干预措施:
Interventions:
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组别:
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干预组
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样本量:
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60
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Group:
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Intervention group
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Sample size:
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干预措施:
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①在中医科专家指导下,选取膀胱、肾俞、尿道、三焦、皮质下、神门、交感、心俞8个耳穴,由我科经同质化培训合格的专科护士进行操作。使用酒精对耳部皮肤消毒后,应用耳穴探棒寻找相应穴位,将王不留行籽固定于所选的穴位,采用点压法、对压法及直压法按压穴位,以患者感到酸、胀、麻、痛等为度,同时以患者耳部皮肤有红晕、感觉烘热、耐受为宜,5min/次,然后更换另一侧耳实施操作。②在对照组的基础上,耳穴压豆组患者于术前30min选定穴位后开始第一次干预,入复苏室后5min内进行第二次干预,苏醒后6h进行第三次干预,此后每6-8h干预一次,直至尿管拔除24h。
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干预措施代码:
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Intervention:
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① Under the guidance of experts in Traditional Chinese medicine, 8 auricular points of bladder, Shenshu, urethra, Sanjiao, cortical, Shenmen, sympathetic and Xinshu were selected and operated by qualified nurses in our department after homogenization training. After the ear skin was disinfected with alcohol, the ear point probing stick was applied to find the corresponding acupoints, and the King's seeds were fixed at the selected acupoints. The acupoints were pressed by point pressure method, counterpressure method and direct pressure method. The patient felt acid, distension, numbness, pain, etc. as the degree, and the patient's ear skin was flushed, felt hot, and tolerance was appropriate, 5min/ time, and then the other ear was replaced for operation. ② On the basis of the control group, the patients in the auricular point pressure bean group started the first intervention 30 minutes before surgery after the selected points, the second intervention was performed within 5 minutes after entering the resuscitation room, the third intervention was performed 6 hours after awakening, and the intervention was performed every 6-8 hours until the urinary tube was removed for 24 hours.
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Intervention code:
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组别:
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对照组
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样本量:
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60
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Group:
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Control group
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Sample size:
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干预措施:
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①所有患者在术前一天接受访视,评估患者的麻醉分级及全身情况,并予以常规手术及麻醉相关健康指导,并予以答疑解惑及心理疏导。②入手术室后常规监测血压、心电图、血氧饱和度、呼末二氧化碳,开放静脉通路,予复方氯化钠静滴。所有患者全凭静脉给药予以实施麻醉诱导及麻醉维持,麻醉诱导用药均选用舒芬太尼0.5ug/kg、通过咪达唑仑0.05 mg/kg、丙泊酚2.5mg/kg、罗库溴铵0.6mg/kg,麻醉维持用药均选用瑞芬太尼0.1~0.3ug/kg/min、丙泊酚4~6mg/kg/h、罗库溴铵0.3~0.4mg/kg/h ;③所有患者均全凭静脉给药予以实施麻醉诱导及麻醉维持,麻醉诱导用药均选用舒芬太尼0.5ug/kg、丙泊酚2.5mg/kg、罗库溴铵0.6mg/kg,麻醉维持用药均选用瑞芬太尼0.1~0.3ug/kg/min、丙泊酚4~6mg/kg/h、罗库溴铵0.3~0.4mg/kg/h;④均在全身麻醉诱导后实施导尿管留置操作,根据患者尿道大小选择合适型号的双腔气囊乳胶导尿管;⑤导尿管留置操作均由经过同质化培训的经验丰富的手术室护士严格在无菌要求下完成,同时要求操作时将尿管全部插入后再往气囊内注入生理盐水10ml+5ml空气固定;⑥手术结束时停用麻醉药物,术后送入麻醉复苏室留观。入复苏室后予以常监测生命体征及病情变化,待患者自主呼吸恢复,肌力恢复,能执行指令动作时拔除气管导管。⑦如患者术后出现中重度导尿管相关膀胱刺激征则由麻醉医生根据情况予以曲马多1mg/kg对症处理;寒战时由麻醉医生根据情况予以曲马多1mg/kg对症处理;中重度疼痛则麻醉医生根据情况予以芬太尼1ug/kg对症处理,如果患者同时主诉中重度导尿管相关膀胱刺激征和术后疼痛,则根据更显著的主诉给予曲马多或芬太尼。⑧所有患者均在麻醉苏醒后24h内根据患者恢复情况及医生建议,由经过同质化培训的研究人员拔除尿管,要求抽尽气囊内生理盐水后,动作轻柔缓慢地拔除尿管。
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干预措施代码:
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Intervention:
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① All patients were interviewed on the day before the operation to evaluate the anesthesia grade and general condition of the patients, and to give routine surgery and anesthesia related health guidance, and to answer questions and psychological counseling. ② After entering the operating room, blood pressure, electrocardiogram, blood oxygen saturation, and end-expiratory carbon dioxide were routinely monitored, and intravenous access was opened and compound sodium chloride was administered. All patients were given anesthesia induction and maintenance by intravenous administration. Sufentanil 0.5ug/kg, midazolam 0.05mg /kg, propofol 2.5mg/kg, rocuronium 0.6mg/kg were selected as anesthetic induction drugs. Remifentanil 0.1~0.3ug/kg/min, propofol 4~6mg/kg/h, rocuronium 0.3~0.4mg/kg/h were selected for anesthesia maintenance. ③ All patients were given anesthesia induction and maintenance by intravenous administration. Sufentanil 0.5ug/kg, propofol 2.5mg/kg, rocuronium 0.6mg/kg were selected as anesthetic induction drugs. Remifentanil 0.1~0.3ug/kg/min, propofol 4~6mg/kg/h, rocuronium 0.3~0.4mg/kg/h were selected for anesthesia maintenance. (4) Catheter indwelling operation was performed after induction of general anesthesia, and the suitable type of double-cavity balloon latex catheter was selected according to the size of the urethra of the patients; (5) Catheter indwelling operations are performed strictly under sterility requirements by experienced operating room nurses with homogenization training. At the same time, it is required to insert all urinary tubes and then inject 10ml of normal saline +5ml of air into the balloon for fixation; (6) Anesthesia drugs were discontinued at the end of the operation and sent to the anesthesia resuscitation room for observation. After entering the resuscitation room, the vital signs and condition changes should be monitored frequently, and the tracheal catheter should be removed when the patient's spontaneous breathing and muscle strength recovered and could execute the ordered actions. ⑦ If the patient has moderate to severe urinary catheter-related bladder irritation after surgery, the anesthesiologist will give tramadol 1mg/kg symptomatic treatment according to the situation; When shivering, the anesthesiologist should give tramadol 1mg/kg symptomatic treatment according to the situation; For moderate to severe pain, the anesthesiologist will give fentanyl 1ug/kg symptomatic treatment according to the circumstances. If the patient complains of moderate to severe catheter-related bladder irritation and postoperative pain at the same time, tramadol or fentanyl will be given according to the more significant complaints. In all patients, the urinary tube was removed within 24h after anesthesia according to the patient's recovery condition and the doctor's advice, and the urinary tube was removed gently and slowly after the normal saline in the air sac was drained.
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Intervention code:
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