不同体位对腹腔镜胆囊切除术病人麻醉恢复期呼吸及舒适度的影响OA北大核心CSTPCD
Influence of different postures on breathing and comfort during anesthesia recovery in patients undergoing laparoscopic cholecystectomy
目的:研究不同体位对腹腔镜胆囊切除术(LC)病人麻醉恢复期呼吸及舒适度的影响.方法:采用便利抽样法选取2022年1月-10月在西南医科大学附属医院行腹腔镜胆囊切除术的 236例病人,随机分为A组(去枕平卧位)、B组(15°半卧位)、C组(30°半卧位)、D组(渐进性半卧位),各59例.比较4组拔除喉罩2 h内的血氧饱和度、呼吸频率、呼气峰流速(PEF)、用力呼气量(FVC)、第1秒用力呼气量(FEV1)、FEV1/FVC、最大吸气压(MIP)、最大呼气压(MEP)、呼吸道并发症和舒适度.结果:B组、C组和D组在拔除喉罩1 h和2 h的PEF、FVC、FEV1、MIP、MEP均高于A组(P<0.05);B组、C组和D组在拔除喉罩2 h的FEV1/FVC高于A组(P<0.05);C组在拔除喉罩2 h的MEP高于B组(P<0.05);D组在拔除喉罩2 h的MIP和MEP值高于B组(P<0.05);B组、C组和D组的Kolcaba舒适状况量表评分高于A组(P<0.05);D组Kolcaba舒适状况量表评分高于A组、B组、C组(P<0.05);4组血氧饱和度、呼吸频率、呼吸道并发症发生率、心率、血压、平均动脉压、体温、疼痛程度、清醒程度比较,差异无统计学意义(P>0.05).结论:腹腔镜胆囊切除术病人拔除喉罩后取15°半卧、30°半卧、渐进性半卧均利于病人肺通气和呼吸力学效应,且舒适度更好.其中30°半卧和渐进性半卧更利于呼吸肌做功,渐进性半卧舒适度最佳.
Objective:To explore the influence of different postures on the patient's breathing and comfort during anesthesia recovery after laparoscopic cholecystectomy were studied.Methods:A total of 236 patients who undergoing laparoscopic cholecystectomy(LC)were selected by convenience sampling.We divided the patients into four groups:group A(supine),group B(15° semi-recumbent),group C(30° semi-recumbent)and group D(progressive semi-recumbent)randomly,59 cases in each group.Patients'SPO2,RR,Peak expiratory flow rate(PEF),forced expiratory volume(FVC),forced expiratory volume in one second(FEV1),FEV1/FVC,maximum inspiratory pressure(MIP),maximum expiratory pressure(MEP),respiratory complications,comfort was compared among four groups.Results:The values of PEF,FVC,FEV1,MIP and MEP in group B,C and D at 1 hour and 2 hours after the laryngeal mask was removed were higher than A group(P<0.05).FEV1/FVC of group B,group C and group D were higher than supine group at 2 hours after the laryngeal mask was removed(P<0.05).The MEP value of group C was higher than group B at 2 hours after the laryngeal mask was removed.The MIP and MEP values of the group D were higher than group B at 2 hours after the laryngeal mask was removed(P<0.05).Kolcaba Comfort scores of group B,group C and group D were higher than group A(P<0.05).The score of Kolcaba Comfort Scale in group D was higher than that in group A,B and C(P<0.05).There was no statistical significance in SPO2,RR,respiratory complications,blood pressure,mean arterial pressure,body temperature,pain level,level of wakefulness between the four groups(P>0.05).Conclusion:15° semi-supine position,30° semi-supine position and progressive semi-supine position after laryngeal mask removal after LC is conducive to lung ventilation and respiratory mechanical effect,and can obtain better comfort.The 30°semi-decubitus position and progressive semi-decubitus position are most conducive to the work of respiratory muscle,and the comfort of progressive semi-supine position is the best.
汤灵宇;陈顺利;蔡璐瑶;陈颖异;宋建英;胡黎欣;郑思琳
西南医科大学附属医院,四川 646000西南医科大学
腹腔镜胆囊切除术麻醉恢复期体位呼吸舒适度护理
laparoscopic cholecystectomy,LCanesthesia recovery periodpositionbreathingcomfortnursing
《护理研究》 2024 (015)
2675-2682 / 8
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