抗阻运动对血液透析患者透析低血压的干预研究

发布时间：2018-03-01 15:38

本文关键词： 维持性血液透析透析低血压抗阻运动　出处：《大连医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：研究目的1.探索抗阻运动对透析中低血压发生频率、血压及血压变异性的干预效果;2.了解抗阻运动对血透患者透析清除率的影响,包括尿素、肌酐、血磷等;3.探索抗阻运动对血液透析患者生活质量的改善情况。研究方法运用方便抽样法选取大连市某三级甲等医院两所透析室频繁发生透析低血压的维持性血液透析80例患者作为研究对象,入组后经过随机数字表法将患者分为实验组和对照组,实验组40例,对照组40例。对照组接受透析中心的常规护理,透析过程中每1h测量一次血压,血流量180~280ml/min,透析液温度36~37°C,饮食指导,相关并发症的预防指导等;实验组在常规护理的基础上,接受为期12周的抗阻运动。干预措施:给予每周3次,共计12周(36次)的运动干预,每次进行血液透析前5分钟的热身运动和血液透析后5分钟的放松运动,以及约30分钟的间断透析中抗阻运动干预(上机开始计时,间断进行运动,约每20分钟进行3分钟的抗阻运动训练,共10次运动,直至透析结束),随时观察患者的不适症状。12周干预结束后,研究者对患者的干预前和干预过程中透析低血压发生频率、收缩压、舒张压、血压变异性,干预前和干预后透析清除率相关的生化指标(血钙、血磷、尿素、肌酐)、生活质量相关数据进行统计并评价。结果12周干预结束时,共77例患者完成本研究。结果显示:1.抗阻运动干预期间,实验组透析低血压的发生率显著低于对照组,差异有统计学意义(P0.05)。同时,患者接受相关护理干预措施的次数显著减少,如调节钠浓度,降低血流速度,调节温度(P0.05)。2.抗阻运动干预期间,实验组患者透析前血压值(收缩压和舒张压)显著低于对照组,差异有统计学意义(P0.01)。同时干预期间,实验组患者透析中最低血压值(收缩压和舒张压)均显著高于对照组,差异有统计学意义(P0.01)。3.抗阻运动干预期间,实验组患者收缩压血压变异性显著低于对照组(P0.05),两组患者舒张压血压变异性差异不明显。2组收缩压SD和CV比较差异有统计学意义(收缩压SD:t=-4.72,P=0.000;收缩压CV:t=-4.356,P=0.000),而舒张压SD与舒张压CV两组比较差异无统计学差异(P0.05)。4.12周抗阻运动可以增加尿素、肌酐、血磷的清除,但差异无统计学意义(P0.05)。5.12周抗阻运动干预后,实验组和对照组在心理方面的社会功能和心理健康维度,差异有统计学意义,实验组得分高于对照组(t=2.131-2.617,P0.05)。结论1.抗阻运动干预可显著降低维持性血液透析患者透析低血压发生频率,并减少其接受相关护理干预措施的次数。2.抗阻运动干预可以降低患者血压变异度,稳定血压。3.抗阻运动干预可以提高血液透析频繁低血压患者生活质量中的社会功能及心理健康维度。4.抗阻运动干预可以作为常规的护理干预方法来改善患者透析低血压的情况,值得临床推广应用。
[Abstract]:Objective 1. To explore the effects of resistance exercise on the frequency of hypotension, blood pressure and blood pressure variability in hemodialysis. 2. To understand the effect of resistance exercise on dialysis clearance rate, including urea and creatinine, in hemodialysis patients. To explore the improvement of the quality of life of hemodialysis patients by anti-resistance exercise. Methods the maintenance hemodialysis with hypotension occurred frequently in two dialysis rooms of Grade 3A hospital in Dalian city by using convenient sampling method. Dialysis of 80 patients as the study object, The patients were divided into experimental group (n = 40) and control group (n = 40). The control group received routine nursing care in dialysis center, and blood pressure was measured every 1 hour during dialysis. Blood flow was 180 ~ 280 ml / min, dialysate temperature was 3637 掳C, diet guidance, prevention guidance of related complications, etc. The experimental group received resistance exercise for 12 weeks on the basis of routine nursing. Intervention measures: 3 times a week, a total of 36 times a week). Warm up exercise 5 minutes before each hemodialysis and relaxation exercise 5 minutes after hemodialysis, and resistance exercise intervention during about 30 minutes of intermittent dialysis. About every 20 minutes of resistance exercise training, a total of 10 exercises, until the end of dialysis, at any time to observe the patient's symptoms. 12 weeks after the end of the intervention, the researchers on the patients before and during the intervention of the frequency of dialysis hypotension. Systolic blood pressure (SBP), diastolic blood pressure (DBP), blood pressure variability (BP), dialysate clearance before and after intervention (blood calcium, phosphorus, urea, creatinine, quality of life) were analyzed and evaluated. The results showed that the incidence of hemodialysis hypotension in the experimental group was significantly lower than that in the control group, and the difference was statistically significant (P 0.05). At the same time, the frequency of nursing intervention was significantly decreased. For example, adjusting the concentration of sodium, decreasing the blood flow velocity, adjusting the temperature, the blood pressure (systolic blood pressure and diastolic pressure) of the patients in the experimental group were significantly lower than those in the control group during the period of resistance exercise intervention, and the difference was statistically significant (P 0.01). At the same time, during the intervention period, the blood pressure of the patients in the experimental group was significantly lower than that in the control group. The lowest blood pressure (systolic blood pressure and diastolic blood pressure) in the experimental group was significantly higher than that in the control group (P 0.01). The systolic blood pressure variability in the experimental group was significantly lower than that in the control group (P 0.05). There was no significant difference in diastolic blood pressure variability between the two groups. 2 there were significant differences in systolic blood pressure SD and CV between the two groups (systolic blood pressure SD: t + -4.72 P 0.000; systolic blood pressure CVt: -4.356n P 0.000; diastolic blood pressure SD). There was no significant difference between the two groups in diastolic blood pressure (CV). The clearance of creatinine and phosphorus in blood, but there was no significant difference between the experimental group and the control group in the social function and the mental health dimension of mental health after the intervention of resistance exercise at week P0.05.5.12, there was significant difference between the experimental group and the control group in terms of psychological function and mental health. The score of the experimental group was higher than that of the control group (2.131-2.617) P0.050.Conclusion 1. The frequency of hemodialysis hypotension in patients with maintenance hemodialysis can be significantly reduced by anti-resistance exercise intervention. And reduce the frequency of nursing intervention. 2.Impedance exercise intervention can reduce the blood pressure variability of patients. Stable blood pressure .3.Impedance exercise intervention can improve social function and mental health dimension in the quality of life of hemodialysis patients with frequent hypotension. Anti-resistance exercise intervention can be used as a routine nursing intervention to improve the situation of hemodialysis hypotension. It is worth popularizing and applying in clinic.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R473.5

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