護(hù)理干預(yù)模式,現(xiàn)報(bào)道如下。
1資料與方法
1.1一般資料
選取2017年7月~2018年7月我院住院治療的60例經(jīng)臍單孔腹腔鏡下VC術(shù)患者為研究對(duì)象。納入標(biāo)準(zhǔn):①經(jīng)臨床診斷證實(shí),并實(shí)施手術(shù);②臨床資料完整者;③研究經(jīng)醫(yī)院醫(yī)學(xué)倫理委員會(huì)批準(zhǔn),患者及家屬簽署知情同意書(shū)。排除標(biāo)準(zhǔn):①不配合研究者;②精神障礙者;③合并其他器質(zhì)性疾病者。按簡(jiǎn)單化隨機(jī)分組方法分為對(duì)照組和觀察組,每組各30例。對(duì)照組中,年齡22~38歲,平均(30.43±5.98)歲,觀察組中,年齡23~38歲,平均(30.14±8.12)歲。兩組的一般資料比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P>0.05),具有可比性。
1.2方法
對(duì)照組選擇常規(guī)方式進(jìn)行護(hù)理,主要包括。①了解患者術(shù)前檢驗(yàn)指標(biāo)水平。②術(shù)前準(zhǔn)備:做好灌腸與備皮準(zhǔn)備工作,并遵醫(yī)患者術(shù)前禁食、禁水。③術(shù)中:配合主治醫(yī)生,完成手術(shù)。④術(shù)后:對(duì)患者生命體征詳細(xì)監(jiān)測(cè),包括心電圖、血氧指標(biāo)、生命體征,觀察患者切口情況,是否存在滲血現(xiàn)象,積極做好切口護(hù)理;指導(dǎo)患者在床上排便。一旦,出現(xiàn)異常,及時(shí)對(duì)癥處理[5-7]。觀察組在常規(guī)護(hù)理基礎(chǔ)上選擇改良護(hù)理方式,具體措施如下。
1.2.1術(shù)前護(hù)理? ①心理護(hù)理:針對(duì)患者術(shù)前出現(xiàn)緊張、恐懼等負(fù)面心理,必須切實(shí)結(jié)合患者年齡特點(diǎn)、受教育程度等,選擇有針對(duì)溝通方式,耐心對(duì)患者講解,使其了解手術(shù)優(yōu)勢(shì)、麻醉方法、流程、相關(guān)注意事項(xiàng)等,全面消除患者疑惑,而提高患者配合度。還可充分利用成功案例,提高患者治療自信心,有效緩解患者負(fù)面情緒[8-9]。②術(shù)前準(zhǔn)備:患者術(shù)前12 h禁食,術(shù)前4 h禁飲,術(shù)前膀胱排空;術(shù)前1 d利用甘油灌腸劑對(duì)患者灌腸[10],以免患者腸道積氣和積便;提前訓(xùn)練在床上排便。
1.2.2術(shù)中護(hù)理? ①幫助患者擺放最舒適的手術(shù)體位,耐心與患者交流,以緩解患者緊張、恐懼等負(fù)面情緒;在交流中切忌討論與手術(shù)相關(guān)事情,以免增加患者心理負(fù)擔(dān)。②配合醫(yī)生完成手術(shù),并做好患者各項(xiàng)生命體征監(jiān)測(cè)工作。
1.2.3術(shù)后護(hù)理? ①呼吸道護(hù)理:術(shù)中患者要行氣管插管,不可避免地?fù)p傷患者呼吸道黏膜。術(shù)后要鼓勵(lì)患者及早下床活動(dòng),并咳出痰液。②飲食護(hù)理:麻醉蘇醒后,若患者不存在腹痛和腹脹感覺(jué),可指導(dǎo)進(jìn)食流質(zhì)食物。進(jìn)食后,如患者未出現(xiàn)嘔吐、腹瀉現(xiàn)象,可逐漸變?yōu)榘肓髻|(zhì)食物。還要指導(dǎo)患者多進(jìn)食新鮮水果、蔬菜、粗纖維食物,以防出現(xiàn)術(shù)后便秘現(xiàn)象。③并發(fā)癥護(hù)理:術(shù)后多數(shù)患者出現(xiàn)腹脹、腹痛和惡心等癥狀,要充分利用心理護(hù)理方式,轉(zhuǎn)移患者注意力。還要觀察患者切口,并遵循無(wú)菌的原則敷料更換,以免患者出現(xiàn)切口感染等并發(fā)癥。
1.3觀察指標(biāo)及評(píng)價(jià)標(biāo)準(zhǔn)
評(píng)定兩組護(hù)理效果。顯效:患者切口愈合優(yōu)良;有效:患者切口基本愈合,但效果欠佳;無(wú)效:患者切口出現(xiàn)化膿等現(xiàn)象[11]。總有效=顯效+有效。統(tǒng)計(jì)兩組的手術(shù)時(shí)間、術(shù)后切口愈合時(shí)間、切口愈合時(shí)間、精子密度、有效精子數(shù)、精子活力指數(shù)。統(tǒng)計(jì)兩組術(shù)后并發(fā)癥發(fā)生情況,包括切口感染、切口滲血、腹脹、惡心、嘔吐等。用焦慮自評(píng)量表(SAS)對(duì)兩組進(jìn)行評(píng)分,患者得分越高,表明焦慮程度越高[12]。
1.4統(tǒng)計(jì)學(xué)方法
采用SPSS 20.0統(tǒng)計(jì)軟件進(jìn)行數(shù)據(jù)分析,計(jì)量資料以均數(shù)±標(biāo)準(zhǔn)差(x±s)表示,采用t檢驗(yàn);計(jì)數(shù)資料以率表示,采用χ2檢驗(yàn),以P<0.05為差異有統(tǒng)計(jì)學(xué)意義。
2結(jié)果
2.1兩組護(hù)理效果的比較
觀察組護(hù)理總有效率為93.33%,高于對(duì)照組的80.00%,差異有統(tǒng)計(jì)學(xué)意義(P<0.05)(表1)。
2.2兩組的精子密度、有效精子數(shù)、精子活力指數(shù)的比較
觀察組精子密度、有效精子數(shù)、精子活力指數(shù)均高于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(P<0.05)(表2)。
2.3兩組切口愈合時(shí)間、住院時(shí)間的比較
觀察組切口愈合時(shí)間、住院時(shí)間短于對(duì)照組,差異均有統(tǒng)計(jì)學(xué)意義(P<0.05)(表3)。
表3? ?兩組切口愈合時(shí)間、住院時(shí)間的比較(d,x±s)
2.4兩組并發(fā)癥總發(fā)生率的比較
觀察組并發(fā)癥總發(fā)生率為10.00%,低于對(duì)照組的26.67%,差異有統(tǒng)計(jì)學(xué)意義(P<0.05)(表4)。
2.5兩組SAS評(píng)分的比較
護(hù)理后,對(duì)照組SAS評(píng)分為(29.01±5.14)分,觀察組SAS評(píng)分為(15.06±2.08)分,觀察組SAS評(píng)分低于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(t=13.780,P=0.000)。
3討論
VC主要指患者精索內(nèi)蔓狀靜脈叢異常伸長(zhǎng)、擴(kuò)張和迂曲,是臨床導(dǎo)致男性不育的重要原因。臨床手術(shù)是最佳治療方式,尤其經(jīng)臍單孔腹腔鏡下精索靜脈曲張術(shù),不僅保持普通精索靜脈高位結(jié)扎術(shù)的優(yōu)勢(shì),也在一定程度上保持患者腹壁完整性和美觀性,尤其適用青年患者[13-14]。但患者在術(shù)前,常因?yàn)樘弁?、?dān)心生育能力及術(shù)后切口愈合美觀程度等因素影響,產(chǎn)生一定心理負(fù)擔(dān),以至患者術(shù)后恢復(fù)效果不甚理想。必須加強(qiáng)患者臨床護(hù)理工作,全面提升護(hù)理質(zhì)量[15]。
本研究結(jié)果顯示,通過(guò)改良式護(hù)理干預(yù),患者護(hù)理總有效率高達(dá)93.33%,并發(fā)癥總發(fā)生率為10.00%,患者精子密度、有效精子數(shù)、精子活力指數(shù)優(yōu)于對(duì)照組,切口愈合時(shí)間和住院時(shí)間短于對(duì)照組,且SAS評(píng)分低于對(duì)照組(P<0.05),提示該護(hù)理方式效果良好。
綜上所述,通過(guò)改良式護(hù)理干預(yù)模式,提高經(jīng)臍單孔腹腔鏡下精索靜脈曲張術(shù)臨床護(hù)理效果,促進(jìn)患者術(shù)后康復(fù),提高患者生活質(zhì)量,有較高的臨床應(yīng)用價(jià)值。
[參考文獻(xiàn)]
[1]廖麗如,李倩倩,付小琴,等.改良護(hù)理干預(yù)對(duì)經(jīng)臍單孔腹腔鏡下精索靜脈曲張術(shù)患者的影響[J].中外醫(yī)學(xué)研究,2019, 17(2):78-79.
[2]張艷,盧增慧.心理護(hù)理干預(yù)對(duì)精索靜脈曲張患者負(fù)性情緒的影響研究[J].世界最新醫(yī)學(xué)信息文摘,2018,18(A3):337,339.
[3]蔣莉.精索靜脈曲張患者術(shù)前負(fù)性情緒的心理護(hù)理干預(yù)措施分析[J].現(xiàn)代醫(yī)學(xué)與健康研究電子雜志,2018,2(7):116.
[4]董翠萍.精索靜脈曲張患者術(shù)前負(fù)性情緒的護(hù)理及施行效果研究[J].中國(guó)繼續(xù)醫(yī)學(xué)教育,2017,9(36):169-171.
[5]尹萍.單側(cè)精索靜脈曲張顯微鏡顯微結(jié)扎術(shù)的快速康復(fù)護(hù)理[J].實(shí)用臨床護(hù)理學(xué)電子雜志,2017,2(16):107,111.
[6]梁燕崧.關(guān)于腹腔鏡精索靜脈曲張手術(shù)后的護(hù)理對(duì)策探討[J].數(shù)理醫(yī)藥學(xué)雜志,2017,30(2):301-302.
[7]姚艷萍.顯微鏡精索靜脈曲張結(jié)扎術(shù)手術(shù)室護(hù)理干預(yù)[J].山西醫(yī)藥雜志,2018,47(23):2895-2896.
[8]種悅,江堯青,車(chē)曉艷.腹腔鏡下精索靜脈高位結(jié)扎術(shù)65例圍術(shù)期護(hù)理體會(huì)[J].實(shí)用臨床護(hù)理學(xué)電子雜志,2018,3(35):136.
[9]汪紅姣.臨床路徑在精索靜脈曲張患者圍術(shù)期護(hù)理中的應(yīng)用[J].飲食保健,2018,5(51):224.
[10]袁園.關(guān)于腹腔鏡精索靜脈曲張手術(shù)后的護(hù)理[J].世界最新醫(yī)學(xué)信息文摘,2016,16(6):230-231.
[11]余琳,陳斌.腹腔鏡下精索靜脈曲張高位結(jié)扎術(shù)的圍術(shù)期護(hù)理研究[J].臨床醫(yī)藥文獻(xiàn)電子雜志,2017,4(97):19 101-19 102.
[12]葉惠連,黃萬(wàn)鵬,劉秀麗.改良護(hù)理模式對(duì)經(jīng)臍單孔腹腔鏡精索靜脈高位結(jié)扎術(shù)患者圍術(shù)期應(yīng)用效果[J].中國(guó)現(xiàn)代藥物應(yīng)用,2017,11(13):164-165.
[13]曹澗敏,藍(lán)麗英,謝芬芳.臨床護(hù)理路徑在精索靜脈曲張患者中的應(yīng)用效果觀察[J].中國(guó)現(xiàn)代藥物應(yīng)用,2017,11(12):146-148.
[14]李萍.精索靜脈曲張采用經(jīng)臍單孔腹腔鏡高位結(jié)扎術(shù)后護(hù)理分析[J].世界最新醫(yī)學(xué)信息文摘,2017,17(46):240.
[15]王娥.精索靜脈曲張高位結(jié)扎術(shù)圍術(shù)期護(hù)理研究[J].大醫(yī)生,2017,(5):137,155.
(收稿日期:2019-10-10? 本文編輯:崔建中)