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| Application effect of improved head-low-foot-high lithotomy placement technique in lumpectomy based on comfort care theory |
| SHEN Qiaowei XU Xuejun▲ HUANG Xiangqiong ZHENG Xiaoling XIANG Caiyun |
Operating Room，Ningbo Women’s and Children’s Hospital, Zhejiang Province, Ningbo 315010, China
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Abstract Objective To analyze the effect of improved head-low-foot-high lithotomy placement technique based on comfort care theory in lumpectomy for gynecologic malignancies. Methods One hundred patients with gynecological malignancies admitted to Ningbo Women’s and Children’s Hospital, Zhejiang Province from October 2019 to February 2020 were divided into two groups of 50 cases each using the random number table method. In the control group, the conventional head-low-hip-high lithotomy position was used intraoperatively, while the observation group used a modified head-low-foot-high lithotomy position technique based on comfort care theory. The fluctuations of arterial pressure lthe time points of detection were T1 to T3, i.e. after completion of anesthesia in the flat-lying truncal position [T1], 5 min after pneumoperitoneum with head low, and hip high position [T2], and 30 min after pneumoperitoneum with head low and hip high position [T3], position-related complications, and position comfort were observed. Results The difference in mean arterial pressure levels between the two groups was statistically significant (P＜0.05). The mean arterial pressure at T2 and T3 time points in the observation group was lower than that in the control group, and the difference was statistically significant (P＜0.05). At 24 h after surgery, the visual analogue scale(VAS) scores of numbness and pain in the shoulder，and lower limbs of the observation group were lower than those of the control group, and the differences were statistically significant (P＜0.05). At 48 h postoperatively, the VAS scores of numbness and pain in the shoulder，and lower limbs were lower in both groups than at 24 h postoperatively, and the differences were statistically significant (P＜0.05). At 48 h postoperatively, there were no statistically significant differences in the VAS scores of numbness and pain in the shoulder and lower limbs between the two groups (P＞0.05). The proportion of subcutaneous emphysema in the observation group was lower than that in the control group, while the postural comfort score was higher than that in the control group, with statistically significant differences (P＜0.05). Conclusion The improved head-low-foot-high lithotomy placement technique based on comfort care theory is used in laparoscopic surgery for gynecologic malignancies, and plays a good role in arterial pressure fluctuation relief, position-related prevention, and pain relief, which could effectively improve the comfort of patients’ position.
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[1] Yamamoto W，Nishihara T，Hamada T，et al. Independent Predicting Factors for Subcutaneous Emphysema Associated with Robotic-Assisted Laparoscopic Radical Prostatectomy：A Retrospective Single-Center Study [J]. J Clin Med，2021， 10（13）：2985.
[2] 郭洪明.手术体位对眼压的影响及护理研究进展[J].护理管理杂志，2020，20（1）：39-43.
[3] 简艳平，周萍.精细化管理在预防手术体位摆放并发症的效果探讨[J].现代消化及介入诊疗，2019，2（A01）：1202- 1203.
[4] 武爱芳，杨树君，尹格平，等.机器人辅助腹腔镜手术在妇科肿瘤中的应用体会[J].腹腔镜外科杂志，2020，25（11）：866-869.
[5] 辛蔚妮，曾博，许青峰，等.视觉模拟评分法评估根管治疗术后疼痛程度及疼痛相关因素分析[J].中华口腔医学研究杂志（电子版），2019，13（5）：278-283.
[6] 刘洋，田丹丹，张超凡，等.目标导向液体治疗对妇科腹腔镜手术术中血流动力学及脑氧饱和度的影响[J].临床麻醉学杂志，2020，36（4）：349-353.
[7] 徐梅，王英丽，赵琳，等.手术体位舒适性量表的形成及信度、效度检测[J].中国护理管理，2014，14（10）：1045- 1047.
[8] 许洁，崇庆国，韩洪超，等.加速康复外科在妇科恶性肿瘤腹腔镜手术中的临床应用[J].中国妇产科临床杂志，2018，19（6）：489-492.
[9] 万晨东，朱晨燕，徐云，等.腹腔镜妇科恶性肿瘤手术25例临床体会[J].海南医学，2019，30（10）：1322-1325.
[10] 戴春阳，韩璐.妇科恶性肿瘤腹腔镜术后穿刺孔转移的研究进展[J].国际妇产科学杂志，2018，45（4）：455-459.
[11] 刘淳，魏乐伟，郭建玲，等.集束化护理措施用于预防妇科恶性肿瘤腹腔镜术后DVT的研究[J].现代中西医结合杂志，2018，27（32）：3631-3634.
[12] 卢贝琳，张晓庆，罗育端.运用腹腔镜子宫切除术治疗妇科良性肿瘤的临床效果研究[J].中国医药科学，2018， 8（5）：220-222.
[13] 丁玉辉，李春梅，梁瑞晨，等.新型多功能下肢手术体位架的临床应用[J].重庆医学，2020，49（24）：4094-4097.
[14] 张新建，王晖玥，叶丽妮.宫腹腔镜联合手术中患者体位对血流动力学与局部脑组织氧饱和度的影响[J].新乡医学院学报，2020，37（7）：657-660.
[15] 韩盖宇，陈晓霞，刘小民，等.手术体位对腔镜心脏外科手术病人体位相关周围神经损伤的影响[J].护理研究，2019，33（17）：3022-3024.
[16] 冯惠芹，谭惠兴，胡敏.快速康复护理对妇科腹腔镜患者术后恢复的影响研究[J].中国医药科学，2019，9（16）：186-188.
[17] 宋兴超，路要武，吴超，等.ERAS对全腹腔镜远端胃癌D2根治术患者应激反应、生命体征及细胞免疫的影响[J].中国普通外科杂志，2019，28（8）：1031-1036.
[18] 汪俊涛，罗磊磊，陈涛，等.妇科腹腔镜手术后预防患者下肢深静脉血栓形成的研究[J].血管与腔内血管外科杂志，2020，6（1）：57-60.
[19] Takmaz O，Asoglu MR，Gungor M. Patient positioning for robot-assisted laparoscopic benigngynecologic surgery：A review [J]. Eur J Obstet Gynecol Reprod Biol，2018，223：8-13.
[20] 张兰.妇科手术后下肢静脉血栓预防中气压治疗仪的应用效果与护理方法[J].结直肠肛门外科，2020，7（S02）：159-160.
[21] 纪妹，赵曌，李悦，等.非倒转体位下机器人系统辅助腹腔镜手术在早期卵巢恶性肿瘤全面分期手术中的应用[J].中华妇产科杂志，2020，55（3）：183-187.
[22] 印李雅，李和，陈少红，等.腹腔镜手术气腹压力体位及时间对下肢深静脉血流速度的影响[J].中国药物与临床，2020，20（4）：518-521.
[23] 王庆，李艳，陈垂凯，等.不同通气策略对行择期腹腔镜妇科手术患者呼吸动力学、氧合指标及安全性影响[J].临床军医杂志，2020，48（12）：1437-1439.
[24] 冯骥.胃肠外科腹腔镜术中不同体位对呼吸动力学和血气的影响[D].南充：川北医学院，2019：1-4.
[25] 刘新莲，常后婵，别逢桂，等.腔镜下分腿式手术洞巾的设计与应用[J].护理学杂志，2018，33（4）：40-41. |
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