鼻內鏡下鼻竇開放術圍手術期的護理

論文編號:HL166  論文字數:10600.頁數:19

論文題目：鼻內鏡下鼻竇開放術圍手術期的護理
 摘  要

研究背景
 鼻內鏡手術是近年來開展的一項新技術，它是在鼻內鏡直視下，以盡可能保留鼻腔、鼻竇的結構和功能為前提，以消除病變、改善和重建鼻腔、鼻竇通氣引流功能為目的的鼻外科手術。是治療慢性鼻竇炎及鼻息肉的新方法，具有痛苦小，操作精細，觀察準確等優點，在清除發病因素的基礎上重建和恢復鼻腔鼻竇的通氣和粘膜纖毛的功能，是一種符合鼻腔鼻竇生理的手術方法，把以往根治性或者破壞性手術改變為功能性手術。鼻竇鏡手術的目的1.拓寬鼻腔和鼻竇間的聯系空間2.最大限度的保留正常的解剖結構和粘膜，對局部生理功能的保護貫穿于整個治療的過程中。對于慢性鼻竇炎而言，手術只是治療的開始，術后要經過復雜的處理過程，才能徹底治愈，單純依靠手術而不注重手術后的處理并不能獲得可靠的療效。特別是手術后的鼻竇沖洗尤其重要，它能有效地去除干痂，增加局部血液循環，促進黏液纖毛清除功能，收縮水腫組織，更加有利于鼻腔和鼻竇的充分通風和引流，從而大大縮短術后治療時間。系統的鼻內窺鏡手術圍手術期的護理!對于縮短手術恢復時間、提高治療效果至關重要。
研究目的
 對鼻內鏡下鼻竇開放術治療慢性鼻竇炎的傳統護理及系統化術前術后護理、并發癥觀察及護理進行探討，預防和避免并發癥的發生，以保證治療效果，提高治愈率。
研究方法
    選擇大學第二附屬醫院耳鼻喉科2009年8月至2010年08月實施鼻內鏡手術病例490例。490例隨機分為標準組和對照組，標準組245例，采用系統化護理，包括術前準備、制定有預見性的護理措施、術中配合和術后護理重點及措施、出院指導；對照組245例，采用常規護理。根據療效標準統計有效率及無效率、并發癥發生率。
研究結果
 兩組有效率比較有顯著性差異（P＜0.05）。標準組有效率為98%，與對照組比較有顯著性差異；無效率為2%，與對照組比較有顯著性差異；并發癥發生率為3%，與對照組比較有顯著性差異。。
結論
 鼻內鏡下鼻竇開放術是較好的治療方法，其手術前后的各種護理措施是否到位，直接關系到手術效果和術后復發等并發癥發生機會。所以為了提高療效，根據術后恢復的不同階段開展規范化的護理及隨訪非常重要。
關鍵詞：慢性鼻竇炎；內鏡手術；護理
論文類型：應用研究論文
    
 Title: Comparison of the effect of different feeding methods to neonates
 ABSTRACT
 
 
Background
 As one kind of nature food, breast-feeds can bring large advantage. It can be absorbed easily, and be of plenty of antibody and immunocyte. At the same time, it can promote the sensation communication. So it is important to mental and physical development of infants. But many mothers have not plenty of latex. Because of latex lack, infants will have hypoglycemia and jaundice easily. So it is necessary to add appendix feeding in good time when latex lack occurs.
Objectives
 To study the influences of two different breast-feeds to neonatal three days after delivery，including jaundice, blood glucose and low weight.
Methods
 118 neonates were randomly divided to experimental group (58 cases) and control group (60 cases), monitored the items of physiology such as: weight, blood glucose, time of fetal feces discharge end, and jaundice index. The neonates in experimental were raised by breastfeeding and mixed feeding, while the neonates in control were raised totally by breastfeeding.
Results:
 The items of physiology between two groups have statistical difference( P＜0.05). Incidence of jaundice , low weight and hypoglycemia in experimental group is lower than that in control group. In experimental group, the number of low weight was 0(0%), the rate of hypoglycemia was 10%, and the incidence of pathological jaundice was 3.4%. compared with ones in control group, there were significant difference. Breastfeeding adding appendix feeding can decrease the incidence of low weight, hypoglycemia and jaundice significantly three days after delivery.
Conclusion
 If breast-feed were not enough, appendix feed should be given to neonates in the first three days, which could decrease jaundice and prevent hypoglycemia of neonates.
KEY WORDS: breast-feed；mixed-feed；neonate；jaundice；hypoglycemia；low weight
TYPE OF THESIS: Research Report
 目  錄
1 緒論 1
 1.1研究背景及意義 1
 1.2研究目標 1
 1.3關鍵詞及定義 1
 1.4文獻回顧 2
 1.4.1鼻內鏡下鼻竇開放術概述…………………………………………………………………2
 1.4.2鼻內鏡下鼻內鏡下鼻竇開放術圍手術期的護理現狀………………………………………3
2研究設計 4
 2.1研究類型…………………………………………………………………………….4
 2.1研究對象 4
 2.2研究步驟 5
 2.3研究工具 5
 2.4資料分析 5
3結果與分析 6
 3.1一般資料…………………………………………………………………………...6
 3.2兩組有效率人次比較 6
 3.3兩組無效率人次比較 6
 3.4兩組并發癥發生率人次比較 7
4討論……………………………………………………………………………………….8
 4.1總結討論…………………………………………………………………………..8
 4.2術前準備及護理制定有預見性護理措施 9
 4.3術中配合 10
 4.4術后護理重點及措施 10
 4.5出院指導………………………………………………………………………12
5結論與展望 14
致    謝 15
參考文獻 17