李石兄 楊萍
【摘要】目的:分析心理干預(yù)用于腹腔鏡膽囊切除術(shù)護(hù)理中的應(yīng)用效果。方法:本次研究選取在2019年11月—2021年3月期間我院收治的在腹腔鏡下進(jìn)行膽囊切除術(shù)的患者作為研究對(duì)象,共112例,按照入院先后順序隨機(jī)分為對(duì)照組與研究組,各56例,對(duì)照組患者采取常規(guī)護(hù)理模式,研究組患者在常規(guī)護(hù)理基礎(chǔ)上增加心理干預(yù)。評(píng)估兩組患者焦慮、抑郁負(fù)面情緒,比較護(hù)理前后患者負(fù)面情緒改善狀態(tài);比較兩組患者排氣時(shí)間、進(jìn)食時(shí)間、下床時(shí)間、住院時(shí)間;比較兩組護(hù)理滿意度。結(jié)果:護(hù)理措施干預(yù)前,對(duì)照組與研究組負(fù)面情緒比較差異不明顯(P>0.05);經(jīng)不同護(hù)理措施干預(yù)后,兩組患者負(fù)面情緒均有不同程度改善,研究組改善情況優(yōu)于對(duì)照組(P<0.05);術(shù)后指標(biāo)比較,研究組各項(xiàng)術(shù)后指標(biāo)均優(yōu)于對(duì)照組(P<0.05);護(hù)理滿意度比較,研究組護(hù)理滿意度為96.43%高于對(duì)照組的80.36%(P<0.05)。結(jié)論:腹腔鏡膽囊切除術(shù)在常規(guī)護(hù)理基礎(chǔ)上增加心理護(hù)理干預(yù),療效顯著,明顯改善患者焦慮、抑郁等不良情緒,提高術(shù)后各項(xiàng)指標(biāo),同時(shí)提升護(hù)理滿意度,具有臨床推廣價(jià)值。
【關(guān)鍵詞】心理干預(yù);腹腔鏡;膽囊切除術(shù);護(hù)理效果
Effect of psychological intervention in nursing of laparoscopic cholecystectomy
LI Shixiong, YANG Ping
Peoples Hospital of Ningxia Hui Autonomous Region, Yinchuan, Ningxia 750001, China
【Abstract】Objective: To analyze the application effect of psychological intervention in the nursing of laparoscopic cholecystectomy. Methods: 112 patients who underwent laparoscopic cholecystectomy in our hospital from November 2019 to March 2021 were selected as the research object. They were randomly divided into control group and study group,with 56 cases in each group.The patients in the control group received routine nursing mode, the patients in the study group increased psychological intervention on the basis of routine nursing.The negative emotions of anxiety and depression of the two groups were evaluated, and the improvement status of negative emotions of the patients before and after nursing between the two groups was compared;The exhaust time, eating time, getting out of bed time and hospitalization time between the two groups were compared;The nursing satisfaction of the two groups were compared. Results: Before nursing intervention, There was no significant difference in negative emotions between the control group and the study group(P>0.05); After intervention with different nursing measures,the negative emotions of the two groups were improved in varying degrees, and the improvement in the study group was better than that in the control group (P<0.05);Compared with postoperative indexes, all postoperative indexes in the study group were better than those in the control group (P<0.05);Compared with the nursing satisfaction, the nursing satisfaction of the study group was 96.43%,which was higher than 80.36% of the control group(P<0.05). Conclusion: Laparoscopic cholecystectomy adds psychological nursing intervention on the basis of routine nursing,which has significant curative effect,significantly improves patients anxiety,depression and other adverse emotions,improves postoperative indicators,and improves nursing satisfaction,which has clinical promotion value.
【Key Words】Psychological intervention; Laparoscopy; Cholecystectomy; Nursing effect
隨著醫(yī)療技術(shù)不斷發(fā)展,腹腔鏡因其創(chuàng)傷小、并發(fā)癥少等優(yōu)勢(shì),越來(lái)越廣泛地應(yīng)用于臨床中,人們對(duì)腹腔鏡手術(shù)接受度也越來(lái)越高,尤其在膽囊切除術(shù)中已成為首選治療方式[1]。但大多數(shù)患者僅了解到腹腔鏡手術(shù)創(chuàng)傷小,缺少相關(guān)專業(yè)知識(shí),易產(chǎn)生不良心理情緒等負(fù)面情緒反而影響治療效果,且在手術(shù)中由于對(duì)醫(yī)院環(huán)境的陌生、擔(dān)心術(shù)后恢復(fù)效果、不良反應(yīng)等因素,易產(chǎn)生應(yīng)激反應(yīng),心率加快,甚至血壓升高,如這種負(fù)面情緒在圍手術(shù)期中持續(xù)存在,不能得到有效緩解,不但妨礙治療的順利進(jìn)行,而且對(duì)治療效果也會(huì)帶來(lái)不良影響[2]。因此在腹腔鏡膽囊切除術(shù)中護(hù)理效果是關(guān)鍵,穩(wěn)定患者心理負(fù)面情緒,加強(qiáng)治療效果,本研究選取我院收治的膽囊切除術(shù)患者作為研究對(duì)象,探討心理干預(yù)用于腹腔鏡膽囊切除術(shù)應(yīng)用效果,現(xiàn)報(bào)道如下。
1.1 一般資料
本次研究選取在2019年11月—2021年3月期間我院收治的在腹腔鏡下進(jìn)行膽囊切術(shù)的患者作為研究對(duì)象,共112例,男性57例,女性55例,按照入院先后順序隨機(jī)分為對(duì)照組與研究組各56例,對(duì)照組患者采取常規(guī)護(hù)理模式,研究組患者在常規(guī)護(hù)理基礎(chǔ)上增加心理干預(yù)。對(duì)照組,男性28例,女性28例,年齡21~67歲,平均年齡(38.91±3.48)歲,病程4個(gè)月~7年,平均病程(4.28±1.08)年,疾病類型統(tǒng)計(jì):膽結(jié)石患者16例,膽囊息肉患者16例,膽囊炎合并膽結(jié)石14例,慢性膽囊炎10例;研究組,男性29例,女性27例,年齡23~65歲,平均年齡(39.07±3.37)歲,病程4個(gè)月~9年,平均病程(5.11±2.03)年,疾病類型統(tǒng)計(jì):膽結(jié)石患者15例,膽囊息肉患者16例,膽囊炎合并膽結(jié)石12例,慢性膽囊炎13例。兩組患者年齡、病程、疾病類型等一般資料對(duì)比差異不顯著,具有可比性(P>0.05)。
1.2 方法[3-4]
對(duì)照組采取常規(guī)護(hù)理措施,包括指導(dǎo)患者入院后手續(xù)辦理、入院檢查、向患者講解疾病相關(guān)知識(shí)、治療中注意事項(xiàng),指導(dǎo)患者術(shù)后用藥、飲食等;研究組在常規(guī)護(hù)理基礎(chǔ)上增加心理干預(yù),具體措施包括:(1)向患者介紹科室環(huán)境,消除患者對(duì)環(huán)境的陌生感;向患者講解腹腔鏡相關(guān)知識(shí)及采用腹腔鏡術(shù)的優(yōu)勢(shì),必要時(shí)可采用播放視頻的形式,消除手術(shù)給患者帶來(lái)的神秘感;關(guān)注患者心理狀態(tài),及時(shí)做心理疏導(dǎo);(2)術(shù)前護(hù)理:手術(shù)室護(hù)理人員到病房進(jìn)行訪視,詳細(xì)了解患者病史等基本資料,主動(dòng)與患者溝通交流,盡量采取通俗易懂的語(yǔ)言,主動(dòng)詢問(wèn)患者真實(shí)想法,鼓勵(lì)患者說(shuō)出自己的需求及問(wèn)題,消除患者疑慮;向患者介紹手術(shù)流程及注意事項(xiàng),提高患者配合度;介紹手術(shù)醫(yī)生、麻醉師資歷,必要時(shí)介紹成功案例,消除患者對(duì)手術(shù)的擔(dān)心、恐懼等不良情緒;采用專業(yè)的評(píng)估工具評(píng)估患者心理狀態(tài),了解患者真實(shí)狀態(tài),依據(jù)評(píng)估結(jié)果采取有針對(duì)性的心理疏導(dǎo);指導(dǎo)患者可采取自己喜愛(ài)的方式舒緩緊張情緒,如聽(tīng)音樂(lè)、閱讀、觀看影片等方式,轉(zhuǎn)移注意力,促使患者緩解緊張、恐懼心理,同時(shí)以樂(lè)觀積極的態(tài)度迎接手術(shù);(3)術(shù)中護(hù)理:患者進(jìn)入手術(shù)室后,手術(shù)室護(hù)理人員面帶微笑,熱情接待患者,態(tài)度溫和地與患者溝通,主動(dòng)安慰患者,消除對(duì)手術(shù)室環(huán)境的陌生感;認(rèn)真核對(duì)患者信息,建立靜脈通道,監(jiān)測(cè)患者生命體征,護(hù)理動(dòng)作輕柔,邊操作邊告知患者下一步準(zhǔn)備做什么;注意患者保暖,詢問(wèn)室內(nèi)溫濕度是否適宜;指導(dǎo)患者擺放正確手術(shù)體位;配合醫(yī)生完成手術(shù);(4)術(shù)后護(hù)理:手術(shù)結(jié)束后,等待患者蘇醒,告知手術(shù)結(jié)果,消除患者對(duì)手術(shù)的擔(dān)憂,同時(shí)告知患者可能出現(xiàn)的并發(fā)癥及注意事項(xiàng),認(rèn)真解答患者及其家屬的問(wèn)題;手術(shù)室護(hù)理人員與病房護(hù)理人員做好交接,告知手術(shù)情況及患者狀態(tài);遵醫(yī)囑指導(dǎo)患者用藥,及早開(kāi)展康復(fù)運(yùn)動(dòng),囑咐患者家屬多關(guān)愛(ài)、照顧患者。
1.3 評(píng)定指標(biāo)
采用焦慮自評(píng)量表(SAS)及抑郁自評(píng)量表(SDS)評(píng)估兩組患者焦慮、抑郁負(fù)面情緒,比較護(hù)理前后患者負(fù)面情緒改善狀態(tài),分值越高負(fù)面情緒越明顯;記錄兩組患者排氣時(shí)間、進(jìn)食時(shí)間、下床時(shí)間、住院時(shí)間,并進(jìn)行比較;采用我院自制護(hù)理調(diào)查問(wèn)卷,比較兩組患者對(duì)不同護(hù)理措施滿意度,統(tǒng)計(jì)非常滿意、滿意例數(shù),計(jì)算滿意度[5-8]。
1.4 統(tǒng)計(jì)學(xué)處理
采用SPSS 23.0統(tǒng)計(jì)學(xué)軟件進(jìn)行數(shù)據(jù)分析。計(jì)數(shù)資料采用(%)表示,進(jìn)行χ2檢驗(yàn),計(jì)量資料采用(χ±s)表示,進(jìn)行t檢驗(yàn),P<0.05為差異具有統(tǒng)計(jì)學(xué)意義[9-10]。
2.1 兩組負(fù)面情緒改善情況比較
護(hù)理措施干預(yù)前,對(duì)照組與研究組負(fù)面情緒比較差異不明顯(P>0.05);經(jīng)不同護(hù)理措施干預(yù)后,兩組患者負(fù)面情緒均有不同程度改善,研究組改善情況優(yōu)于對(duì)照組,經(jīng)統(tǒng)計(jì)學(xué)分析,差異具有統(tǒng)計(jì)學(xué)意義(P<0.05),詳細(xì)數(shù)據(jù)見(jiàn)表1。
2.2 比較兩組患者排氣時(shí)間、進(jìn)食時(shí)間、下床時(shí)間、住院時(shí)間
研究組各項(xiàng)術(shù)后指標(biāo)均優(yōu)于對(duì)照組,經(jīng)統(tǒng)計(jì)學(xué)分析,差異具有統(tǒng)計(jì)學(xué)意義(P>0.05),詳細(xì)數(shù)據(jù)見(jiàn)表2。
2.3 兩組護(hù)理滿意度比較
經(jīng)調(diào)查研究組護(hù)理滿意度為96.43%高于對(duì)照組的80.36%,經(jīng)統(tǒng)計(jì)學(xué)分析,差異具有統(tǒng)計(jì)學(xué)意義(P<0.05),詳細(xì)數(shù)據(jù)見(jiàn)表3。
腹腔鏡膽囊切除術(shù)是借助腹腔鏡進(jìn)行膽囊切除的手術(shù),具有手術(shù)創(chuàng)傷小、恢復(fù)快、手術(shù)時(shí)間短、出血量少、并發(fā)癥少等優(yōu)勢(shì),臨床被接受度較高,但由于患者對(duì)相關(guān)知識(shí)了解少,且多為初次手術(shù),難免會(huì)出現(xiàn)焦慮、抑郁等負(fù)面情緒,如不及時(shí)進(jìn)行心理疏導(dǎo),會(huì)對(duì)手術(shù)及預(yù)后產(chǎn)生極大的影響,因此在患者入院后及手術(shù)過(guò)程中及時(shí)對(duì)患者展開(kāi)心理護(hù)理干預(yù)具有重要意義[11-12]。
總而言之,腹腔鏡膽囊切除術(shù)在常規(guī)護(hù)理基礎(chǔ)上增加心理護(hù)理干預(yù),療效顯著,明顯改善患者焦慮、抑郁等不良情緒,提高術(shù)后各項(xiàng)指標(biāo),同時(shí)提升護(hù)理滿意度,具有臨床推廣價(jià)值。
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