陈瑶 肖莹 李贵萍

【摘要】 目的：观察术后体位管理对子宫内膜异位症患者腹腔镜术后康复效果的影响。方法：将150例子宫内膜异位症行腹腔镜手术并置放盆腔引流管的患者采用随机数字表法随机分为对照组和试验组，各75例。对照组进行常规护理，试验组在对照组基础上实施体位管理。干预后比较两组患者的疼痛视觉模拟评分（visual analogue scale，VAS）、伤口感染、腹胀发生情况、首次肛门排气时间、首次下床活动时间、引流管置管时间及术后住院时间。结果：干预后试验组术后6、12、24、48 h的VAS评分均低于对照组，差异均有统计学意义（P<0.05）。试验组伤口感染率（5.3%）和腹胀发生率（13.3%）均低于對照组（17.3%、34.7%），差异均有统计学意义（P<0.01）。试验组首次肛门排气时间、首次下床活动时间、引流管置管时间及术后住院时间均短于对照组（P<0.01）。结论：体位管理能有效减轻子宫内膜异位症患者腹腔镜术后疼痛程度，减少伤口感染的发生，促进患者胃肠功能的恢复，缩短引流时间，加速患者术后康复。

【关键词】 体位管理; 子宫内膜异位症; 引流; 疼痛

【Abstract】 Objective：To evaluate the effect of postural management on the rehabilitation of patients with endometriosis after laparoscopic surgery.Method：A total of 150 patients with endometriosis after laparoscopic surgery and pelvic drainage tube placement were randomly divided into control group and experimental group by random number table method，75 cases in each group.The control group was given routine nursing，and the experimental group was given postural management on the basis of the control group.After the intervention，the visual analogue scale（VAS）score，wound infection，abdominal distension，time of first anal exhaust，time of first movement out of bed，time of drainage tube placement and postoperative hospitalization time were compared between the two groups.Result：After the intervention，the VAS scores of the experimental group at 6，12，24，48 h after the surgery were lower than those of the control group，and the pain gradually decreased，the differences were statistically significant（P<0.05）.The wound infection rate（5.3%）and abdominal distention rate（13.3%）in the experimental group were lower than 17.3%，34.7% in the control group，the differences were statistically significant（P<0.01）.The time of first anal exhaust，time of first movement out of bed，time of drainage tube placement and postoperative  hospitalization time in the experimental group were lower than those in the control group（P<0.01）.Conclusion：Postural management can effectively relieve the pain of patients with endometriosis after laparoscopic surgery，reduce the incidence of wound infection，promote the recovery of gastrointestinal function，shorten the time of drainage，accelerate postoperative rehabilitation.

【Key words】 Postural management; Endometriosis; Drainage; Pain

First-authors address：Jiangxi Medical College，Shangrao 334000，China

doi：10.3969/j.issn.1674-4985.2019.17.022

子宫内膜异位症（内异症）是常见的妇科疾病，患病率高达15%，虽为良性疾病，但有恶变风险[1]。调查显示内异症相关性卵巢癌的发生率为11.64万人/年[2]。腹腔镜手术是子宫内膜异位症的常用治疗方法[3]。术后为了将腹腔内积血积液充分引流，避免腹腔内炎症反应的扩散，还会常规放置引流管，以便于直接观察术后有无活动性出血[4-5]。但是引流管的存在不利于患者术后早期下床活动，降低患者的舒适度，增加疼痛并且影响伤口愈合，从而延缓了患者的康复速度[6-7]。本研究旨在通过体位管理来改善子宫内膜异位症患者腹腔镜术后引流效果，减轻疼痛，缩短拔管时间，从而加速患者康复。现报道如下。

1 资料与方法

1.1 一般资料 选取2017年1-12月在本院妇科住院的子宫内膜异位症患者150例，所有患者均行全麻腹腔镜下卵巢囊肿剔除术+盆腔引流术，经病理证实为卵巢型子宫内膜异位症。……