经股静脉心导管射频消融术后患者早期活动的效果
发布时间：2018-09-10 11:18
【摘要】：研究背景心导管射频消融术(Radiofrequency catheter ablation)目前已成为心律失常最有效的治疗方法,在临床应用广泛。然而术后医护人员因过度关注出血及血肿等血管并发症,忽视了患者因长时间卧床及制动而造成的躯体及心理问题,使患者自理能力受限,增加了腰背酸痛、肢体麻木、食欲下降、排尿困难等负性效应,产生焦虑、烦躁等负性心理,大大降低了术后患者的舒适度。经股静脉路径行心导管射频消融术后出血危险性低,不需过长卧床时间来保障其安全,患者可以提早解除制动及下床活动,有利于促进术后患者的早期康复。研究目的本研究旨在通过对消融术后患者实施早期活动的护理干预,探讨既能促进患者舒适,又不增加血管并发症发生风险的安全有效的活动方案,以提高术后患者的舒适度,提升患者自理能力及恢复信心,减少术后生理及心理不适,减少护理人员床边照护时间,节省人力,同时也为早期活动的临床实践提供有利的循证依据。研究方法选取2016年3月-12月广州市某三级甲等综合性医院心血管内科经股静脉穿刺行射频消融术的患者120例作为观察对象。将符合入选标准的患者随机分为对照组和试验A、B组,每组40例。对照组采用常规护理方法,术后患肢制动4h,卧床8h后下地行走;试验A组术后患肢制动4h后下地行走;试验B组术后床上体位改变,4h后下地行走。在规定时间点评估各组患者的腰背酸痛程度、舒适度、焦虑及血管并发症发生情况。研究结果三组患者一般统计学资料无显著差异(P0.05);各组的出血及血肿等血管并发症的发生率比较差异无统计学意义(P0.05);试验A组及试验B组的术后腰背疼痛强度显著低于对照组;试验B组术后肢体麻木、入睡困难、食欲下降、排尿困难等舒适相关并发症发生率最低,其次为试验A组,对照组发生率最高;干预前后三组患者的焦虑及舒适度评分差异有统计学意义(P0.05),对照组的整体舒适度评分最低,焦虑评分最高;与对照组相比,试验B组的整体舒适状况最好。研究结论经股静脉心导管射频消融患者术后早期活动是安全可行的,不会增加穿刺部位血管并发症的发生率,且能显著提高术后患者的舒适度;通过早期活动的护理干预,降低了因限制性体位及卧床时间过长而导致的相关不适的发生率,减少了术后患者的痛苦;术后开始床上体位改变,4h下床活动的护理方法是安全有效的。
[Abstract]:Background Cardiac catheter radiofrequency ablation (Radiofrequency catheter ablation) has become the most effective method for the treatment of arrhythmia and has been widely used in clinical practice. However, due to excessive attention to vascular complications such as hemorrhage and hematoma, medical staff ignored the physical and psychological problems caused by prolonged bed rest and immobilization, which limited the patient's ability to take care of themselves, increased pain in the back of the waist and numbness of the limbs. Negative effects, such as decreased appetite, dysuria, anxiety, irritability and so on, greatly reduced the postoperative comfort. The risk of bleeding after radiofrequency catheter ablation via femoral vein pathway is low and it is not necessary to stay in bed too long to ensure its safety. Patients can release braking and get out of bed early which is beneficial to the early recovery of patients after operation. Objective to explore a safe and effective program which can promote the comfort of patients without increasing the risk of vascular complications through nursing intervention of early activities after ablation, so as to improve the comfort of patients after operation. To improve patients' self-care ability and restore confidence, to reduce postoperative physical and psychological discomfort, to reduce nursing staff bedside care time, to save manpower, but also to provide a favorable evidence-based basis for early clinical practice. Methods 120 patients who underwent radiofrequency ablation via femoral vein puncture in a general hospital of Grade 3A in Guangzhou from March to December 2016 were selected as observation objects. The patients who met the inclusion criteria were randomly divided into control group and test Agna B group with 40 cases in each group. The patients in the control group were treated with routine nursing methods. The patients in the control group were kept in bed for 4 hours, then walked under the ground after 8 hours of bed rest; in group A, the patients walked under the ground after 4 hours of immobilization; in group B, the position of the upper bed changed 4 hours after operation and then walked under the ground. The degree of pain, comfort, anxiety and vascular complications were evaluated at a specified time point. Results there was no significant difference in general statistical data among the three groups (P0.05); there was no significant difference in the incidence of vascular complications such as hemorrhage and hematoma among the three groups (P0.05); the postoperative pain intensity of the patients in group A and group B was significantly lower than that in the control group. In group B, the incidence of comfortable complications such as numbness of limbs, difficulty in falling asleep, decreased appetite and dysuria was the lowest, followed by group A and control group. Before and after intervention, the anxiety and comfort scores of the three groups were significantly different (P0.05), the overall comfort score of the control group was the lowest, and the anxiety score was the highest; compared with the control group, the overall comfort of group B was the best. Conclusion it is safe and feasible for the patients with radiofrequency catheter ablation of femoral vein to take part in the early operation, which does not increase the incidence of vascular complications at the puncture site, and can significantly improve the comfort of the patients after operation. It can reduce the incidence of discomfort caused by restrictive posture and prolonged bed-rest time, and reduce the pain of patients after operation, and the nursing method of moving out of bed for 4 hours after operation is safe and effective.
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R473.5
本文编号：2234286
[Abstract]:Background Cardiac catheter radiofrequency ablation (Radiofrequency catheter ablation) has become the most effective method for the treatment of arrhythmia and has been widely used in clinical practice. However, due to excessive attention to vascular complications such as hemorrhage and hematoma, medical staff ignored the physical and psychological problems caused by prolonged bed rest and immobilization, which limited the patient's ability to take care of themselves, increased pain in the back of the waist and numbness of the limbs. Negative effects, such as decreased appetite, dysuria, anxiety, irritability and so on, greatly reduced the postoperative comfort. The risk of bleeding after radiofrequency catheter ablation via femoral vein pathway is low and it is not necessary to stay in bed too long to ensure its safety. Patients can release braking and get out of bed early which is beneficial to the early recovery of patients after operation. Objective to explore a safe and effective program which can promote the comfort of patients without increasing the risk of vascular complications through nursing intervention of early activities after ablation, so as to improve the comfort of patients after operation. To improve patients' self-care ability and restore confidence, to reduce postoperative physical and psychological discomfort, to reduce nursing staff bedside care time, to save manpower, but also to provide a favorable evidence-based basis for early clinical practice. Methods 120 patients who underwent radiofrequency ablation via femoral vein puncture in a general hospital of Grade 3A in Guangzhou from March to December 2016 were selected as observation objects. The patients who met the inclusion criteria were randomly divided into control group and test Agna B group with 40 cases in each group. The patients in the control group were treated with routine nursing methods. The patients in the control group were kept in bed for 4 hours, then walked under the ground after 8 hours of bed rest; in group A, the patients walked under the ground after 4 hours of immobilization; in group B, the position of the upper bed changed 4 hours after operation and then walked under the ground. The degree of pain, comfort, anxiety and vascular complications were evaluated at a specified time point. Results there was no significant difference in general statistical data among the three groups (P0.05); there was no significant difference in the incidence of vascular complications such as hemorrhage and hematoma among the three groups (P0.05); the postoperative pain intensity of the patients in group A and group B was significantly lower than that in the control group. In group B, the incidence of comfortable complications such as numbness of limbs, difficulty in falling asleep, decreased appetite and dysuria was the lowest, followed by group A and control group. Before and after intervention, the anxiety and comfort scores of the three groups were significantly different (P0.05), the overall comfort score of the control group was the lowest, and the anxiety score was the highest; compared with the control group, the overall comfort of group B was the best. Conclusion it is safe and feasible for the patients with radiofrequency catheter ablation of femoral vein to take part in the early operation, which does not increase the incidence of vascular complications at the puncture site, and can significantly improve the comfort of the patients after operation. It can reduce the incidence of discomfort caused by restrictive posture and prolonged bed-rest time, and reduce the pain of patients after operation, and the nursing method of moving out of bed for 4 hours after operation is safe and effective.
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R473.5
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