切换至 "中华医学电子期刊资源库"

中华肥胖与代谢病电子杂志 ›› 2021, Vol. 07 ›› Issue (01) : 41 -46. doi: 10.3877/cma.j.issn.2095-9605.2021.01.008

所属专题: 文献

论著

超级肥胖患者腹腔镜代谢手术的手术室护理操作要领
公凤霞1, 赵赏1, 曹李1, 董光龙1,()   
  1. 1. 100853 北京,解放军总医院第一医学中心普通外科
  • 收稿日期:2020-08-21 出版日期:2021-02-28
  • 通信作者: 董光龙
  • 基金资助:
    国家自然科学基金面上项目(81773247)

Operating room risk management strategies for laparoscopic metabolic surgery in super obese patients

Fengxia Gong1, Shang Zhao1, Li Cao1, Guanglong Dong1,()   

  1. 1. Department of General Surgery, First Medical Center, General Hospital of PLA, Beijing 100853, China
  • Received:2020-08-21 Published:2021-02-28
  • Corresponding author: Guanglong Dong
引用本文:

公凤霞, 赵赏, 曹李, 董光龙. 超级肥胖患者腹腔镜代谢手术的手术室护理操作要领[J]. 中华肥胖与代谢病电子杂志, 2021, 07(01): 41-46.

Fengxia Gong, Shang Zhao, Li Cao, Guanglong Dong. Operating room risk management strategies for laparoscopic metabolic surgery in super obese patients[J]. Chinese Journal of Obesity and Metabolic Diseases(Electronic Edition), 2021, 07(01): 41-46.

目的

探讨超级肥胖患者腹腔镜代谢手术中手术室护理操作要领。

方法

分析我院2016年1月至2020年1月实施的30例超级肥胖患者的腹腔镜代谢手术的手术室中遇到的相关风险因素与采取的相应解决措施,提出较安全、精准、完善的超级肥胖患者手术室护理操作要领。

结果

通过处理导尿困难、外周静脉穿刺及中心静脉置管困难、血压监测困难、体位放置和固定困难等手术室护理困难,建立了针对降低超级肥胖患者腹腔镜代谢手术的手术室风险的对策和管理模式,保证手术顺利进行,减少围手术期并发症的发生。

结论

超级肥胖患者的腹腔镜代谢手术较一般体重患者存在极大的手术室管理风险。手术室风险的处理,相关护理风险的有效控制和完善管理模式的建立有助于保障手术顺利进行,减少手术相关并发症的发生,是腹腔镜减肥代谢手术成功的重要保证。

Objective

The project is conducted to explore risks, characteristics and countermeasures during laparoscopic metabolic surgery for super-obese patients at operating rooms.

Methods

Relevant risk factors and countermeasures arising from laparoscopic metabolic surgery for 30 super-obese patients at operating rooms of the hospital between January 2016 and January 2020 were studied. On this basis, safe, accurate and perfect operating room risk controlling and management schemes were proposed.

Results

Countermeasures and management patterns, designed to minimize operating room risks during laparoscopic metabolic surgery for super-obese patients, ensure smooth progress of operation and reduce periprocedural complications, were established through effective countermeasures for problems with urethral catheterization, peripheral venipuncture, central-vein catheterization,blood pressure monitoring, body positioning and immobilization as well as other problems with operating room nursing.

Conclusions

Compared with patients of average weight, super-obese patients will face much more operation room management risks. The treatment with operation room risks, effective control of relevant nursing risks and the establishment of improved management patterns will contribute to smooth surgical progress, minimize operation-related complications and ensure the success of laparoscopic metabolic surgery for weight loss.

表1 患者术前基本资料
表2 导尿术及相关并发症
表3 外周和深部静脉穿刺及相关并发症
表4 手术相关资料
[1]
中国医师协会外科医师分会肥胖和糖尿病外科医师委员会.中国肥胖和2型糖尿病外科治疗指南(2014)[J]. 中国实用外科杂志, 2014, 34 (11): 1005-1010.
[2]
中华医学会外科学分会甲状腺及代谢外科学组,中国医师协会外科医师分会肥胖和糖尿病外科医师委员会. 中国肥胖及2型糖尿病外科治疗指南(2019版)[J]. 中国实用外科杂志, 2019, 39(4): 301-306.
[3]
Stephens DJ,Saunders JK,Belsley S,et al. Short-term outcomes for super-super obese (BMI > or =60 kg/m2) patients undergoing weight loss surgery at a high-volume bariatric surgery center: laparoscopic adjustable gastric banding, laparoscopic gastric bypass, and open tubular gastric bypass[J]. Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery, 2008, 4(3): 408-15.
[4]
Duprée A, Gammal AT, Wolter S, et al. Perioperative Short-Term Outcome in Super-Super-Obese Patients Undergoing Bariatric Surgery[J]. Obesity Surgery, 2018, 28(7): 1895-1901.
[5]
刘少壮,刘腾,王超, 等. 袖状胃切除术治疗BMI≥100 kg/m2肥胖症患者1例报告[J]. 腹腔镜外科杂志, 2019, 24(01): 67-71.
[6]
Santo MA, Riccioppo D, Pajecki D, et al. Preoperative weight loss in super-obese patients: study of the rate of weight loss and its effects on surgical morbidity[J]. Clinics, 2014, 69(12): 828-834.
[7]
Joshi GP, Ahmad S, Riad W, et al. Selection of obese patients undergoing ambulatory surgery: a systematic review of the literature[J]. Anesth Analg, 2013, 117(5): 1082-1091.
[8]
Santo MA, Pajecki D, Riccioppo D, et al. Early complications in bariatric surgery: incidence, diagnosis and treatment[J]. Arq Gastroenterol, 2013, 50(1): 50-55.
[9]
Martins-Filho ED, Katz L, Amorim M, et al. Predicition of severe complications and death in superobese patients undergoing open gastric bypass[J]. Arq Gastroenterol, 2011, 48(1): 8-14.
[10]
Victorzon M. Revisional bariatric surgery by conversion to gastric bypass or sleeve-Good short-term outcomes at higher risks[J]. Obes Surg, 2012(1), 22: 29-33.
[11]
Hewes JC, Kelly J, Hashemi M.Buried penis in super obesity: a technique for urethral catheterization under direct vision[J]. Surg Obes Relat Dis, 2011, 7(3): 332-335.
[12]
Cullen A, Ferguson A. Perioperative management of the severely obese patient: a selective pathophysiological review[J]. Can J Anesth, 2012, 59(10): 974-996.
[13]
O’Brien E. Review: a century of confusion: which bladder for accurate blood pressure measurement[J]. J Hum Hypertens, 1996, 10(9): 565-572.
[14]
Araghi A, Bander JJ, Guzman JA. Arterial blood pressure monitoring in overweight critically ill patients: invasive or noninvasive?[J]. Crit Care, 2006, 10(2): R64.
[15]
Leblanc Mé, Croteau S, Ferland A, et al. Blood pressure assessment in severe obesity: validation of a forearm approach[J]. Obesity (Silver Spring), 2013, 21(12): E533-541.
[16]
Pelosi P, Croci M, Ravagnan I, et al. Respiratory system mechanics in sedated, paralyzed, morbidly obese patients[J]. J Appl Physiol, 1997, 82(3): 811-818.
[17]
Mathews PV, Perry JJ, Murray PC. Compartment syndrome of the well leg as a result of the hemilithotomy position: a report of two cases and review of literature[J]. J Orthop Trauma, 2001, 15(8): 580-583
[18]
Hewes JC, Kelly J, Hashemi M.Buried penis in super obesity: a technique for urethral catheterization under direct vision[J]. Surgery for Obesity and Related Diseases, 2011, 7(3): 332.
[19]
Ghaffary G, Yohannes A, Villanueva C. Practical Approach to Difficult Urinary Catheterizations[J]. Curr Urol Rep, 2013, 14(6): 565-579.
[20]
Brusasco C, Corradi F, Zattoni PL, et al. Ultrasound-guided central venous cannulation in bariatric patients[J]. Obes Surg, 2009, 19(6): 1365-1370.
[21]
McGrath TM, Farabaugh EA, Pickett MJ, et al.Obesity hinders ultrasound visualization of the subclavian vein: implications for central venous access[J]. J Vasc Access, 2012, 13(2): 246-250.
[22]
Leblanc Mé, Croteau S, Ferland A, et al.Blood pressure assessment in severe obesity: validation of a forearm approach[J]. Obesity (Silver Spring), 2013, 21(12): E533-541.
[23]
Helmut H, Mandadi G, Eagon C, et al.Intraoperative blood pressure measurement on the wrist is more accurate than on the upper arm in morbidly obese patients[J].Abstract presented at the American Society of Anesthesia, 2004.
[24]
Hager H, Mandadi G, Pulley D, et al. A comparison of noninvasive blood pressure measurement on the wrist with invasive arterial blood pressure monitoring in patients undergoing bariatric surgery[J]. Obes Surg, 2009, 19(6): 717-724.
[25]
Perilli V, Sollazzi L, Bozza P et al. The effects if the reverse Trendelenburg position on respiratory mechanics and blood gases in morbidly obese patients during bariatric surgery[J]. Anesth Analg, 2000, 91(6): 1520-1525.
[26]
Association of Perioperative Registered Nurses. Recommended practices for positioning the patient in the perioperative practice setting[J]. AORN J, 2001, 73(1): 231-235, 237-238.
[27]
Neil JA. Perioperative Nursing Care of the Patient Undergoing Bariatric Revision Surgery [J]. AORN J, 2013, 97(2): 210-226.
[1] 韩笑, 王鑫, 谷禹, 邓述华, 田华. 机器人辅助全髋关节置换术的护理模式探讨[J]. 中华关节外科杂志(电子版), 2022, 16(03): 373-376.
[2] 武现生, 李丁昌, 高文星, 赵稳, 陈鹏, 金露佳, 董光龙. 超级肥胖患者术式选择及疗效分析[J]. 中华普外科手术学杂志(电子版), 2023, 17(01): 27-31.
[3] 熊岩, 徐欣, 郝雪梅, 王筱君, 王亚, 沈正礼, 侯艳君. 新型冠状病毒肺炎疫情下手术室感染控制与管理[J]. 中华普外科手术学杂志(电子版), 2020, 14(02): 211-213.
[4] 朱玉华, 任希燕, 季如如, 顾海燕. 手术室流程再造对腹腔镜经腹腹膜前腹股沟疝修补术患者院内感染的影响[J]. 中华疝和腹壁外科杂志(电子版), 2022, 16(05): 600-604.
[5] 刘娅娟, 王少华, 蒋丽, 代景友, 刘伟. 手术室细节护理在小儿腹腔镜下腹股沟疝囊高位结扎手术中的应用[J]. 中华疝和腹壁外科杂志(电子版), 2022, 16(04): 473-476.
[6] 杨怀霞, 张源源, 杨倩, 李丽娟. 优质精细化术中护理在小儿腹腔镜腹股沟疝手术中的应用效果[J]. 中华疝和腹壁外科杂志(电子版), 2022, 16(04): 451-454.
[7] 汤松琴, 朱晓兰, 程明云. 鼓励性护理联合共情护理对腹股沟疝手术患者应激反应的效果[J]. 中华疝和腹壁外科杂志(电子版), 2021, 15(05): 521-524.
[8] 杨波, 王巧桂. 手术室短期综合干预对腹股沟疝患者的效果评价[J]. 中华疝和腹壁外科杂志(电子版), 2020, 14(03): 293-295.
[9] 李旭阳, 李明睿, 刘鑫, 王欣欣. 手术室护理干预对直肠癌患者术后快速康复作用的研究[J]. 中华结直肠疾病电子杂志, 2020, 09(06): 633-635.
[10] 吴晓舟, 魏彦姝, 闵玉娣, 刘晓黎. 肩关节镜手术患者术中低体温预测模型的构建及验证[J]. 中华肩肘外科电子杂志, 2020, 08(04): 335-339.
[11] 潘冬生, 宋振全, 李晋江, 雷伟, 李靖远, 冯思哲. 应用复合手术室治疗颅脑穿通伤手术经验总结[J]. 中华神经创伤外科电子杂志, 2021, 07(06): 368-371.
[12] 田红梅, 李温荣, 刘俐惠, 张文静. 风险管理联合积极心理护理预防PICC置管患者机械性静脉炎风险的价值[J]. 中华临床医师杂志(电子版), 2022, 16(06): 593-596.
[13] 聂清美, 班梅梅, 包怀英, 肖植文. 基层医疗机构实验室人力资源风险管理分析[J]. 中华临床实验室管理电子杂志, 2020, 08(04): 193-196.
[14] 李志刚. 以精入微——台湾长庚医院早期肺癌精准诊疗经验专访[J]. 中华胸部外科电子杂志, 2022, 09(02): 104-108.
[15] 陈嘉伟, 王锐, 何嘉曦, 李树本. 一体化手术室肺结节精准诊疗现状:系统性回顾研究[J]. 中华胸部外科电子杂志, 2022, 09(02): 80-85.
阅读次数
全文


摘要