摘要
目的:探讨改变甲状腺患者手术体位对术后头痛及身体疼痛的影响,并与常规手术体位患者比较术后头痛和呕吐发生情况。方法:将哈尔滨医科大学附属第二临床医学院普外四科2000-0l/2003-08收治的485例甲状腺手术患者分成两组,常规手术体位组200例,改变手术体位组285例。根据手术时间长短,各组再分为小于1h和大于1h2组,对术中及术后连续2d患者出现的术后头痛与呕吐症状进行观察,记录头痛、呕吐发生数;在改变手术体位组治疗前后1周,分别由患者填写健康调查简易量表(36个单项以8大主要方面表示:躯体性功能、角色受限、社会性功能、心理健康情况、角色生理情况、活力和精力、身体疼痛、综合健康情况,每方面均按百分制进行评分),评估患者症状改善后所发生的心理及生理状况改变情况。结果:按实际处理分析,两组485例均进入结果分析。①两组术后头痛和呕吐发生率情况:改变手术体位组明显少于常规手术体位组(47%和63%,60%和75%,P<0.01);常规手术小于1h体位组明显少于常规手术大于1h体位组(48%和65%,68%和82%,P<0.01);改变手术小于1h体位组明显少于改变手术大于1h体位组(35%和50%,54%和70%,P<0.01)。②两组术后躯体性功能、角色受限、社会性功能、心理健康情况、身体疼痛、综合健康情况评分:改变手术体位组治疗后高于治疗前犤治疗后:(81.81±19.37),(28.53±5.75),(50.97±11.82),(56.20±13.04),(60.71±19.76),(57.87±10.41)分;治疗前:(78.27±18.82),(26.76±5.29),(48.85±12.33),(54.17±15.81),(57.41±18.92),(52.42±11.50)分,P<0.01或0.05犦。③两组术后活力和精力评分:改变手术体位组治疗后高于其治疗前及常规手术体位组治疗后犤(60.23±15.37),(54.36±16.26),(56.83±13.76)分,P<0.01或0.05犦。④两组术后身体疼痛评分:改变手术体位组治疗后高于其治疗前低于常规手术体位组治疗后犤(60.23±15.37),(57.41±18.92),(64.12±17.27)分,P<0.05犦。结论:术后出现头痛、呕吐症状与切除术患者甲状腺体位手术期间摆放的持续时间有关,时间越长出现症状比率越高。采用改变手术体位,尽量减少手术时间等措施可有效预防或减少甲状腺手术后头痛与呕吐的发生,从而使患者心理和生理状态改善情况优于常规手术体位治疗。
AIM： To investigate the effects of improved operative posture during thyroidectomy on the postoperative headache and body pain in the patients,and compare the postoperative occurrences of headache and vomiting with the patients using routine operative posture.METHODS： Totally 485 patients, who received thyroidectomy in the Forth Department of General Surgery, the Second Affiliated Hospital of Harbin Medical University from January 2000 to August 2003, were divided into two groups： routine posture group （n=200） and improved posture group （n=285）; According to the length of operation, each group was subdivided into shorter and longer than 1 hour groups respectively.The symptoms of headache and vomiting were observed during operation and after operation for 2 continuous days, the occurrence numbers of headache and vomiting were recorded; One week before and after treatment, patients in the improved posture goup were investigated with simple health survey scale （including 36 items of 8 main aspects： somatic function, role restriction, social function, mental health status, role physiological status, vigor and energy, body pain, general health; each aspect was scored as 100-point system）; The physiological and psychological changes after amelioration of symptoms in the patients were evaluated. The obtained data were statistically analyzed with the SAS 6.12 software,RESULTS： According to analysis of actual treatment, all the 485 cases in both groups were involved in the analysis of results. ① Postoperative incidence rates of headache and vomiting： Those were obviously lower in the improved posture group than in the routine posture group （47% and 63%; 60% and 75%; P 〈 0.01）;（48% and 65%; 68% and 82%; P 〈 0.01）;In the routine posture group, those were obviously lower in the shorter than 1 hour subgroup than in the longer than 1 hour subgroup （35% and 50%,54% and 70%, P 〈 0.01）. ② The scores of somatic function, role restriction,social function, mental health status, body pain, general health after operation in both groups： In the improved posture group, those were higher after treatment than before treatment [After treatment： （81.81±19.37）,（28.53±5.75）, （50.97±11.82）, （56.20＋13.04）, （60.71±19.76）, （57.87±10.41）points; Before treatment： （78.27 ＋18.82）, （26.76 ＋5.29）, （48.85 ＋12.33）,（54.17＋15.81）, （57.41＋18.92）, （52.42＋11.50） points; P 〈 0.01 or 0.05]. ③The score of vigor and energy after operation in both groups： It was higher improved posture group after treatment than that before treatment and that in the routine posture group after treatment [（60.23＋15.37）,[（54.36±16.26）,（56.83＋13.76） points; P 〈 0.01 or 0.05]. ④ The score of body pain after operation in both groups：h was higher in the improved posture group after treatment than that before treatment and that in the routine posture group after treatment [（60.23± 15.37）, （57.41 ± 18.92）, （64.12±17.27） points, P〈 0.05].CONCLUSION： The occurrences of postoperative headache and vomiting symptoms are assoeiated with the lasting duration of the posture during thyroideetomy; The longer the duration, the higher the incidence rate of the symptoms. The measures of improved operative posture and reduee of operative duration can effectively prevent and decrease the occurrences of headache and vomiting after thyroideetomy,so as to improve the psychological and physiological status of the patients superior to those of patients treated with routine operative posture.
出处
《中国临床康复》
CAS
CSCD
北大核心
2005年第20期66-67,共2页
Chinese Journal of Clinical Rehabilitation
