腹腔镜治疗卵巢囊肿查房PPT课件.ppt

,云南省第一人民医院,护理双语查房-快速康复护理在腹腔镜治疗卵巢囊肿围手术期的应用BilingualNursingRoundFast-tracknursinginperioperativeoflaparoscopictreatmentforOvariancyst,生殖妇科朱芸,护理查房的目的(Thepurposeofthisnursinground),熟悉卵巢囊肿的围手术期护理BefamiliarwiththeperioperativenursingforOvariancyst掌握快速康复医学理念，应用于妇科腹腔镜手术的围手术期护理MastertheFast-trackconception,andapplyingynecologicallaparoscopicsurgeryinperioperativenursingcare加强护患沟通能力，提高更好的服务Strengthenthecommunicationskills,toprovidebetterservice,2019/12/15,关键词（keywords）,Bil-双Bilingualbalgw()lNursingRound双语查房Bilateralbalt()r()l双侧=onbothsides（双侧卵巢囊肿:bilateralovarianverncystssst）腹腔镜：laparoscopy,lprskp（-scopy腔镜，eg）.hysteroscopyhistrskpi宫腔镜）术前preoperative（前：Pre-）术中intraoperative（中：intra-）（手术-Perative）术后postoperative（后：Post-）快速康复外科：Fast-tracksurgery(FTS)病人自控麻醉泵：Patientcontrolledanalgesia,n()ldiz=PCA微创手术:Minimallyinvasivenvesvsurgery,2019/12/15,“FTS”的相关理念,快速康复外科（最早在世纪初由丹麦外科医生提出并倡导付诸实践。它是指在术前、术中及术后的各个阶段广泛运用已经实践证实的各种行之有效的途径和方法，以减少外科手术病人的并发症和应激反应，促进患者手术后的康复，改善预后，促进健康。Fast-tracksurgery(FTS)(asearlyasatthebeginningofthecenturybyaDanishsurgeonsandinitiatesintopracticeisputforward.Itreferstothepreoperative,intraoperativeandpostoperativestageswereconfirmedpracticewidelyusedavarietyofeffectivewaysandmethods,inordertoreducethecomplicationsandsurgicalpatientsstressresponse,promotepatientsrecoveryaftertheoperation,improvetheprognosis,promotehealth.,2019/12/15,“FTS”的相关理念,2019/12/15,（2）LassenK,SoopM,NygrenJ,etal.Consensusreviewofoptimalperioperativecareincolorectalsurgery:EnhancedRecoveryAfterSurgery(ERAS)Grouprecommendations.ArchSurg,2009,144(10):961-969.,FTS干预措施,2019/12/15,(1)吴茜，陈静娟等，多学科合作快速康复外科模式中护理的作用,中国护理管理J，2014,14（2），215-218,术前评估与优化,患者信息,减轻压力,液体治疗,缓解疼痛,特殊护理（引流管）,经口营养,活动与锻炼,术后加快康复,术前,术后,“FTS”TIPS,术前准备,充分的术前准备缩短术前禁食禁饮的时间,术后护理,保暖和心理护理完备充分的疼痛护理早期经口进食和早期活动重视术后休息和睡眠,2019/12/15,“FTS”TIPS,充分的术前准备：完备的护理健康教育，强调充分履行告知义务和健康宣教的责任，充分告知病人手术各个环节和相关注意事项。Sufficientpreoperativepreparation,Completenursinghealtheducation,emphasizingthefullperformanceoftheinformobligationandtheresponsibilityofthehealtheducation,fillingeachlinkpointstoinformpatientsandrelatedmattersneedingattention.,2019/12/15,“FTS”TIPS,缩短术前禁食禁饮的时间有研究表明，长时间禁食水会导致病人的饥饿，口渴，脱水，烦躁等不良应激和由此产生的血容量减少以及低血糖等的病理生理变化，会极大的增加手术的不耐受性。ToshortenthetimeofbanningfoodandfliudinpreoperativeResearchhasshownthatbanningfoodandfliudforalongtimecanleadtothepatientshunger,thirst,dehydration,irritabilityandotheradversestress,theresultingbloodvolumedecreaseandthepathologyofhypoglycemiaandphysiologicalchanges,willgreatlyincreasethesurgeryisnottolerated.,2019/12/15,缩短术前禁食禁饮的时间,Themajorpurposeofwithholdingfoodandfluidbeforesurgeryistopreventaspiration.Lengthyrestrictionoffoodandfluidisunncessary.TheAmericansocietyofanesthesologistshasresultedinnewrecommendationsforpersonsundergoingelectivesurgerywhoareotherwisehealthy.Therecommendationsdependontheageofthepatientandtypeoffoodeaten.Forexample,adultsareadivsedtofastfor8hoursaftereatingfattyfoodand4hoursafteringestingmilkproducts.Mostpatientsarecurrentlyallowedclearliquidsupto2hoursbeforeanelectiveprocedure.,2019/12/15,“FTS”TIPS,早期经口进食和早期活动。有研究表明，长时间禁食水会导致手术病人内环境紊乱，且两者呈负相关。禁食时胃肠蠕动缓慢、不规律；而进食时胃肠蠕动则有力、频繁和有规律。Earlyfeedingandearlyactivities.ResearchhasshownthatbanningforalongtimecanleadtosurgerypatientsEnvironmentaldisturbance,andnegativelycorrelatedwithboth.Whenfastinggastrointestinalprayermoveslow,irregular;Whileeatinggastrointestinalscrewmotionstrongly,frequentlyandregularly.,2019/12/15,早期经口进食,术后保证早期的保温工作及宣教工作，术后3小时麻醉清醒后可饮1020mL水，观察患者有无不适症状，半小时后再增加饮水量50100mL.(3)Theinsulationworkoftheearlypostoperativeandmissionarywork,after3hoursawakeanesthesiacandrink1020mLwater,observingthepatientssymptoms,andaddingwaterquantityinhalfanhour50100mL.(3)李玉文，何婉珠等，快速康复护理模式在腹腔镜治疗卵巢囊肿围手术期的应用研究，临床医学工程J，2016,23（3）379-380.,2019/12/15,早期活动,鼓励患者术后早期进行活动，术后6小时进行半坐卧未出现头晕等不适症状后，再进行床上活动，渐进式床旁活动，初次活动在5分钟内,在上述的基础下，可进行床旁的慢走，渐渐增加走的路程(4).Earlypostoperativeactivities,encouragepatientsafteroperation6hourstohavehalfsit,ifthereisnosymptomssuchasdizziness,canhavebedactivity,progressiveactivitiesbythebed,thefirstactivityin5minutes,onthebasisoftheabove,walkingbesidethebed,canbegraduallyincreasejourney.(4)单葵顺,邓晨晖.快速康复外科理念在手术室护理中的应用J.广东医学,2014,35(4):637-639.,2019/12/15,Howtouseftsintoperioperative?,如何将“快速康复外科”的理念运用下述患者的围手术期？,2019/12/15,病史汇报（Casereport）,床号：08姓名：马丽性别：女年龄：30岁现病史：患者因不孕症就诊，B超示双侧卵巢囊肿（左侧5.5*3.5cm，5.3*3.9cm，右侧2.2*1.8cm）,有生育要求，要求手术治疗。既往史：否认外伤、手术输血史及过敏史生育史：0-0-0-0,BedNo.:NO.08Name:MaryGender:femaleAge:30yearsoldHpi:Patientwithinfertility,Bultrasonicshownbilateralovariancysts(leftsideofthe5.5*3.5cm,3.5*3.9cm,rightsideof2.2*1.8cm)，fertilityrequirement，requiressurgery.Pastmedicalhistory:Denythathistoryoftrauma,surgery，bloodtransfusion，anddrugallergy;Reproductivehistory:0-0-0-0,2019/12/15,查体（Physicalexamination）,体温36.9，脉搏88次/分，呼吸18次/分，血压113/73mmHg。神志清楚，一般情况好，神清。腹平软，无压痛及反跳痛。外阴：婚型，阴毛分布正常；阴道：通畅，少量白色分泌物；宫颈：柱状，光滑；无举摆痛；宫体：前位，常大，表面光滑，无压痛；双附件区(阳性体征)：右附件区可触及一约7*5cm的包块，质中等，轻压痛，左附件去未触及明显异常,Temperature36.9,pulse88/cent,breathing18timesperminute,bloodpressureis113/73MMHG.Conscious,generallygood.Abdominalplainsoft,notendernessandbouncepainful.Vulva:marriagetype,pubichairnormaldistribution;Vagina:smoothasmallamountofwhitedischarge;Thecervical:columnar,smooth;Noplacepain;From:front,normollarge,smoothsurface,notenderness;Adnexamassa(Positivesigns):therightareacantouchamassabout7*5cm,lighttenderness,2019/12/15,诊断（Diagnosis）,【入院日期】：2016-12-15【拟手术日期】：2016-12-16【术前诊断】：双侧卵巢囊肿【拟施手术名称】：腹腔镜下卵巢囊肿剥除术【麻醉方式】：全麻【Admissiondate】December15，2016【Proposedsurgerydate】:December16,2016【Preoperativediagnosis】:Bilateralovariancysts【Intendstooperateon】:Laparoscopicsurgery【anesthesia】:Generalanesthesia.,2019/12/15,术前肠道准备（Thebowelpreparationforthesurgery）,2019/12/15,半流质,导泻剂0.9%NS500ml+20%甘露醇250ml,常规灌肠一次,禁食不禁饮,禁食、禁饮,手术前晚,手术当天,手术记录（Theoperationrecords）,【手术日期】：10:15December16,2016【实施手术名称】：腹腔镜下双侧卵巢巧克力卵巢囊肿剥除术+盆腔粘连松解术【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【病人自控镇痛泵（PCA）】：是,2019/12/15,护理诊断（Thenursingdiagnosis）,恐惧：与担心手术失败有关，担心不能妊娠有关Fear：worryabouttheoperationfailure,andworrycannotpregnant术前舒适的改变：与长时间禁食、禁饮有关Preoperativecomfortablechange:relatedtothebannedfromfoodanddrinkforalongtime疼痛：与术后麻醉失效有关Pain:associatedwithpostoperativeanestheticfailure有导管滑脱的危险Riskofcatheterslipping有感染的危险：与手术有关Riskofinfection:associatedwithoperation,2019/12/15,护理措施（Thenursinginterventions）,恐惧：向病人介绍卵巢囊肿的有关知识，增强患者信心，联合家属给予患者术前术后的心理支持Introducetothepatientontheknowledgeofovariancyst,enhancepatientsconfidence,jointfamiliesforthepatientaboutpreoperativeandpostoperativewithpsychologicalsupport,2019/12/15,术前舒适的改变：与长时间禁食、禁饮有关,2019/12/15,Canweuse“FTS”intointervention?,护理措施（Thenursinginterventions）,术前舒适的改变：与长时间禁食、禁饮有关,2019/12/15,半流质,导泻剂0.9%NS500ml+20%甘露醇250ml,常规灌肠一次,禁食不禁饮,禁食、禁饮,手术前晚,手术当天,Patientsfeeling：Thirsty,hungry,anddizzy！,Canweuse“FTS”intointervention?,护理措施（Thenursinginterventions）,疼痛,定时翻身，协助患者采取舒适卧位安慰病人，缓解其焦虑和恐惧感各种操作时动作轻柔合理使用麻醉镇痛泵（PCA）,Timingturn,helppatientstotakecomfortablelyingpositionComfortthepatients,alleviatetheanxietyandfearAllkindsofoperationisgentleAnesthesiaanalgesiapump,2019/12/15,护理措施（Thenursinginterventions）,防导管滑脱妥善固定（fixed）悬挂警示标示（score=10），床头交接向家属及患者行防导管滑脱的健康宣教早日拔管,2019/12/15,drainagetube,urinetube,传统的围手术期护理,Thetraditionalperioperativenursing包括入院宣教、术前指导、解答患者疑问，按照常规的腹腔镜手术准备和外科护理常规进行护理，要求患者术前口服导泻剂，12小时禁食，46小时前禁饮水；术后根据麻醉方式采去枕平卧或平卧，血压平稳后，采取侧卧位或半卧位，于患者肛门排气后方可进食、水。,2019/12/15,2019/12/15,护理措施（Thenursinginterventions）,术前舒适的改变：与长时间禁食、禁饮有关,2019/12/15,Canweuse“FT