1、云南省第一人民医院云南省第一人民医院Bilingual Nursing Round Fast-track nursing in perioperative of laparoscopic treatment for Ovarian cyst生殖妇科生殖妇科 1护理查房的目的(The purpose of this nursing round)熟悉卵巢囊肿的围手术期护理Be familiar with the perioperative nursing for Ovarian cyst掌握快速康复医学理念，应用于妇科腹腔镜手术的围手术期护理Master the Fast-track concep
2、tion,and apply in gynecological laparoscopic surgery in perioperative nursing care加强护患沟通能力，提高更好的服务 Strengthen the communication skills,to provide better service2关键词（key words）Bil-双Bilingual balgw()l Nursing Round 双语查房Bilateral balt()r()l 双侧=on both sides（双侧卵巢囊肿:bilateral ovarian vern cysts sst）腹腔镜：l
3、aparoscopy,lprskp（-scopy 腔镜，eg）.hysteroscopy histrskpi 宫腔镜）术前 preoperative（前：Pre-）术中 intraoperative（中：intra-）（手术 -Perative）术后 postoperative（后：Post-）快速康复外科：Fast-track surgery(FTS)病人自控麻醉泵：Patient controlled analgesia,n()ldiz=PCA微创手术:Minimally invasive nvesv surgery3“FTS”的相关理念快速康复外科（最早在世纪初由丹麦外科医生提出并倡导付
4、诸实践。它是指在术前、术中及术后的各个阶段广泛运用已经实践证实的各种行之有效的途径和方法，以减少外科手术病人的并发症和应激反应，促进患者手术后的康复，改善预后，促进健康。Fast-track surgery(FTS)(as early as at the beginning of the century by a Danish surgeons and initiates into practice is put forward.It refers to the preoperative,intraoperative and postoperative stages were confirme
5、d practice widely used a variety of effective ways and methods,in order to reduce the complications and surgical patients stress response,promote patients recovery after the operation,improve the prognosis,promote health.4“FTS”的相关理念（2）Lassen K,Soop M,Nygren J,et al.Consensus review of optimal periop
6、erative care in colorectal surgery:Enhanced Recovery After Surgery(ERAS)Group recommendations.Arch Surg,2009,144(10):961-969.5FTS干预措施(1)吴茜，陈静娟等，多学科合作快速康复外科模式中护理的作用,中国护理管理J，2014,14（2），215-218术前评估与优化患者信息减轻压力液体治疗缓解疼痛特殊护理（引流管）经口营养活动与锻炼术后加快康复术前术后6“FTS”TIPS术前准备充分的术前准备 缩短术前禁食禁饮的时间术后护理 保暖和心理护理 完备充分的疼痛护理 早期经
7、口进食和早期活动 重视术后休息和睡眠7“FTS”TIPS充分的术前准备：完备的护理健康教育，强调充分履行告知义务和健康宣教的责任，充分告知病人手术各个环节和相关注意事项。Sufficient preoperative preparation,Complete nursing health education,emphasizing the full performance of the inform obligation and the responsibility of the health education,filling each link points to inform patie
8、nts and related matters needing attention.8“FTS”TIPS缩短术前禁食禁饮的时间有研究表明，长时间禁食水会导致病人的饥饿，口渴，脱水，烦躁等不良应激和由此产生的血容量减少以及低血糖等的病理生理变化，会极大的增加手术的不耐受性。To shorten the time of banning food and fliud in preoperativeResearch has shown that banning food and fliud for a long time can lead to the patients hunger,thirst,d
9、ehydration,irritability and other adverse stress,the resulting blood volume decrease and the pathology of hypoglycemia and physiological changes,will greatly increase the surgery is not tolerated.9缩短术前禁食禁饮的时间The major purpose of withholding food and fluid before surgery is to prevent aspiration.Leng
10、thy restriction of food and fluid is unncessary.The American society of anesthesologists has resulted in new recommendations for persons undergoing elective surgery who are otherwise healthy.The recommendations depend on the age of the patient and type of food eaten.For example,adults are adivsed to
11、 fast for 8 hours after eating fatty food and 4 hours after ingesting milk products.Most patients are currently allowed clear liquids up to 2 hours before an elective procedure.10“FTS”TIPS早期经口进食和早期活动。有研究表明，长时间禁食水会导致手术病人内环境紊乱，且两者呈负相关。禁食时胃肠蠕动缓慢、不规律；而进食时胃肠蠕动则有力、频繁和有规律。Early feeding and early activities
12、.Research has shown that banning for a long time can lead to surgery patientsEnvironmental disturbance,and negatively correlated with both.When fasting gastrointestinal prayer move slow,irregular;While eating gastrointestinal screw motion strongly,frequently and regularly.11早期经口进食 术后保证早期的保温工作及宣教工作，术
13、后 3 小时麻醉清醒后可饮 10 20 mL 水，观察患者有无不适症状，半小时后再增加饮水量 50 100 mL.(3)The insulation work of the early postoperative and missionary work,after 3 hours awake anesthesia can drink 10 20 mL water,observing the patients symptoms,and adding water quantity in half an hour 50 100 mL.(3)李玉文，何婉珠等，快速康复护理模式在腹腔镜治疗卵巢囊肿围手术
14、期的应用研究，临床医学工程J，2016,23（3）379-380.12早期活动鼓励患者术后早期进行活动，术后 6 小时进行半坐卧未出现头晕等不适症状后，再进行床上活动，渐进式床旁活动，初次活动在 5 分钟内,在上述的基础下，可进行床旁的慢走，渐渐增加走的路程(4).Early postoperative activities,encourage patients after operation 6 hours to have half sit,if there is no symptoms such as dizziness,can have bed activity,progressive
15、activities by the bed,the first activity in 5 minutes,on the basis of the above,walking beside the bed,can be gradually increase journey.(4)单葵顺,邓晨晖.快速康复外科理念在手术室护理中的应用 J.广东医学,2014,35(4):637-639.13HOW TO USE FTS INTO PERIOPERATIVE?如何将“快速康复外科”的理念运用下述患者的围手术期？14病史汇报（Case report）床号：08姓名：马丽性别：女年龄：30岁现病史：患者
16、因不孕症就诊，B超示双侧卵巢囊肿（左侧5.5*3.5cm，5.3*3.9cm，右侧2.2*1.8cm）,有生育要求，要求手术治疗。既往史：否认外伤、手术输血史及过敏史生育史：0-0-0-0 Bed No.:NO.08Name:MaryGender:femaleAge:30 years oldHpi:Patient with infertility,B ultrasonic shown bilateral ovarian cysts(left side of the 5.5*3.5 cm,3.5*3.9 cm,right side of 2.2*1.8 cm)，fertility require
17、ment，requires surgery.Past medical history:Deny that history of trauma,surgery，blood transfusion，and drug allergy;Reproductive history:0-0-0-015查体（Physical examination）体温36.9，脉搏88次/分，呼吸18次/分，血压113/73mmHg。神志清楚，一般情况好，神清。腹平软，无压痛及反跳痛。外阴：婚型，阴毛分布正常；阴道：通畅，少量白色分泌物；宫颈：柱状，光滑；无举摆痛；宫体：前位，常大，表面光滑，无压痛；双附件区(阳性体征)：
18、右附件区可触及一约7*5cm的包块，质中等，轻压痛，左附件去未触及明显异常Temperature 36.9,pulse 88/cent,breathing 18 times per minute,blood pressure is 113/73 MMHG.Conscious,generally good.Abdominal plain soft,no tenderness and bounce painful.Vulva:marriage type,pubic hair normal distribution;Vagina:smooth a small amount of white disc
19、harge;The cervical:columnar,smooth;No place pain;From:front,normol large,smooth surface,no tenderness;Adnexa massa(Positive signs):the right area can touch a mass about 7*5 cm,light tenderness16诊断（Diagnosis）【入院日期】：2016-12-15【拟手术日期】：2016-12-16【术前诊断】：双侧卵巢囊肿【拟施手术名称】：腹腔镜下卵巢囊肿剥除术【麻醉方式】：全麻【Admission date】
20、December 15，2016【Proposed surgery date】:December 16,2016【Preoperative diagnosis】:Bilateral ovarian cysts【Intends to operate on】:Laparoscopic surgery【anesthesia】:General anesthesia.17术前肠道准备（The bowel preparation for the surgery）17:0019:0021:0022:0000:00半流质导泻剂0.9%NS500ml+20%甘露醇250ml常规灌肠一次禁食不禁饮禁食、禁饮手术前
21、晚手术当天18手术记录（The operation records）【手术日期】：10:15 December 16,2016【实施手术名称】：腹腔镜下双侧卵巢巧克力卵巢囊肿剥除术+盆腔粘连松解术【麻醉方式】：全麻【出血量（Bleeding)】：300ml 【管道】：腹腔引流管1 根，留置尿管1根【病人自控镇痛泵（PCA）】：是19护理诊断（The nursing diagnosis）恐惧：与担心手术失败有关，担心不能妊娠有关Fear：worry about the operation failure,and worry cannot pregnant术前舒适的改变：与长时间禁食、禁饮有关Pr
22、eoperative comfortable change:related to the banned from food and drink for a long time疼痛：与术后麻醉失效有关Pain:associated with postoperative anesthetic failure有导管滑脱的危险Risk of catheter slipping有感染的危险：与手术有关 Risk of infection:associated with operation20护理措施（The nursing interventions）恐惧：向病人介绍卵巢囊肿的有关知识，增强患者信心，联
23、合家属给予患者术前术后的心理支持Introduce to the patient on the knowledge of ovarian cyst,enhance patients confidence,joint families for the patient about preoperative and postoperative with psychological support21术前舒适的改变：与长时间禁食、禁饮有关Can we use“FTS”into intervention?22护理措施（The nursing interventions）术前舒适的改变：与长时间禁食、禁饮
24、有关17:0019:0021:0022:0000:00半流质导泻剂0.9%NS500ml+20%甘露醇250ml常规灌肠一次禁食不禁饮禁食、禁饮手术前晚手术当天Patients feeling：Thirsty,hungry,and dizzy！Can we use“FTS”into intervention?23护理措施（The nursing interventions）疼痛定时翻身，协助患者采取舒适卧位安慰病人，缓解其焦虑和恐惧感各种操作时动作轻柔合理使用麻醉镇痛泵（PCA）Timing turn,help patients to take comfortable lying positi
25、onComfort the patients,alleviate the anxiety and fearAll kinds of operation is gentleAnesthesia analgesia pump24护理措施（The nursing interventions）防导管滑脱妥善固定（fixed）悬挂警示标示（score=10），床头交接向家属及患者行防导管滑脱的健康宣教早日拔管drainage tubeurine tube25传统的围手术期护理The traditional perioperative nursing包括入院宣教、术前指导、解答患者疑问，按照常规的腹腔镜手
26、术准备和外科护理常规进行护理，要求患者术前 口服导泻剂，12 小时禁食，4 6 小时前禁饮水；术后根据麻醉方式采去枕平卧或平卧，血压平稳后，采取侧卧位或半卧位，于患者肛门排气后方可进食、水。2627护理措施（The nursing interventions）术前舒适的改变：与长时间禁食、禁饮有关Can we use“FTS”into intervention?28HOW TO USE FTS INTO PERIOPERATIVE?快速康复外科护理可促进卵巢囊肿行腹腔镜治疗患者的术后恢复，减少住院时间，比传统护理模式更具优势，值得在临床中应用和推广(3)。(3)李玉文，何婉珠等，快速康复护理模
27、式在腹腔镜治疗卵巢囊肿围手术期的应用研究，临床医学工程J，2016,23（3）379-380.29护士在 FTS 的具体执行中不能被动地执行医嘱，而应积极动态观察和有效地评估、分析患者的病情，主动与医生沟通，主动地采取及时有效的措施提高患者舒适度，个性化地开展护理措施，切实做到因人施护、因病施护，促进术后康复(1)。Nurses cant passively in the specific execution of FTS executed the doctors advice,and should actively dynamic observation and effective asse
28、ssment,analysis of the patient,take the initiative to communicate with the doctor,and the initiative to take timely and effective measures to improve patient comfort,give the patient an personalized nursing measures,effectively because the nursing and the nursing due to illness,promote postoperative recovery.(1)吴茜，陈静娟等，多学科合作快速康复外科模式中护理的作用,中国护理管理J，2014,14（2），215-21830云南省第一人民医院云南省第一人民医院Thanks for your listening！31
