护理本科本科毕业论文（精）

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1、斜卧截石位在微创经皮肾镜碎石术中的应用研究摘要目的:探讨三种不同体位对微创经皮肾镜碎石取石术（PCNL）患者的影响。方法:将180例微创经皮肾镜碎石手术患者，按手术体位分为俯卧位、侧卧位、斜卧截石位，每组各60例。观察3种体位安置前后患者心率、血压的变化；记录手术时间，出血量，术中并发症发生情况；结石清除率及患者术后的舒适度。护士对3种体位手术护理工作强度的评价。结果:3种体位均能顺利完成手术，斜卧截石位体位安置后血压、心率比其余两种体位更稳定，手术时间明显缩短。侧卧位术后出现肢体不适高于其余两组。俯卧位出现胸膜损伤3例，4例肠道损伤，侧卧位发生4例胸膜损伤，

2、肠道损伤2例；斜卧截石位肠道损伤1例；斜卧结石位明显降低护士工作强度。结论:PCNL患者采用斜卧截石位，能稳定患者的呼吸循环功能，减少并发症的发生，便于医生操作，减少护士的工作量。【关键词】经皮肾镜；碎石取石；体位；AbstractObjectiveToinvestigatethethreedifferentposturalrubbleofminimallyinvasivepercutaneousnephrolithotomylithotomy(PCNL)inpatientsaffected.Methods180casesofminimallyinvasive

3、13percutaneousnephrolithotomylithotripsypatients,surgicalpositionintotheproneposition,lateralposition,recumbencythelithotomyposition,eachgrouphad60cases.Observationofthepatient'sheartrate,bloodpressurebeforeandaftertheplacementofthethreekindsofposturalchanges;recordingoperativetime,

4、bloodloss,intraoperativecomplicationshappened;stoneclearancerateandthepostoperativecomfort.Nursesurgerythreekindsofposturalstrengthevaluationofnursingwork.ResultsThreekindsofposturalabletosuccessfullycompletethesurgery,recumbencyaftertheplacementofthelithotomypositionposturalbloodpr

5、essure,heartrateismorestablethantheothertwopositions,theoperativetimewassignificantlyshortened.Thelateralbitpostoperativelimbdiscomfortthantheothertwogroups.Threecasesofpleuralinjuryproneposition,fourcasesofintestinalinjury,thelateralpositionfourcasesofpleuralinjury,twocasesofintest

6、inalinjury;decumbenslithotomypositionintestinalinjurycases;theRecliningstonesthebitsignificantlyreducetheintensityoftheworkofnurses.ConclusionPCNLpatientswithrecumbencythelithotomyposition,abletostabilizethepatient'srespiratoryandcirculatoryfunction,reducetheincidenceofcomplications

7、,andeasyfordoctorstooperatetoreducetheworkloadofnurses.【Keywords】Percutaneousnephrolithotomy;Lithotripsy;Postural;13nursing一、绪论（一）研究目的与意义经皮肾镜碎石术（PCNL）是目前治疗上尿路结石及复杂性肾结石的主要方式，手术体位多采用俯卧位和侧卧位[1、2]，麻醉后需先取截石位留置输尿管导管和尿管后，再改为俯卧位及侧卧位。两种体位均造成患者呼吸循环功能的不稳定，且可引起胸膜及肠道损伤等并发症的发生【3】；术中由于体位的更改，延长了手术时

8、间，增加了护士的工作量。而斜卧截石位术