吐纳法联合穴位贴敷预防中老年髋部骨折卧床后便秘的护理研究

发布时间：2018-05-26 19:47

  本文选题：吐纳法 + 穴位贴敷　； 参考：《中国中医科学院》2017年硕士论文

【摘要】：[目的]基于肺与大肠相表里理论,通过观察吐纳法联合穴位贴敷预防中老年髋部骨折卧床后便秘的临床护理效果,探索预防中老年髋部骨折卧床后便秘的中医特色护理方法,提高患者的舒适度及满意度。[方法]本研究选取2016年4月23日至2017年3月10日期间中国中医科学院望京医院创伤一科中老年髋部骨折患者66例,经随机数字表分为对照组和试验组各33例。两组患者均给予相同的入院健康宣教,同时,试验组患者给予吐纳法联合穴位贴敷5天。穴位贴敷:采用中医经典的调味承气方加减,中药从我院药房自取,大黄、芒硝各30g,玄参、麦冬、生地各25g,柴胡、桔梗、枳壳20g,当归、桃仁、红花各15g混合后研磨成粉,取其中5 g兑75%的酒精调制成0.2cm×0.3cm的药膏。针对中老年髋部骨折卧床后患者,入院24小时内即开始给予第一次贴敷,每次敷8小时,连续使用5日。吐纳法:患者采取仰卧位,双手掌根重叠于脐下,全身肌肉放松状态,将注意力集中于呼吸,口闭,鼻吸气至腹部后,噘嘴圆唇吐“嘘”音,匀吸慢呼。于完成穴位贴敷1小时内,午饭后半小时,穴位贴敷8小时后药物去除前的15分钟,3次/日,15分钟/次。15分钟可分为第一个7分钟呼吸吐纳,间歇休息15分钟后,进行第二个8分钟呼吸吐纳。记录两组患者每分钟肠鸣音次数、入院后第一次开始排便的时间(h)、Wexner便秘评分及其子项目评分、Bristol粪便性状、Kolcaba的舒适状况量表评分以及纽卡斯尔护理服务满意度量表评分比较(NSNS)。[结果]本课题入组病例66例,试验组和对照组共有6例研究对象脱落,其中,试验组有1例患者药物敷脐使用当日即出现脐周局部皮肤发痒发红,敷脐药物去除1小时后皮肤恢复正常;1例患者因入院第三日急诊手术给于清洁灌肠;1例患者因自觉腹胀不易排便使用开塞露。对照组有2例患者自觉有便无力排出,使用甘油灌肠剂;1例患者因自行饮用促便药茶饮中止。最终两组各有30例患者进行数据分析。1.两组患者基线比较两组患者在性别(P=0.601)、年龄(P=0.743)、骨折部位(P=0.299)、学历(P=0.794)等方面,无统计学意义,P0.05,两组具有可比性;2.两组患者每分钟肠鸣音次数与患者入院后第一次开始排便的时间(h)试验组患者的每分钟肠鸣音次数多于对照组,有统计学意义,P=3.112X 10-6;试验组患者入院后第一次开始排便的时间提前于对照组,有统计学意义,P=1.469×10-4。3.两组患者Wexner便秘症状评分及Wexner便秘症状评分子项目评分试验组患者的Wexner便秘症状评分低于对照组,有统计学意义,P=1.526 X 10-5;其中Wexner便秘症状评分子项目评分中试验组患者在大便次数(P=6.248×10-6)、排便困难程度(P=0.024)、排便不成功次数(P=4.536×10-4)、排便时间(P=0.002)评分均低于对照组,有统计学意义。Wexner便秘症状评分子项目中试验组和对照组患者在排空程度(不完全排空感P=0.109)、疼痛(腹痛P=0.089)方面,无统计学意义。4.两组患者粪便性状比较根据Bristol(bristol stool scale)大便性状分类法,试验组患者Ⅳ型与V型占所有排便性状的68.9%,对照组患者Ⅳ型与Ⅴ型占所有排便性状的49%。5.Kolcaba的舒适状况评分试验组患者的Kolcaba舒适状况评分为76.90±8.20,对照组的Kolcaba舒适状况评分为96.43±7.32,有统计学意义,P=9.851X 10-10。6.纽卡斯尔护理服务满意度评分试验组患者的纽卡斯尔护理服务满意度评分为82.33±6.56,对照组的纽卡斯尔护理服务满意度评分为68.23±7.66,有统计学意义,P=2.728 × 10-10。[结论]1.基于中医理论肺与大肠相表里,运用吐纳法联合穴位贴敷,可缩短中老年髋部骨折卧床后第一次排便的间隔时间,改善患者大便性状,较好的预防患者骨折卧床后便秘的发生。2.吐纳法联合穴位贴敷是一套有效的预防中老年髋部骨折卧床后便秘的中医特色护理干预方法,可以提高患者舒适度及满意度。
[Abstract]:[Objective] Based on the theory of the lung and the large intestine, the clinical nursing effect of the combined acupoint application and Acupoint Application on the prevention of constipation of the hip fracture in the middle and old age of the aged and the elderly was observed, and the traditional Chinese medicine nursing method to prevent the constipation of the hip fracture in the middle and old age was explored to improve the patient's comfort and satisfaction. [Methods] this study selected April 23, 2016. To March 10, 2017, 66 cases of middle-aged and elderly hip fractures in Wangjing Hospital of Chinese Academy of traditional Chinese medicine (Chinese Academy of traditional medicine) were divided into the control group and the experimental group with 33 cases. The two groups were given the same admission health education. At the same time, the patients in the experimental group were given the combined acupoint application for 5 days. The acupoint application: the traditional Chinese medicine classics were applied. The Chinese medicine from the pharmacy of our hospital, Chinese medicine from the pharmacy of our hospital, 30g of rhubarb, mirabilite, Radix Ophiopogon, Ophiopogon, Radix 25g, Radix Bupleuri, Platycodon, Fructus aurantii 20g, angelica, peach kernel and safflower 15g, and then pulverized into 0.2cm * 0.3cm ointment with 5 g / 75% alcohol. Apply the first application for 8 hours each time and use 5 days. The patients take the supine position, the palmar roots overlap under the umbilicus, the body muscles relax under the umbilical cord, the whole body muscle relaxes, the attention is focused on the breathing, the mouth closed, the nasal suction to the abdomen, the pouted Round Lip spit "Shh" tone, and sucked slowly. Within 1 hours after the acupoint application, the point post is half an hour after lunch, acupoint sticker After 8 hours of application, 15 minutes, 3 / day, 15 minutes /.15 minutes can be divided into the first 7 minute breathing tuna, 15 minutes after intermittent rest, second 8 minutes to breathe tuna. Record the number of bowel sounds per minute in two groups, the first time to start defecation (H), Wexner constipation score and sub item score, Bristo L stool traits, Kolcaba Comfort Scale score and Newcastle nursing service satisfaction scale score were compared (NSNS). [results] 66 cases were enrolled in this study. There were 6 subjects in the experimental group and the control group. Among them, 1 patients in the test group were applied to the umbilicus on the same day to make the skin reddish and apply the umbilical medicine. The skin was restored to normal after 1 hours of removal; 1 patients were given a clean enema for third days of hospitalization; 1 patients were unable to defecate easily because of self-conscious abdominal distention. In the control group, 2 patients were consciously unable to discharge them, using Enemia Glycerini; 1 cases were stopped by their own drinking propelled drug tea. The final two groups had 30 patients. Data analysis.1. two groups of patients with baseline comparison of two groups of patients in sex (P=0.601), age (P=0.743), fracture site (P=0.299), education (P=0.794), and so on, no statistical significance, P0.05, two groups have comparability; 2. two groups of patients per minute bowel sounds and the first time after admission to the patient's bowel movement (H) test group of patients per minute The number of bowel sounds was more than that of the control group, with statistical significance, P=3.112X 10-6. The time of the first start of defecation in the experimental group was earlier than that in the control group, with statistical significance. The scores of the Wexner constipation symptom score and the Wexner constipation score test group of the patients with P=1.469 x 10-4.3. were lower than those in the group of the Wexner constipation test group. In the control group, there were statistical significance, P=1.526 X 10-5, in which the times of stool (P=6.248 x 10-6), the degree of defecation (P=0.024), the number of unsuccessful defecation (P=4.536 x 10-4), and the time for defecation (P=0.002) were lower than those of the control group, and the statistical significance of.Wexner constipation was statistically significant in the Wexner constipation score. In the test group and the control group, the degree of emptying (incomplete emptying P=0.109) and pain (abdominal pain P=0.089), there was no statistical significance in the stool traits of the.4. two groups according to the Bristol (Bristol stool scale) stool character classification, and the patients in the experimental group were 68.9% of all the defecation characters and the type IV and V in the control group. The comfort status of the 49%.5.Kolcaba in the test group was 76.90 + 8.20, and the Kolcaba comfort score of the control group was 96.43 + 7.32, with statistical significance. The satisfaction evaluation of the Newcastle nursing service satisfaction score in the P=9.851X 10-10.6. Newcastle nursing service satisfaction test group was evaluated. It was divided into 82.33 + 6.56. The satisfaction score of Newcastle nursing service in the control group was 68.23 + 7.66, which was statistically significant. P=2.728 x 10-10.[conclusion]1. based on the theory of TCM theory of lung and large intestine, using TNA method combined acupoint application can shorten the interval time of the first defecation after the bed fracture in the middle and old age, and improve the patient's stool character. The combination of.2. Tun and acupoint application is a set of effective nursing intervention to prevent the constipation of the hip fracture in the middle and old age, which can improve the comfort and satisfaction of the patients.
【学位授予单位】：中国中医科学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R473.6

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