余家菊 趙娟
【摘要】目的:探討人性化護(hù)理在瘢痕子宮妊娠產(chǎn)婦子宮動(dòng)脈栓塞術(shù)后的應(yīng)用價(jià)值。方法:選取我院婦產(chǎn)科收治的子宮動(dòng)脈栓塞術(shù)后的瘢痕子宮妊娠患者80例,時(shí)間區(qū)間設(shè)置在2019年10月—2020年11月。以隨機(jī)數(shù)字抽取法將選中病例進(jìn)行分組,分別命名為觀察組和對(duì)照組。兩組病例均為40例,觀察組進(jìn)行人性化護(hù)理,對(duì)照組進(jìn)行常規(guī)護(hù)理,觀察分析人性化護(hù)理在子宮動(dòng)脈栓塞術(shù)治療瘢痕子宮妊娠護(hù)理中的應(yīng)用價(jià)值。結(jié)果:兩組患者VAS評(píng)分對(duì)比,觀察組疼痛程度小于對(duì)照組(P<0.05);兩組產(chǎn)婦住院時(shí)間、自主哺乳時(shí)間以及入住新生兒ICU率上,觀察組均小于對(duì)照組(P<0.05);觀察組新生兒出生5minApgar評(píng)分上低于對(duì)照組(P<0.05);兩組患者護(hù)理滿意度比較上,觀察組為95%、高于對(duì)照組的70%(P<0.05)。結(jié)論:人性化護(hù)理在子宮動(dòng)脈栓塞術(shù)治療瘢痕子宮妊娠護(hù)理中的應(yīng)用可有效緩解產(chǎn)婦術(shù)后疼痛,縮短住院時(shí)間,對(duì)產(chǎn)婦和新生兒均起到積極作用。
【關(guān)鍵詞】瘢痕子宮妊娠;子宮動(dòng)脈栓塞術(shù);人性化護(hù)理;應(yīng)用價(jià)值
Application value of humanized nursing in uterine artery embolization in the treatment of scar uterus pregnancy nursing
YU Jiaju1,ZHAO Juan2
1.Zhenba Peoples Hospital, Hanzhong, Shaanxi 723600, China; 2.Jingyang Community Health and Family Planning Service Center, Zhenba County, Hanzhong, Shaanxi 723600, China
【Abstract】Objective: To explore the application value of humanized nursing inscar uterus pregnancy after uterine artery embolization. Methods: A total of 80 patients with scar uterus pregnancy after uterine artery embolization were selected in our hospital from October 2019 to November 2020.The selected cases were divided into observation group and control group by random number extraction method.There were 40 cases in both groups.Humanized nursing was performed in the observation group and routine nursing was performed in the control group.The value of humanized nursing in the treatment of uterine artery embolization for scar uterus pregnancy was observed and analyzed. Results: VAS scores of the two groups were compared,and the pain degree of the observation group was less than that of the control group(P<0.05);The duration of maternal hospitalization,self-lactation time and neonatal ICU admission rate in the observation group were lower than those in the control group(P<0.05);The Apgar score at 5 min after birth in the observation group was lower than that in the control group(P<0.05);The nursing satisfaction of patients in the observation group was 95.00%,which was higher than 70.00% in the control group(P<0.05). Conclusion: The application of humanized nursing in uterine artery embolization inthe treatment ofscar uterus pregnancy nursing can effectively alleviate the postoperative pain of pregnant women,shorten the hospital stay,and play a positive role inboth puerpera women and newborns.
【Key Words】Scar uterus pregnancy; Uterine artery embolization; Humanized nursing; Application value
瘢痕妊娠,又稱瘢痕子宮疤痕妊娠[1]。子宮手術(shù)史如剖宮產(chǎn)術(shù)、子宮肌瘤剔除術(shù)、子宮成形術(shù)等均可導(dǎo)致瘢痕子宮妊娠[2]。瘢痕妊娠是特殊部位的異位妊娠,子宮切口瘢痕沒(méi)有破裂時(shí),癥狀常不明顯。典型臨床表現(xiàn)為此次起病有停經(jīng)史,出現(xiàn)陰道少量流血,部分患者可有輕微下腹痛,但是出現(xiàn)癥狀的孕周早晚不一。隨著妊娠的進(jìn)展,患者可發(fā)生子宮破裂,出現(xiàn)突發(fā)的劇烈腹痛、陰道大出血、暈厥或有血壓下降、心跳增快等休克癥狀。嚴(yán)重威脅女性的生殖健康甚至生命。子宮動(dòng)脈栓塞術(shù)是目前臨床對(duì)瘢痕子宮妊娠產(chǎn)婦的有效治療手段,其具有安全性高、創(chuàng)口小的特點(diǎn)。為探尋提高對(duì)經(jīng)子宮動(dòng)脈栓塞術(shù)治療瘢痕妊娠的治療療效,我院將婦產(chǎn)科收治的子宮動(dòng)脈栓塞術(shù)后的80例瘢痕子宮妊娠患者進(jìn)行臨床分組研究,觀察人性化護(hù)理對(duì)其的應(yīng)用價(jià)值。
1.1 臨床資料
選取我院婦產(chǎn)科收治的子宮動(dòng)脈栓塞術(shù)后的瘢痕子宮妊娠患者80例,時(shí)間區(qū)間設(shè)置在2019年10月—2020年11月?;颊邼M足下列條件:①患者知曉本次研究并積極配合;②患者及家屬簽署相關(guān)同意書;③患者無(wú)免疫功能缺失;④患者無(wú)精神病史;⑤患者無(wú)其它重大疾患。以隨機(jī)數(shù)字抽取法將選中病例進(jìn)行分組,組別命名為觀察組和對(duì)照組,兩組病例均為40例。觀察組進(jìn)行人性化護(hù)理,年齡28~40歲,平均年齡(31.57±3.21)歲,孕周7~38周,平均孕周(25.07±7.53)周,子宮手術(shù)至此次妊娠時(shí)間2~6年,平均時(shí)間(4.31±1.25)年;對(duì)照組進(jìn)行常規(guī)護(hù)理,年齡27~81歲,平均年齡(32.11±3.24)歲,孕周8~39周,平均孕周(25.03±7.56)周,子宮手術(shù)至此次妊娠時(shí)間2.5~6年,平均時(shí)間(4.37±1.29)年。以上個(gè)人資料對(duì)比均無(wú)統(tǒng)計(jì)學(xué)意義(P>0.05)。
1.2 方法
1.2.1 對(duì)照組進(jìn)行常規(guī)護(hù)理:對(duì)患者生命體征及每日情況進(jìn)行監(jiān)測(cè),異常情況及時(shí)告知醫(yī)生。對(duì)患者進(jìn)行疾病科普,對(duì)病情發(fā)展及轉(zhuǎn)歸耐心講解。給予患者飲食、睡眠、用藥指導(dǎo),對(duì)家屬詢問(wèn)的問(wèn)題進(jìn)行通俗易懂的解答,關(guān)注患者情緒狀況,做好相關(guān)防預(yù)工作。
1.2.2 觀察組在對(duì)照組基礎(chǔ)上進(jìn)行個(gè)性化護(hù)理:①用藥護(hù)理:遵循醫(yī)囑給予患者藥物治療,對(duì)患者每日需要服用的藥物及劑量進(jìn)行囑咐,告知服用方式、禁忌和注意事項(xiàng)。給患者進(jìn)行藥物科普,讓患者了解到用藥的原因和目的,解答患者提出的困惑,對(duì)服藥所會(huì)出現(xiàn)的不良反應(yīng)進(jìn)行解釋,并告知患者若服藥后出現(xiàn)不良反應(yīng)需及時(shí)按床頭鈴或令家屬告知護(hù)理人員。②體位護(hù)理:患者術(shù)后12h內(nèi)需進(jìn)行制動(dòng),并加壓包扎。部分患者可能因長(zhǎng)時(shí)間保持單一體位而難以耐受,出現(xiàn)焦躁不安、配合度降低等抗拒反應(yīng),護(hù)理人員應(yīng)及時(shí)對(duì)患者情緒予以緩解和鎮(zhèn)定,待患者冷靜下來(lái)后,護(hù)理人員向患者講解保持正確體位的重要性,使患者深刻了解到體位的保持對(duì)后續(xù)的影響,可適當(dāng)輔助患者進(jìn)行另一側(cè)肢體或手術(shù)肢體其他關(guān)節(jié)的活動(dòng),適當(dāng)變換體位,緩解患者生理和心理上的不適感[3]。③心理護(hù)理:自患者住院起,護(hù)理人員應(yīng)開(kāi)始對(duì)其進(jìn)行心理干預(yù)。因術(shù)前患者可能會(huì)對(duì)疾病和手術(shù)產(chǎn)生恐懼心理,持續(xù)的恐慌和擔(dān)憂會(huì)使患者處于時(shí)刻緊張狀態(tài),對(duì)治療和預(yù)后均會(huì)產(chǎn)生影響。護(hù)理人員應(yīng)注意觀察患者情緒,了解到患者情緒問(wèn)題的癥結(jié)所在,并在日常治療和護(hù)理的接觸中對(duì)患者進(jìn)行針對(duì)性的情緒疏導(dǎo),溫柔地疏解患者的緊張情緒,向患者解釋手術(shù)的原因和治療的必要,術(shù)前會(huì)使用鎮(zhèn)痛藥以減輕術(shù)中及術(shù)后疼痛,可提及成功或積極案例以鼓勵(lì)患者,增強(qiáng)患者手術(shù)和治療的自信。術(shù)中應(yīng)注意將手術(shù)室環(huán)境保持整潔舒適、手術(shù)氛圍不宜過(guò)于嚴(yán)肅,對(duì)于分娩過(guò)程中保持清醒的患者在條件允許的情況下可與之交談,時(shí)刻觀察患者的精神狀況,幫助緩解其心理壓力,轉(zhuǎn)移注意力,對(duì)于患者所提出的不適要予以適當(dāng)?shù)奶幚恚够颊叩氖中g(shù)更為順利。術(shù)后患者會(huì)因關(guān)心手術(shù)效果、自身恢復(fù)情況、新生兒情況等產(chǎn)生焦慮、抑郁情緒,在家屬和病情允許的情況下,可適當(dāng)向患者透露手術(shù)的效果及相關(guān)情況,消除患者的擔(dān)憂[4]。④飲食護(hù)理:患者術(shù)后無(wú)需禁食,護(hù)理人員應(yīng)結(jié)合病情和患者日常飲食習(xí)慣,來(lái)為患者制定科學(xué)合理的飲食食譜。⑤運(yùn)動(dòng)護(hù)理:在患者解除制動(dòng)后,觀察患者手術(shù)部位。若手術(shù)部位無(wú)滲血、滲液、無(wú)血腫等異常情況,可囑患者家屬根據(jù)患者的意愿和身體素質(zhì),進(jìn)行適當(dāng)?shù)倪\(yùn)動(dòng)。
1.3 觀察指標(biāo)
(1)對(duì)比兩組患者術(shù)后疼痛程度評(píng)分:以VAS疼痛模擬評(píng)分來(lái)對(duì)患者疼痛程度進(jìn)行評(píng)價(jià),準(zhǔn)備一刻度為10的標(biāo)尺,0~10刻度分別代表患者疼痛的不同程度,“0”度為無(wú)疼痛感覺(jué),“10”度為疼痛急劇難忍,患者口述疼痛程度,度數(shù)越大疼痛越劇烈。(2)記錄兩組產(chǎn)婦及患兒相關(guān)指標(biāo):產(chǎn)婦住院時(shí)間、自主哺乳時(shí)間、新生兒出生5min Apgar評(píng)分以及入住新生兒ICU率。(3)兩組患者護(hù)理滿意度比較:患者出院時(shí)進(jìn)行護(hù)理滿意度評(píng)估,分為十分滿意(90~100分),滿意(61~89分),不滿意(≤60分),統(tǒng)計(jì)滿意程度數(shù)據(jù),護(hù)理滿意度為十分滿意和滿意人數(shù)占總例數(shù)的比。
1.4 統(tǒng)計(jì)學(xué)分析
采用SPSS 19.0統(tǒng)計(jì)學(xué)軟件進(jìn)行數(shù)據(jù)分析。計(jì)數(shù)資料采用(%)表示,進(jìn)行χ2檢驗(yàn),計(jì)量資料采用(χ±s)表示,進(jìn)行t檢驗(yàn),P<0.05為差異具有統(tǒng)計(jì)學(xué)意義。
2.1 兩組患者術(shù)后疼痛程度比較
兩組患者術(shù)后疼痛評(píng)估,觀察組疼痛評(píng)分小于對(duì)照組,且檢驗(yàn)后(P<0.05),見(jiàn)表1。
2.2 兩組患者相關(guān)指標(biāo)對(duì)比
觀察組患者的住院時(shí)間、自主哺乳時(shí)間以及入住新生兒ICU率均低于對(duì)照組,且對(duì)比明顯(P<0.05),觀察組新生兒出生5min Apgar評(píng)分明顯高于對(duì)照組,差異具有統(tǒng)計(jì)學(xué)差異(P<0.05),見(jiàn)表2。
2.3 兩組患者護(hù)理滿意度比較
兩組患者出院時(shí)護(hù)理滿意度統(tǒng)計(jì),觀察組護(hù)理滿意度為95.00%,高于對(duì)照組的70.00%,兩組護(hù)理滿意度比較差異具統(tǒng)計(jì)學(xué)意義(P<0.05),見(jiàn)表3。
人性化護(hù)理模式的應(yīng)用,對(duì)患者術(shù)前、術(shù)中、術(shù)后的心理狀態(tài)均進(jìn)行密切的觀察,及時(shí)了解到患者情緒的波動(dòng),并針對(duì)性地對(duì)其情緒的癥結(jié)所在進(jìn)行開(kāi)導(dǎo)和疏解?;颊咭蝰:廴焉锒霈F(xiàn)的擔(dān)憂、恐慌情緒均會(huì)得到較好的緩解。護(hù)理人員通過(guò)對(duì)其進(jìn)行飲食、用藥和運(yùn)動(dòng)、體位的指導(dǎo),全方位地對(duì)患者住院期間所會(huì)遇到的問(wèn)題進(jìn)行解答和科學(xué)的引導(dǎo),幫助患者規(guī)范飲食、嚴(yán)格用藥,適當(dāng)?shù)財(cái)[正體位和舒緩地進(jìn)行運(yùn)動(dòng),很大程度上提高治療的整體療效,對(duì)患者預(yù)后也產(chǎn)生積極影響。護(hù)理全程通過(guò)人性化的方式,理解患者的痛苦,緩解患者的情緒,解決患者的問(wèn)題,從而提升整體護(hù)理質(zhì)量,使患者在擁有正確心態(tài)的前提下邁向人生的下一步[4]。
本次研究中,兩組患者術(shù)后疼痛評(píng)估,觀察組疼痛評(píng)分小于對(duì)照組(P<0.05);觀察組住院時(shí)間、自主哺乳時(shí)間以及入住新生兒ICU率均低于對(duì)照組,新生兒出生5min Apgar評(píng)分明顯高于對(duì)照組(P<0.05);觀察組護(hù)理滿意度高于對(duì)照組,且差異較大(P<0.05)。
綜上所述,人性化護(hù)理在子宮動(dòng)脈栓塞術(shù)治療瘢痕子宮妊娠護(hù)理中的應(yīng)用可有效緩解產(chǎn)婦術(shù)后疼痛,縮短住院時(shí)間,對(duì)產(chǎn)婦和新生兒均起到積極作用。
參考文獻(xiàn)
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