体位护理对胃内镜黏膜下剥离术后患者康复的影响

郑传江 罗梅 陶健 左赞 李霆 代玲丽 李爱华 李芳芳

[摘要]目的 探讨体位护理对胃内镜黏膜下剥离（ESD）术后患者康复的影响。方法 选取2016年7月～2017年9月我院行胃ESD术的患者72例，采用随机数字表法将其分为对照组和观察组，每组36例。对照组给予常规护理；观察组在常规护理的基础上进行体位护理。分别对两组术后1、3、7 d的上腹饱胀、上腹疼痛、嗳气和恶心等症状，迟发性出血，术后8周溃疡愈合等情况进行比较，并行统计分析。结果 两组术后1 d的上腹饱胀、上腹疼痛、嗳气和恶心症状评分比较，差异均无统计学意义（P>0.05）；观察组患者的术后3、7 d的上腹饱胀和上腹疼痛及术后7 d的恶心症状评分均低于对照组，差异有统计学意义（P<0.05）；观察组患者的术后8周溃疡愈合率高于对照组，差异有统计学意义（P<0.05）；两组迟发性出血发生率的比较，差异无统计学意义（P>0.05）。结论 胃ESD术后采取体位护理能够增加患者的舒适度，促进溃疡的愈合，提高患者术后的康复质量和满意度。

[关键词]内镜黏膜下剥离术；胃肿瘤；体位护理；康复

[中图分类号] R473.73 [文献标识码] A [文章编号] 1674-4721（2018）5（b）-0152-03

Effect of postural nursing on the rehabilitation of patients after gastric endoscopic submucosal dissection

ZHENG Chuan-jiang1 LUO Mei TAO Jian ZUO Zan LI Ting DAI Ling-li LI Ai-hua LI Fang-fang

Department of Gastroenterology，the First People′s Hospital of Fuzhou of Yunnan Province，The Affiliated Hospital of Kunming University of Science and Technology，Yunnan Province，Kunming 650032，China

[Abstract]Objective To investigate the effect of postural nursing on the rehabilitation of patients after gastric endoscopic submucosal dissection（ESD）.Methods From July 2016 to September 2017，72 patients underwent gastric ESD in our hospital were randomly divided into control group and observation group，36 patients in each group.The control group was given routine nursing.The observation group was treated with posture nursing on the basis of routine nursing. The symptoms of fullness，pain，belching and nausea，delayed bleeding and ulcer healing at 8 weeks after operation in the two groups were compared and analyzed statistically.Results There was no significant difference in the scores of epigastric fullness，epigastric pain，belching and nausea between the two groups at 1 d after operation （P>0.05）.The scores of abdominal fullness，abdominal pain and nausea symptoms in the observation group were lower than those in the control group at 3，7 d after operation （P<0.05）.The healing rate of ulcer in the observation group was higher than that in the control group at 8 weeks after operation （P<0.05）.There was no significant difference between the two groups （P>0.05）.Conclusion Postural nursing after gastric ESD can increase the patient′s comfort，promote ulcer healing，improve the recovery quality and satisfaction of the patients after operation.

[Key words]Endoscopic submucosal dissection （ESD）；Gastric tumor；Postural nursing；Rehabilitation

內镜黏膜下剥离术（ESD）是在内镜黏膜切除术基础上发展而来的新技术[1-2]，目前已成为消化道早期癌症、癌前病变、黏膜下肿瘤的常规治疗方式[3-4]。与开腹手术比较，ESD具有降低肿瘤复发率，减少并发症、风险小，对患者影响较小、恢复快等优点。但ESD手术切除病变的同时直接破坏黏膜甚至固有肌层，因而术后形成“人工溃疡”[5]，而且造成的“人工溃疡”较普通消化性溃疡面积较大，溃疡愈合时间相对较长。另外ESD术后溃疡的形成比较复杂，它的愈合是否还受其他因素的影响目前还不明确。因……