兩種護(hù)理干預(yù)措施對(duì)老年截石位手術(shù)患者血壓變化的影響

論文編號(hào):HL244 論文字?jǐn)?shù):13428,頁數(shù):25

論文題目：兩種護(hù)理干預(yù)措施對(duì)老年截石位手術(shù)患者血壓變化的影響
摘　要
 目的：探討實(shí)施下肢被動(dòng)運(yùn)動(dòng)和醫(yī)用彈力繃帶兩種護(hù)理干預(yù)措施對(duì)老年截石位手術(shù)患者放平下肢后血壓、心率等指標(biāo)的影響，并比較兩種方法預(yù)防截石位體位改變性低血壓的有效性。
 方法：選取2009年2-9月期間在我院手術(shù)室行經(jīng)尿道前列腺電切術(shù)(TURP)的老年患者90例，隨機(jī)分為觀察1組、觀察2組和對(duì)照組各30例。手術(shù)結(jié)束后所有患者均采用單腿慢放，其中觀察1組實(shí)施下肢被動(dòng)運(yùn)動(dòng)；觀察2組應(yīng)用醫(yī)用彈力繃帶；對(duì)照組未實(shí)施護(hù)理干預(yù)。記錄三組患者術(shù)畢放平下肢前(截石位)、放平-N下肢即刻、放平雙下肢即刻、放平雙下肢1、3、5min時(shí)的血壓、心率。
 結(jié)果：被動(dòng)運(yùn)動(dòng)組和彈力繃帶組患者血壓維持穩(wěn)定，體位改變前后收縮壓(SBP)、平均動(dòng)脈壓(MAP)無明顯變化(P>0.05)，且兩組之間比較無顯著性差異(P>0.05)；對(duì)照組患者放平下肢后SBP、MAP明顯降低，與體位改變前及被動(dòng)運(yùn)動(dòng)組和彈力繃帶組比較均顯著下降(P<0.01或P<0.05)；三組患者心率(HR)均出現(xiàn)增快(P<0.01或P<0.05)。
 結(jié)論：實(shí)施下肢被動(dòng)運(yùn)動(dòng)和醫(yī)用彈力繃帶兩種護(hù)理干預(yù)措施，均可減輕老年截石位手術(shù)患者血壓的波動(dòng)程度，對(duì)預(yù)防截石位體位改變性低血壓，保證患者圍手術(shù)期安全有一定的實(shí)際意義。
 關(guān)鍵詞: 截石位；老年患者；血壓；護(hù)理
 
Title: Influence of 2 kinds of nursing interventions on blood pressure of elderly patients undergoing lithotomy position surgery
ABSTRACT
Objective
To explore the influence of two different nursing interventions on blood pressure of elderly patients undergoing lithotomy position surgery．And to compare the effectiveness of two methods to prevent hypothension when position change．
Methods
 90 cases of gerontal patient treated by transurethral resection of prostate(TURP) from February 2009 to September in hospital were randomly divided into the observation group 1，observation group 2，and control group with 30 patients in each．After surgery all patients were using one leg slow—release．In which observation group 1 implementation of the lower limb passive movement，observation group 2 applied medical elastic bandage，and the control group with no intervention．The blood pressure and heart rate of all patients at different time points were recorded．The time points including before flat lower extremities(1ithotomy postion)，fiat side of the lower extremities immediately,flat lower extremities immediately,flat lowerlimbs 1、3、5min．
Results
Passive motion group and the elastic bandage group blood pressure remained stable．The systolic blood pressure(SBP)，mean arterial pressure(MAP)with no significant change before and after the postural change(P>O．05)．The blood pressure decreased significantly in control group compared with the before postural change leveland passive motion group and the elastic bandage group(P<0．01或P<O．05)：three
groups of patients increased heart rate fast(P<O．01或P<0．05)．
Conclusion
 Implementation of the lower limb passive movement and medical elastic bandage can help to maintain the blood pressure in a normal level in elderly patients during lithotomy position surgery．Thus Can prevent orthostatic hypotension and ensure the safety of patients in the perioperative period with a certain degree of practical significance．．

Key words：Lithotomy position；Elderly patient；Blood pressure；Nursing care 
 
 
目  錄
 
摘　要 IV
ABSTRACT………………………………………………………………………………….V
目錄………………………………………………………………………………………….VI
1 緒論 1
1.1 背景及意義 1
1.2目的 1
1.3關(guān)鍵詞及定義 2
1.4 文獻(xiàn)回顧 2
2 研究設(shè)計(jì)…………………………………………………………………………………...6
2.1研究設(shè)計(jì)…………………………………………………………………………….6
2.2研究對(duì)象…………………………………………………………………………….6
2.4研究工具…………………………………………………………………………….6
2.4研究步驟…………………………………………………………………………….6
2.5統(tǒng)計(jì)分析…………………………………………………………………………….7
3 研究結(jié)果…………………………………………………………………………………...9
 3.1對(duì)照組干預(yù)前后各指標(biāo)較……………………………………………………….9
 3.1.1各組放腿后各時(shí)間點(diǎn)收縮壓與放腿前收縮壓的比較（表1）…………………9
 3.1.2各組放腿后舒張壓與放腿前舒張壓的比較（表2）……………………………9
 3.1.3各組放腿后各時(shí)間點(diǎn)平均動(dòng)脈壓與放腿前平均動(dòng)脈壓的比較……………...10 
 3.1.4各組放腿后各時(shí)間點(diǎn)心率與放腿前心率的比較(表4)……………………….10
 3.2同一時(shí)間點(diǎn)收縮壓、舒張壓、平均動(dòng)脈壓、心率的組間比較…………………10
 3.2.1同一時(shí)間點(diǎn)舒張壓、心率的組間比較結(jié)果(表5)……………………………..11
 3.2.2同一時(shí)間點(diǎn)收縮壓的組間比較結(jié)果（表6）………………………………….11
 3.2.3同一時(shí)間點(diǎn)平均動(dòng)脈的組間比較結(jié)果（表7）……………………………….12
4 討論……………………………………………………………………………………….13
4.1三組患者血壓、心率變化情況及分析……………………………………………13
4.2兩種護(hù)理干預(yù)措施防血壓下降的效果分析……………………………………...13
 4.3小結(jié)………………………………………………………………………………...14
5 推論及建議……………………………………………………………………………….15
致謝………………………………………………………………………………………….16
參考文獻(xiàn)…………………………………………………………………………………….17