老年患者行腹腔镜胆囊切除术围手术期的护理

论文编号:HL162  论文字数:11004.页数:23

论文题目：老年患者行腹腔镜胆囊切除术围手术期的整体护理
摘  要

研究背景
 近年来,随着医药卫生事业的发展和人们生活水平的提高， 我国逐渐进入老龄化社会。老年人的疾病谱也随之发生变化，加之饮食结构的改变，使得慢性结石性胆囊炎和胆囊息肉等胆囊良性疾患的发病率逐年上升，目前已成为临床上老年患者的常见病、多发病。但由于老年患者在生理上不可避免地出现重要脏器和功能的改变，其合并症多，病情复杂，在一定程度上增加了开腹手术的难度与风险性。腹腔镜胆囊切除术（LC）是近二十年来微创外科开展的新项目之一, 与传统胆囊切除术式相比，具有独特的优点如术前只需要进行简单准备工作；术中对其他腹部器官干扰少、切口小、美观、痛苦少、手术时程短；术后恢复快，并发症少等优点，目前已成为腹部微创手术的一个经典范例[1]。而规范系统的围手术期整体护理,是保证老年患者手术成功、 促进术后康复的重要保证。
研究目的
 探讨围手术期高质量的整体护理措施对患慢性结石性胆囊炎和胆囊息肉的老年LC术后康复的影响。
研究方法
 以皖南医学院附属弋矶山医院肝胆外科2009年12月1日到2010年6月1日期间住院的60岁以上的患慢性结石性胆囊炎和胆囊息肉的患者总计180例作为研究对象，随机分为实验组和对照组，其中实验组90例，采用规范系统的护理方法进行整体精心护理；对照组90例，给予外科一般常规护理。进行以病人为中心的责任制护理模式和以工作为中心的功能制护理模式的比较，以平均住院时间，并发症出现例数以及病人满意与否作为评价标准，探讨规范系统的整体护理方法对患者康复的影响。
研究结果
 180例中，175例手术成功，术后住院平均3～5天后痊愈出院。4例中转开腹，5～8天痊愈出院。腹腔镜胆囊切除术术后并发胆漏1例，经积极治疗和护理后于术后15天出院。
结论
 通过术前的心理护理及认真细致的宣教和术后积极的病情观察、合理的饮食指导等，对促进老年患者LC术后早日康复起到了十分重要的作用。
关键词：老年患者，腹腔镜胆囊切除术，围手术期整体护理。
论文类型：调查分析研究。

Title: Perioperative care of aged patients with Laparoscopic Cholecystectomy
ABSTRACT
 
 
Background
 In recent years, with developments of health and economy,we entered an aging society and the disease spectrum of aged people had changed accordingly. Now the incidence of aged patients with benign gallbladder disease such as chronic cholecystitis and Gallbladder polyps has increased rapidly. Laparoscopic cholecystectomy has now replaced open cholecystectomy as the first-choice of treatment for gallstones and inflammation of the gallbladder unless there are contraindications to the laparoscopic approach. This technical improvement has benifited the patients so much that more and more person choose it as his first choice to remove the gallbladder, whereas systematic and standardized nursing approaches are of vital importance to the safety of the procedure and the rehabilitation of the patients.
Objectives
 To study the influences of systematic and standardized nursing approaches on the rehabilitation of the patients.
Methods
 180 aged patients (average aged above 60) were chosen as our study objectives, sysytematic and standardized nursing approaches were conducted.All data were analysed by SPSS13.0 software with x2 value.
Results:
    175 cases were successfully operated with LC, 4 cases were operated with open cholecystectomy for safety consideration, 1 case was found bile leakage after LC. The patients were discharged after 3-5days,5-8days and 20days, respectively.
Conclusion
 With systematic and standardized nursing approaches, the rehabilitation of the aged patients wuld be greatly improved.
 
KEY WORDS: aged patinets；LC；Perioperative systematic care.
TYPE OF THESIS: Clinical Research Report

目  录
1 绪论 1
 1.1研究背景及意义 1
 1.2研究目标 2
 1.3关键词及定义 2
 1.4文献回顾 3
 1.4.1整体护理观念 3
 1.4.2护理与安全耐受手术 3
 1.4.3高质量的护理技术提高手术成功率 4
2对象与方法 5
 2.1研究设计                                                          5
 2.2研究对象 5
 2.3研究步骤 5
 2.4研究工具 8
 2.5资料分析 8
3结果与分析 10
 3.1一般资料                                                         10
 3.2两组患者平均住院时间比较 10
 3.3两组患者并发症出现例数比较 11
 3.4两组患者满意程度比较 11
4讨论 12
 4.1LC术后并发症的原因分析 12
 4.2强化术前评估，加强医患沟通，保障患者安全 12
 4.3整体护理对医护、医患关系的影响 13
5结论与展望 14
致    谢 15
参考文献 16