腹腔鏡治療卵巢囊腫查房

1、,云南省第一人民醫(yī)院,護(hù)理雙語(yǔ)查房--快速康復(fù)護(hù)理在腹腔鏡治療卵巢囊腫圍手術(shù)期的應(yīng)用Bilingual Nursing Round Fast-track nursing in perioperative of laparoscopic treatment for Ovarian cyst,生殖婦科 朱蕓,護(hù)理查房的目的(The purpose of this nursing round),熟悉卵巢囊腫的圍手術(shù)期護(hù)理Be

2、familiar with the perioperative nursing for Ovarian cyst掌握快速康復(fù)醫(yī)學(xué)理念，應(yīng)用于婦科腹腔鏡手術(shù)的圍手術(shù)期護(hù)理Master the Fast-track conception, and apply in gynecological laparoscopic surgery in perioperative nursing care加強(qiáng)護(hù)患溝通能力，提高更好的服務(wù) 

3、0;Strengthen the communication skills, to provide better service,2024/3/19,關(guān)鍵詞（key words）,Bil- 雙Bilingual [ba?'l??gw(?)l]  Nursing Round 雙語(yǔ)查房Bilateral   [ba?'læt(?)r(?)l] 雙側(cè) = on both s

4、ides（雙側(cè)卵巢囊腫: bilateral ovarian [??‘ve?r??n] cysts [s?st]）腹腔鏡：laparoscopy [,læp?'r?sk?p?] （-scopy 腔鏡，eg）.hysteroscopy [hist?'r?sk?pi] 宮腔鏡）術(shù)前 preoperative（前：Pre- ） 術(shù)中 intraoperative（中：intra-）

5、 （手術(shù) -Perative）術(shù)后 postoperative （后：Post-）快速康復(fù)外科： Fast - track surgery (FTS)病人自控麻醉泵：Patient controlled analgesia[,æn(?)l'd?i?z??] =PCA微創(chuàng)手術(shù):Minimally invasive [?n've?s?v] surgery,2024/3/19,,“FTS”的相關(guān)理念

6、,快速康復(fù)外科（最早在世紀(jì)初由丹麥外科醫(yī)生提出并倡導(dǎo)付諸實(shí)踐。它是指在術(shù)前、術(shù)中及術(shù)后的各個(gè)階段廣泛運(yùn)用已經(jīng)實(shí)踐證實(shí)的各種行之有效的途徑和方法，以減少外科手術(shù)病人的并發(fā)癥和應(yīng)激反應(yīng)，促進(jìn)患者手術(shù)后的康復(fù)，改善預(yù)后，促進(jìn)健康。Fast - track surgery(FTS) (as early as at the beginning of the century by a Danish surgeons and initiates

7、into practice is put forward. It refers to the preoperative, intraoperative and postoperative stages were confirmed practice widely used a variety of effective ways and methods, in order to reduce the complications and s

8、urgical patients stress response, promote patients recovery after the operation, improve the prognosis, promote health.,2024/3/19,“FTS”的相關(guān)理念,2024/3/19,（2）Lassen K,Soop M,Nygren J,et al.Consensus review of optimal periope

9、rative care in colorectal surgery: Enhanced Recovery After Surgery (ERAS) Group recommendations. Arch Surg, 2009,144(10): 961-969.,,FTS干預(yù)措施,2024/3/19,(1)吳茜，陳靜娟等，多學(xué)科合作快速康復(fù)外科模式中護(hù)理的作用,中國(guó)護(hù)理管理[J]，2014,14（2），215-218,術(shù)前評(píng)估與優(yōu)化,患者

10、信息,減輕壓力,液體治療,緩解疼痛,特殊護(hù)理（引流管）,經(jīng)口營(yíng)養(yǎng),活動(dòng)與鍛煉,術(shù)后加快康復(fù),,,,術(shù)前,術(shù)后,“FTS”TIPS,術(shù)前準(zhǔn)備,充分的術(shù)前準(zhǔn)備 縮短術(shù)前禁食禁飲的時(shí)間,術(shù)后護(hù)理,保暖和心理護(hù)理完備充分的疼痛護(hù)理早期經(jīng)口進(jìn)食和早期活動(dòng)重視術(shù)后休息和睡眠,2024/3/19,“FTS”TIPS,充分的術(shù)前準(zhǔn)備：完備的護(hù)理健康教育，強(qiáng)調(diào)充分履行告知義務(wù)和健康宣教的責(zé)任，充分告知病人手術(shù)各個(gè)環(huán)節(jié)和相關(guān)注意事項(xiàng)。Suf

11、ficient preoperative preparation,Complete nursing health education, emphasizing the full performance of the inform obligation and the responsibility of the health education, filling each link points to inform patien

12、ts and related matters needing attention.,2024/3/19,“FTS”TIPS,縮短術(shù)前禁食禁飲的時(shí)間有研究表明，長(zhǎng)時(shí)間禁食水會(huì)導(dǎo)致病人的饑餓，口渴，脫水，煩躁等不良應(yīng)激和由此產(chǎn)生的血容量減少以及低血糖等的病理生理變化，會(huì)極大的增加手術(shù)的不耐受性。To shorten the time of banning food and fliud in preoperativeResearch

13、has shown that banning food and fliud for a long time can lead to the patient's hunger, thirst, dehydration, irritability and other adverse stress , the resulting blood volume decrease and the pathology of hypoglycem

14、ia and physiological changes, will greatly increase the surgery is not tolerated.,2024/3/19,縮短術(shù)前禁食禁飲的時(shí)間,The major purpose of withholding food and fluid before surgery is to prevent aspiration. Lengthy restriction of food

15、 and fluid is unncessary. The American society of anesthesologists has resulted in new recommendations for persons undergoing elective surgery who are otherwise healthy. The recommendations depend on the age of the patie

16、nt and type of food eaten. For example ,adults are adivsed to fast for 8 hours after eating fatty food and 4 hours after ingesting milk products. Most patients are currently allowed clear liquids up to 2 hours before an

17、elective procedure.,2024/3/19,“FTS”TIPS,早期經(jīng)口進(jìn)食和早期活動(dòng)。有研究表明，長(zhǎng)時(shí)間禁食水會(huì)導(dǎo)致手術(shù)病人內(nèi)環(huán)境紊亂，且兩者呈負(fù)相關(guān)。禁食時(shí)胃腸蠕動(dòng)緩慢、不規(guī)律；而進(jìn)食時(shí)胃腸蠕動(dòng)則有力、頻繁和有規(guī)律。Early feeding and early activities.Research has shown that banning for a long time can lead to sur

18、gery patientsEnvironmental disturbance, and negatively correlated with both. When fasting gastrointestinal prayer move slow, irregular; While eating gastrointestinal screw motion strongly, frequently and regularly.,202

19、4/3/19,早期經(jīng)口進(jìn)食,術(shù)后保證早期的保溫工作及宣教工作， 術(shù)后 3 小時(shí)麻醉清醒后可飲 10 ～ 20 mL 水， 觀(guān)察患者有無(wú)不適癥狀， 半小時(shí)后再增加飲水量 50 ～ 100 mL.(3)The insulation work of the early postoperative and missionary work, after 3 hours awake anesthesia can drink 10 ~ 20 m

20、L water, observing the patient`s symptoms, and adding water quantity in half an hour 50 ~ 100 mL.(3)李玉文，何婉珠等，快速康復(fù)護(hù)理模式在腹腔鏡治療卵巢囊腫圍手術(shù)期的應(yīng)用研究，臨床醫(yī)學(xué)工程[J]，2016,23（3）379-380.,2024/3/19,早期活動(dòng),鼓勵(lì)患者術(shù)后早期進(jìn)行活動(dòng)， 術(shù)后 6 小時(shí)進(jìn)行半坐臥未出現(xiàn)頭暈等不適癥狀后

21、， 再進(jìn)行床上活動(dòng)， 漸進(jìn)式床旁活動(dòng)， 初次活動(dòng)在 5 分鐘內(nèi),在上述的基礎(chǔ)下， 可進(jìn)行床旁的慢走， 漸漸增加走的路程(4).Early postoperative activities, encourage patients after operation 6 hours to have half sit , if there is no symptoms such as dizziness, can have bed activi

22、ty, progressive activities by the bed, the first activity in 5 minutes, on the basis of the above, walking beside the bed, can be gradually increase journey. (4)單葵順 , 鄧晨暉 . 快速康復(fù)外科理念在手術(shù)室護(hù)理中的應(yīng)用 [J]

23、 .廣東醫(yī)學(xué), 2014, 35 (4) : 637-639.,2024/3/19,How to use 'fts' into perioperative?,如何將“快速康復(fù)外科”的理念運(yùn)用下述患者的圍手術(shù)期？,2024/3/19,病史匯報(bào)（Case report）,床號(hào)：08姓名：馬麗性別：女年齡 ：30歲現(xiàn)病史：患者因不孕癥就診，B超示雙側(cè)卵巢囊腫（左側(cè)5.5*3.5cm，5.3*3.9cm，右側(cè)2.2*1.

24、8cm）,有生育要求，要求手術(shù)治療。既往史：否認(rèn)外傷、手術(shù)輸血史及過(guò)敏史生育史：0-0-0-0,Bed No. : NO.08Name: MaryGender: femaleAge: 30 years oldHpi: Patient with infertility, B ultrasonic shown bilateral ovarian cysts (left side of the 5.5 * 3.5 cm, 3.5

25、 * 3.9 cm, right side of 2.2 * 1.8 cm) ， fertility requirement，requires surgery.Past medical history: Deny that history of trauma, surgery ， blood transfusion ，and drug allergy;Reproductive history: 0-0-0-0,2024/3/19

26、,查體（Physical examination）,體溫36.9℃，脈搏88次/分，呼吸18次/分，血壓113/73mmHg。神志清楚，一般情況好，神清。腹平軟，無(wú)壓痛及反跳痛。外陰：婚型，陰毛分布正常；陰道：通暢，少量白色分泌物；宮頸：柱狀，光滑；無(wú)舉擺痛；宮體：前位，常大，表面光滑，無(wú)壓痛；雙附件區(qū)(陽(yáng)性體征)：右附件區(qū)可觸及一約7*5cm的包塊，質(zhì)中等，輕壓痛，左附件去未觸及明顯異常,Temperature 36.9

27、 ℃, pulse 88 / cent, breathing 18 times per minute, blood pressure is 113/73 MMHG.Conscious, generally good.Abdominal plain soft, no tenderness and bounce painful.Vulva: marriage type, pubic hair normal distribution;

28、Vagina: smooth a small amount of white discharge;The cervical: columnar, smooth; No place pain;From: front, normol large, smooth surface, no tenderness;Adnexa massa(Positive signs): the right area can touch a mass abo

29、ut 7 * 5 cm, light tenderness,2024/3/19,診斷（Diagnosis）,【入院日期】： 2016-12-15【擬手術(shù)日期】：2016-12-16　【術(shù)前診斷】：雙側(cè)卵巢囊腫【擬施手術(shù)名稱(chēng)】：腹腔鏡下卵巢囊腫剝除術(shù)【麻醉方式】：全麻【 Admission date 】 December 15，2016【 Proposed surgery date】: December 16, 2016

30、【 Preoperative diagnosis 】 : Bilateral ovarian cysts【 Intends to operate on】: Laparoscopic surgery【 anesthesia 】 : General anesthesia.,2024/3/19,術(shù)前腸道準(zhǔn)備 （ The bowel preparation for the surgery）,2024/3/19,半流質(zhì),導(dǎo)瀉劑0.9%NS

31、500ml+ 20%甘露醇250ml,常規(guī)灌腸一次,禁食不禁飲,禁食、禁飲,,手術(shù)前晚,,手術(shù)當(dāng)天,,手術(shù)記錄（ The operation records ）,【手術(shù)日期】： 10:15 December 16, 2016【實(shí)施手術(shù)名稱(chēng)】：腹腔鏡下雙側(cè)卵巢巧克力卵巢囊腫剝除術(shù)+盆腔粘連松解術(shù)【麻醉方式】：全麻【出血量（Bleeding)】：300ml 【管道】：腹腔引流管1 根，留置尿管1根【病人自控鎮(zhèn)痛泵（PCA）】：

32、是,2024/3/19,護(hù)理診斷（The nursing diagnosis）,恐懼：與擔(dān)心手術(shù)失敗有關(guān)，擔(dān)心不能妊娠有關(guān)Fear： worry about the operation failure, and worry cannot pregnant術(shù)前舒適的改變：與長(zhǎng)時(shí)間禁食、禁飲有關(guān)Preoperative comfortable change: related to the banned from food and dr

33、ink for a long time疼痛：與術(shù)后麻醉失效有關(guān)Pain: associated with postoperative anesthetic failure有導(dǎo)管滑脫的危險(xiǎn)Risk of catheter slipping有感染的危險(xiǎn)：與手術(shù)有關(guān) Risk of infection: associated with operation,2024/3/19,護(hù)理措施（The nursing interventio

34、ns）,恐懼：向病人介紹卵巢囊腫的有關(guān)知識(shí)，增強(qiáng)患者信心，聯(lián)合家屬給予患者術(shù)前術(shù)后的心理支持Introduce to the patient on the knowledge of ovarian cyst, enhance patient's confidence, joint families for the patient about preoperative and postoperative with psycho

35、logical support,2024/3/19,,術(shù)前舒適的改變：與長(zhǎng)時(shí)間禁食、禁飲有關(guān),2024/3/19,Can we use “FTS” into intervention?,護(hù)理措施（The nursing interventions）,術(shù)前舒適的改變：與長(zhǎng)時(shí)間禁食、禁飲有關(guān),2024/3/19,半流質(zhì),導(dǎo)瀉劑0.9%NS500ml+ 20%甘露醇250ml,常規(guī)灌腸一次,禁食不禁飲,禁食、禁飲,,手術(shù)前晚,,手術(shù)當(dāng)天,P

36、atient`s feeling：Thirsty, hungry, and dizzy！,Can we use “FTS” into intervention?,護(hù)理措施（The nursing interventions）,疼痛,定時(shí)翻身，協(xié)助患者采取舒適臥位安慰病人，緩解其焦慮和恐懼感各種操作時(shí)動(dòng)作輕柔合理使用麻醉鎮(zhèn)痛泵（PCA）,,Timing turn, help patients to take comfortable

37、 lying positionComfort the patients, alleviate the anxiety and fearAll kinds of operation is gentleAnesthesia analgesia pump,2024/3/19,護(hù)理措施（The nursing interventions）,防導(dǎo)管滑脫妥善固定（fixed）懸掛警示標(biāo)示（score=10），床頭交接向家屬及患者行防導(dǎo)

38、管滑脫的健康宣教早日拔管,2024/3/19,drainage tube,urine tube,傳統(tǒng)的圍手術(shù)期護(hù)理,The traditional perioperative nursing包括入院宣教、 術(shù)前指導(dǎo)、 解答患者疑問(wèn)， 按照常規(guī)的腹腔鏡手術(shù)準(zhǔn)備和外科護(hù)理常規(guī)進(jìn)行護(hù)理， 要求患者術(shù)前 口服導(dǎo)瀉劑，12 小時(shí)禁食， 4 ～ 6 小時(shí)前禁飲水； 術(shù)后根據(jù)麻醉方式采去枕平臥或平臥， 血壓平穩(wěn)后， 采取側(cè)臥位或半臥位， 于患者肛

39、門(mén)排氣后方可進(jìn)食、 水。,2024/3/19,,2024/3/19,護(hù)理措施（The nursing interventions）,術(shù)前舒適的改變：與長(zhǎng)時(shí)間禁食、禁飲有關(guān),2024/3/19,Can we use “FTS” into intervention?,\(^o^)/YES!,How to use 'fts' into perioperative?,2024/3/19,快速康復(fù)外科護(hù)理可促進(jìn)卵巢囊腫行腹腔鏡治療

40、患者的術(shù)后恢復(fù)， 減少住院時(shí)間， 比傳統(tǒng)護(hù)理模式更具優(yōu)勢(shì)， 值得在臨床中應(yīng)用和推廣(3)。,(3)李玉文，何婉珠等，快速康復(fù)護(hù)理模式在腹腔鏡治療卵巢囊腫圍手術(shù)期的應(yīng)用研究，臨床醫(yī)學(xué)工程[J]，2016,23（3）379-380.,,護(hù)士在 FTS 的具體執(zhí)行中不能被動(dòng)地執(zhí)行醫(yī)囑，而應(yīng)積極動(dòng)態(tài)觀(guān)察和有效地評(píng)估、分析患者的病情，主動(dòng)與醫(yī)生溝通，主動(dòng)地采取及時(shí)有效的措施提高患者舒適度，個(gè)性化地開(kāi)展護(hù)理措施，切實(shí)做到因人施護(hù)、因病施護(hù)，促進(jìn)術(shù)后

41、康復(fù)(1)。Nurses can't passively in the specific execution of FTS executed the doctor's advice, and should actively dynamic observation and effective assessment, analysis of the patient, take the initiative to commu

42、nicate with the doctor, and the initiative to take timely and effective measures to improve patient comfort, give the patient an personalized nursing measures, effectively because the nursing and the nursing due to illn