两种护理干预措施对老年截石位手术患者血压变化的影响

论文编号:HL244 论文字数:13428,页数:25

论文题目：两种护理干预措施对老年截石位手术患者血压变化的影响
摘　要
 目的：探讨实施下肢被动运动和医用弹力绷带两种护理干预措施对老年截石位手术患者放平下肢后血压、心率等指标的影响，并比较两种方法预防截石位体位改变性低血压的有效性。
 方法：选取2009年2-9月期间在我院手术室行经尿道前列腺电切术(TURP)的老年患者90例，随机分为观察1组、观察2组和对照组各30例。手术结束后所有患者均采用单腿慢放，其中观察1组实施下肢被动运动；观察2组应用医用弹力绷带；对照组未实施护理干预。记录三组患者术毕放平下肢前(截石位)、放平-N下肢即刻、放平双下肢即刻、放平双下肢1、3、5min时的血压、心率。
 结果：被动运动组和弹力绷带组患者血压维持稳定，体位改变前后收缩压(SBP)、平均动脉压(MAP)无明显变化(P>0.05)，且两组之间比较无显著性差异(P>0.05)；对照组患者放平下肢后SBP、MAP明显降低，与体位改变前及被动运动组和弹力绷带组比较均显著下降(P<0.01或P<0.05)；三组患者心率(HR)均出现增快(P<0.01或P<0.05)。
 结论：实施下肢被动运动和医用弹力绷带两种护理干预措施，均可减轻老年截石位手术患者血压的波动程度，对预防截石位体位改变性低血压，保证患者围手术期安全有一定的实际意义。
 关键词: 截石位；老年患者；血压；护理
 
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  录
 
摘　要 IV
ABSTRACT………………………………………………………………………………….V
目录………………………………………………………………………………………….VI
1 绪论 1
1.1 背景及意义 1
1.2目的 1
1.3关键词及定义 2
1.4 文献回顾 2
2 研究设计…………………………………………………………………………………...6
2.1研究设计…………………………………………………………………………….6
2.2研究对象…………………………………………………………………………….6
2.4研究工具…………………………………………………………………………….6
2.4研究步骤…………………………………………………………………………….6
2.5统计分析…………………………………………………………………………….7
3 研究结果…………………………………………………………………………………...9
 3.1对照组干预前后各指标较……………………………………………………….9
 3.1.1各组放腿后各时间点收缩压与放腿前收缩压的比较（表1）…………………9
 3.1.2各组放腿后舒张压与放腿前舒张压的比较（表2）……………………………9
 3.1.3各组放腿后各时间点平均动脉压与放腿前平均动脉压的比较……………...10 
 3.1.4各组放腿后各时间点心率与放腿前心率的比较(表4)……………………….10
 3.2同一时间点收缩压、舒张压、平均动脉压、心率的组间比较…………………10
 3.2.1同一时间点舒张压、心率的组间比较结果(表5)……………………………..11
 3.2.2同一时间点收缩压的组间比较结果（表6）………………………………….11
 3.2.3同一时间点平均动脉的组间比较结果（表7）……………………………….12
4 讨论……………………………………………………………………………………….13
4.1三组患者血压、心率变化情况及分析……………………………………………13
4.2两种护理干预措施防血压下降的效果分析……………………………………...13
 4.3小结………………………………………………………………………………...14
5 推论及建议……………………………………………………………………………….15
致谢………………………………………………………………………………………….16
参考文献…………………………………………………………………………………….17