How much do you know about the nursing care for posture and complications of gynecological laparoscopic surgery?

With the development of surgical technology, laparoscopic surgery is increasingly used in gynecological diseases. Its advantages are small trauma, fast postoperative recovery, and short hospitalization time, so it has been widely used in clinical practice. Due to individual differences in patients and the needs of surgery, some patients can adopt different positions. Next, let's learn about the position of laparoscopic surgery and the care of complications.

1. What are the positions for gynecological laparoscopic surgery ?

1. Traditional lithotomy position

The traditional lithotomy position is a widely used and relatively safe position, with the lower limbs abducted to less than 90°. The traditional lithotomy position can reduce the pressure of abdominal pressure on the abdominal wall muscles and effectively prevent urinary retention. However, the traditional lithotomy position also has certain shortcomings.

1. The traditional lithotomy position is prone to orthostatic hypotension and headaches. If the patient experiences symptoms such as headache, nausea, vomiting, irritability, etc., the doctor should be notified in time for treatment.

2. In the traditional lithotomy position, the head is tilted to one side or a pillow is placed under the head, which makes it difficult for oral and tracheal secretions to flow out, which can easily cause choking and suffocation. Therefore, attention should be paid to the patient's airway being unobstructed, and nebulization or sputum suction should be given when necessary.

3. The traditional lithotomy position compresses the chest cavity, which affects the recovery of cardiopulmonary function, so the patient should be assisted to turn over.

4. The traditional lithotomy position will block venous return because the patient's lower limbs are lifted up; the prone position is prone to venous thrombosis. Therefore, the lower limb muscles should be massaged or pulled, and appropriate restraints should be given when necessary.

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2. Modified lithotomy position

The modified lithotomy position is based on the lithotomy position. The patient's thighs and abdomen are kept at the same level, the knees are bent, the angle between the upper and lower legs is about 120 degrees, and the angle between the legs is about 85 degrees. The modified lithotomy position has the following advantages:

1. Fully expose the surgical field. Because it is a lithotomy position, the surgeon can clearly observe the situation in the abdominal cavity during the operation under laparoscopy. Especially when the surgery requires pelvic organ removal, it is more convenient for the surgeon to operate.

2. It is conducive to blood transfusion, infusion and gas exchange. Because the patient's surgical position is close to the supine position, there is no need to prepare blood supply intravenous infusion tubes, gas exchange devices and blood transfusion infusion sets during laparoscopic surgery.

( III ) Human position

The spica position is a commonly used position that allows the patient to remain in a relatively comfortable position throughout the entire operation, which is conducive to the cooperation between the doctor and the patient and also facilitates observation of the surgical field. The spica position evolved from the supine position, in which the legs are no longer raised and placed on the position frame, and complications such as lower limb nerve damage are also greatly reduced.

4. High and low lithotomy positions

The patient lies on his back, lower one leg and slightly raise the other leg, first lower the lower leg stand to 70°, flex the hip and knee to 110°, then slightly raise the higher leg stand to 100°, flex the hip and knee to 80°, so that the two legs are 30° apart in height.

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2. How to choose the surgical position?

1. Check the function of lower limbs: After ensuring the safety of the patient, check whether there is any movement disorder or pain in the lower limbs. If there is any movement disorder or pain in the lower limbs, consider whether there is any injury to the knee, ankle and hip joints. When checking the function of lower limbs, you can use the tapping method, that is, tap the sides of the patient's thighs and the outside of the calves with your hands. If there is pain or other discomfort, contact the doctor in time.

2. Pay attention to the patient's breathing: During the operation, you should pay attention to the patient's breathing at all times. If the patient has symptoms such as shortness of breath and dizziness, you should contact the doctor in time. During the operation, you should pay attention to the changes in the patient's complexion and chest rise and fall. If you find that the patient's chest rise and fall suddenly decreases or disappears, you should notify the doctor in time to deal with it.

3. Pay attention to the patient's vital signs: During the operation, closely observe the changes in the patient's vital signs. If the patient has symptoms such as dizziness, nausea, vomiting, and increased heart rate, report it to the doctor in time. If the patient has symptoms such as confusion, indifferent expression, and pale face, notify the doctor in time to deal with it.

4. Keep the skin of the surgical field dry: During the operation, the surgical site should be changed frequently. If the skin is found to be moist, wet or exudate, the surgical site should be changed in time. When changing the surgical site, pay attention to protecting the skin around the incision and the wound surface.

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3. How to deal with complications of gynecological laparoscopic surgery?

1. Intraperitoneal bleeding: It accounts for more than 50% of complications of gynecological laparoscopic surgery. Causes of intraperitoneal bleeding include: residual endometriosis lesions, uterine fibroid removal, tubal perfusion, electroresection, electrocoagulation and other surgeries that damage the peritoneum, causing intraperitoneal bleeding; excessive force during suturing, increased abdominal pressure; rupture of blood vessels, etc. Treatment method: Strictly abide by the principles of aseptic operation, completely free the hematoma and adhesion tissue after removing the lesion, and suture the peritoneum first and then the blood vessels during suturing. Perform emergency laparotomy if necessary.

2. Pneumoperitoneum: refers to a series of pathological and physiological changes caused by increased intra-abdominal pressure due to increased pressure during gynecological laparoscopic surgery, including hypoxemia caused by CO2 gas entering the abdominal cavity, toxic effects of CO2 gas on tissue cells, adverse stimulation between CO2 gas and blood vessel walls, and direct toxic effects of CO2 gas on tissue cells in the abdominal cavity. Severe pneumoperitoneum can cause a series of complications, including hypoxemia, decreased blood pressure, tachypnea and arrhythmia, and in severe cases, respiratory failure and death. Treatment: Strictly follow aseptic procedures, closely observe changes in vital signs, and be alert to pneumoperitoneum complications.

3. Infection: Infection is the most common complication of gynecological laparoscopic surgery. The main reasons are rough operation and improper suturing during the operation. Prevention methods: Strictly abide by the principles of aseptic operation to reduce the surgeon's irregular operation; pay attention to protecting the incision during the operation to avoid tissue damage as much as possible; strictly abide by the principles of aseptic operation; strengthen antibiotic treatment after the operation and closely observe the changes in the condition.

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4. How to provide care during gynecological laparoscopic surgery?

1. Preoperative visit and psychological care: Preoperative visit can understand the patient's physical condition and psychological state, surgical method, anesthesia method, intraoperative cooperation, postoperative pain, etc., so as to make full psychological preparation for the patient. After the operation, one-on-one psychological care is provided to the patient, and more communication is conducted with the patient, caring and considerate of the patient, so that the patient can eliminate his or her worries and cooperate with the operation with a good attitude.

2. Closely observe changes in the patient's condition: Closely observe changes in the patient's vital signs and keep corresponding records. At the same time, strengthen the monitoring of the condition and promptly detect and deal with abnormal conditions. Especially changes in vital signs such as body temperature, heart rate, and blood pressure. When symptoms such as dizziness, palpitations, and sweating occur, be alert to whether pneumoperitoneum has occurred.

3. During the operation, the surgical site should be closely observed for bleeding, hematoma or tissue defect, as well as the blood supply to the surgical field, especially the blood supply to the thoracic and abdominal organs. If any abnormality is found, the doctor should be notified in time.

4. Observe whether the skin in the surgical field is red, swollen, hot or painful, and whether there is hematoma formed in the incision and surrounding tissues. If it occurs, notify the doctor in time and assist in treatment.

5. Observe the blood flow of the skin in the surgical field, whether there is skin necrosis, and the size and depth of the necrosis. If bleeding or exudation is found in the wound, notify the doctor in time for treatment.

6. Closely observe the amount, nature and color of the drainage fluid. If the amount is large or the nature is abnormal, report it to the doctor immediately.

7. After the operation, the patient should get out of bed and move around under the guidance of a doctor to facilitate blood circulation and recovery of limb function.

8. After you are able to eat, it is advisable to eat high-calorie, high-protein and vitamin-rich foods. Avoid spicy and irritating foods, and encourage patients to eat more vegetables, fruits and other foods rich in vitamins.

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The above is the relevant content about gynecological laparoscopic surgery. I hope it can be helpful to everyone.