个体化护理干预联合右美托咪定在老年患者尿道前列腺电切术中的应用

余桃芬　陈水英

【摘要】 目的：觀察个体化护理干预联合右美托咪定在老年患者尿道前列腺电切术中的应用效果。方法：选取2011年6月-2015年12月在笔者所在医院治疗的180例的行尿道前列腺电切术老年患者，采用随机数字表法分为常规组、个体化护理组、右美托咪定组和联合组四组，每组45例。常规组和右美托咪定组给予常规护理，个体化护理组和联合组给予个体化护理干预。右美托咪定组、联合组患者术前15 min均给予注射0.5 μg/kg的右美托咪定于外周静脉泵注，常规组、个体化护理组给予等量的生理盐水，患者术后均行镇痛泵止痛。记录并观察术前1 d和术后3 d简易智力量表（MMSE）分数及发生术后认知功能障碍发生的例数，术前1 d、麻醉前和术毕行患者状态焦虑（SAI）评分，观察术中麻醉效果，术后4、8、12、24 h 疼痛视觉模拟（VAS）评分和镇痛药用量、麻醉满意度和患者满意度。结果：与常规组比较，其余三组术后3 d的MMSE评分增高，POCD发生率、麻醉前和术毕SAI评分、术后各个时间点的疼痛VAS评分均降低，镇痛药用量减少，麻醉效果和满意度高（P<0.05）。与个体化护理组、右美托咪定组比较，联合组MSE评分增高，POCD发生率、麻醉前和术毕SAI评分、术后各个时间点疼痛VAS评分均降低，镇痛药用量减少，麻醉效果和满意度高（P<0.05）。结论：个体化护理干预联合右美托咪定能够有效降低行尿道前列腺电切术的老年患者POCD发生率，缓解其焦虑情绪，减轻术后疼痛，提高麻醉效果及满意度。

【关键词】 个体化护理； 右美托咪定； 术后认知功能障碍； 老年； 焦虑； 疼痛

doi：10.14033/j.cnki.cfmr.2018.11.030 文献标识码 B 文章编号 1674-6805（2018）11-0062-03

The Effect of Individualized Nursing Intervention Combined with Dexmedetomidine in Elderly Patients with Transurethral Resection of the Prostate/YU Taofen，CHEN Shuiying.//Chinese and Foreign Medical Research，2018，16（11）：62-64

【Abstract】 Objective：To observe the application effect of individualized nursing intervention combined with Dexmedetomidine in elderly patients with transurethral resection of the prostate.Method：One hundred and eighty elderly patients with transurethral resection of the prostate from Jun 2011 to Dec 2015 in our hospital，were randomly divided into 4 groups as conventional group，individual nursing group，Dexmedetomidine group and combination group，45 cases in each group.The conventional group and Dexmedetomidine group received conventional nursing，individual nursing group and combination group were treated with individualized nursing intervention.Dexmedetomidine group and combined group patients were given injection 0.5 g/kg Dexmedetomidine at 15 minutes before operation，the conventional group and individual nursing group were given Saline in the same protocol，all patients were treated with analgesia pump after operation.The minimum mental state examination（MMSE） was performed for 1 d before operation and 3 d after operation respectively.MMSE score and the incidence of post operative cognitive dysfunction（POCD） were compared as criterion.The state anxiety（SAI） score were compared at 1 d before operation，before anesthesia and the end of operation，and after operation，the effect of anesthesia during operation were observed.Visual analogue scale（VAS） were assessed respectively at 4 hours，8 hours，12 hours and 24 hours after surgery，anesthesia satisfaction and patient satisfaction were also recorded.Result：The MMSE scores，the effect and satisfaction of anesthesia of the other 3 groups were significantly higher，the incidence of POCD，preoperative and postoperative SAI scores，the VAS scores after operation at each time and the amount of analgesic drugs were significantly lower than that of conventional group（P<0.05），the MMSE scores，the effect and satisfaction of anesthesia of the combined group were significantly higher，the incidence of POCD，preoperative and postoperative SAI scores，the VAS scores after operation at each time and the amount of analgesic drugs the combined group were significantly lower than that of individual nursing group，Dexmedetomidine group（P<0.05）.Conclusion：Individualized nursing intervention combined with Dexmedetomidine can reduce the incidence of POCD of elderly patients undergoing transurethral resection of prostate，alleviate their anxiety，reduce postoperative pain，improve the anesthetic effect and satisfaction.

【Key words】 Individualized nursing intervention； Dexmedetomidine； Post operative cognitive dysfunction； Elderly； Anxious； Pain

First-authors address：Yangxin Peoples Hospital，Yangxin 435200，China

老年男性患者易患前列腺增生症，严重者需要接受手术治疗，经尿道前列腺电切除术虽然已经在临床上广泛开展应用，但由于老年患者往往合并其他慢性疾病、脏器功能衰退等原因，容易导致术后认知功能障碍（post operative cognitive dysfunction，POCD）的发生[1]，这使得患者住院时间延长，加剧患者痛苦，明显升高术后并发症发生率及死亡率。……