CT下经皮胸交感射频联合无水乙醇注射治疗手汗症的护理

Nursing care of patients with primary palmar hyperhidrosis treated by CT guided percutaneous thoracic sympathetic nerve radiofrequency thermocoagulation combined with absolute ethanol injection

摘要:

摘 要 目的：总结CT引导下经皮穿刺胸交感神经射频热凝术联合无水乙醇注射术治疗原发性手汗症的围手术期护理方法。方法：回顾性总结并分析2020年5月1日至2021年4月30日疼痛科收治的40例在CT引导下行经皮穿刺胸交感神经射频热凝术联合无水乙醇注射术治疗的原发性手汗症病人的临床资料。结果：40例病人均顺利完成手术，其中37例症状缓解、2例PPH分级为轻度、1例为中度；术后病人手掌皮肤平均温度由33.09±0.42℃升高至35.92±0.39℃，手指末梢灌注指数(perfusion index, PI)由0.91±0.11升高至4.79±0.54，差异均有统计学意义（P＜0.001）；术后出现1例胸闷、8例胸背部疼痛、3例代偿性多汗、1例霍纳综合征，经及时有效处理后症状均得以缓解；护理后病人HADS焦虑评分、HADS抑郁评分、PSQI睡眠评分及满意度评分均明显改善。结论：术前做好病情评估、心理护理、完善相关术前准备；术中做好手术配合；术后密切观察病人病情、做好伤口护理、疼痛护理管理、并发症防范及出院指导能有效保证手术效果，使病人得到更好地恢复，并改善其就医体验。

Abstract:

Abstract Objective: To summarize the perioperative nursing methods of CT-guided percutaneous thoracic sympathetic radiofrequency thermocoagulation combined with absolute ethanol injection in the treatment of primary palmar hyperhidrosis. Methods: The clinical data of 40 patients with primary palmar hyperhidrosis who underwent CT-guided percutaneous thoracic sympathetic radiofrequency thermocoagulation combined with absolute ethanol injection from May 1,2020 to April 30,2021 were retrospectively summarized and analyzed. Results: 40 patients were successfully completed surgery, of which 37 cases of symptomatic relief, 2 cases of PPH classified as mild, 1 case of moderate ; the mean temperature of palm skin increased from 33.09 ± 0.42 °C to 35.92 ± 0.39 °C, and the perfusion index ( PI ) of finger increased from 0.91 ± 0.11 to 4.79 ± 0.54 ( P < 0.001 ). There were 1 case of chest tightness, 8 cases of chest and back pain, 3 cases of compensatory hyperhidrosis and 1 case of Horner syndrome after operation, and the symptoms were relieved after timely and effective treatment. HADS anxiety score, HADS depression score, PSQI sleep score and satisfaction score were significantly improved after nursing. Conclusion : Preoperative disease assessment, psychological care, improve the relevant preoperative preparation ; intraoperative surgical cooperation ; postoperative close observation of the patient 's condition, good wound care, pain care management, complication prevention and discharge guidance can effectively ensure the surgical effect, so that patients can get better recovery and improve their medical experience.