肠道术后患者肠蠕动功能恢复影响因素的研究

发布时间：2018-04-28 16:09

本文选题：肠道术后 + 肠蠕动恢复　；参考：《吉林大学》2016年硕士论文

【摘要】：目的:通过本研究,收集结直肠外科腹部肠道术后患者的病例,分析影响肠道术后肠蠕动功能恢复的影响因素,并寻找促进肠蠕动功能恢复的最佳护理方式,为临床采用有效的护理措施提供科学依据,确定并推广安全、可行、有效的促进肠蠕动功能恢复的护理方式,为临床护理事业的发展尽一份贡献。方法:(1)收集2015年4月—2016年6月于吉林大学白求恩第一医院结直肠外科住院部住院治疗的患者病例。(2)自行设计护理措施观察记录表通过收集临床患者资料和阅读病历的方式收集数据。(3)收集可能影响术后肠功能恢复的相关因素内容包括年龄、性别、医保形式、文化程度、营养状况、主要基础疾病(糖尿病、心脏病、高血压、甲状腺疾病)、提示胃肠道蠕动恢复的指标(肠鸣音的恢复时间,首次排气时间、首次肛门排便时间、患者术后腹胀发生情况、伤口愈合情况以及并发症发生情况)、采取促进肠蠕动功能恢复的护理措施(主要包括以下7方面:咀嚼口香糖,腹部热敷、按摩,床上翻身,有效咳嗽、深呼吸,热水足浴,早期下床活动,抬臀运动。)(4)对所收集的患者病例的护理干预进行描述分析。通过频数分析法单因素分析,得出临床应用频繁的护理措施,再对这些护理措施进行单因素分析,即对护理措施的有效性进行分析,得出有效的、应用频繁的单项护理措施。最后对所有相关因素进行多因素分析,得出影响肠道术后肠蠕动功能恢复的相关影响因素。结果:入选患者病例共232例,其中男性145例,女性87例;对入选患者病例所记录的护理措施进行统计,其中采取咀嚼口香糖的127例,占总例数的54.74%;采取腹部热敷、按摩的61例,占总例数的26.29%;采取床上翻身的166例,占总例数的71.55%;采取有效咳嗽、深呼吸的113例,占总例数的48.71%;采取热水足浴护理方式的95例,占总数的40.95%;采取早期下床活动的132例;占总例数的56.9%;采取抬臀运动的患者数为111例,占总例数的47.84%。通过对七项护理措施组合频数的计算,得出采用二、三种、四种护理措施的组合频数较多。通过最高频次法分析,以及结合临床护理措施的可操作性以及患者的依从性,最后确定联合应用咀嚼口香糖、床上翻身和早期下床活动为临床比较常用的护理措施。肠功能恢复的单因素分析结果显示:咀嚼口香糖、床上翻身、早期下床活动对肠蠕动的恢复影响差异具有统计学意义;床上翻身、早期下床活动对首次排气的影响差异有统计学意义(P0.05);床上翻身对首次排便的影响差异有统计学意义(P0.05);早期下床活动对腹胀的影响差异有统计学意义(P0.05);床上翻身对肠功能恢复综合指标的影响差异有统计学意义(P0.05)。肠功能各项指标的多因素Logistic回归分析结果显示:早期下床活动是腹胀以及肠蠕动恢复的影响因素;年龄、早期下床活动是首次排气时间的影响因素;文化程度、麻醉时间、床上翻身以及早期下床活动是首次排便的影响因素;麻醉管理时间、联合应用护理措施(咀嚼口香糖、床上翻身以及早期下床活动联合应用)是胃肠评价综合指标的影响因素;各项护理措施(咀嚼口香糖、床上翻身、早起下床活动等)对伤口愈合不良情况的发生、并发症发生的无明显影响,P0.05,无统计学意义。结论:(1)早期下床活动可以有效降低腹胀的发生率、促进肠蠕动以及缩短首次排气、排便时间,而且可改善胃肠评价的综合指标;(2)腹部肠道手术后患者术后给于假饲(咀嚼口香糖)有利于促进术后胃肠道功能恢复;(3)腹部肠道术后给于床上翻身的护理措施有利于提早首次排便时间,改善胃肠评价综合指标,加速病人康复。(4)联合护理方式(术后联合应用咀嚼口香糖、床上翻身和早期下床活动三种护理措施)可促进肠道术后患者的肠功能恢复。(5)各项护理措施对术后并发症的发生及伤口愈合不良情况的发生无明显影响,为临床安全、有效的护理干预措施。
[Abstract]:Objective: to collect the factors affecting the recovery of intestinal peristalsis after intestinal surgery, and to find the best nursing methods to promote the recovery of intestinal peristalsis, and to provide a scientific basis for the clinical use of effective nursing measures, to determine and promote the safety, feasibility and effective promotion of the intestine. The nursing mode of peristaltic function resumed to make a contribution to the development of clinical nursing. Methods: (1) collect patients hospitalized in the inpatient department of colorectal surgery in Bethune First Hospital of Jilin University from April 2015 to June 2016. (2) self designed nursing measure observation record table by collecting clinical patient data and reading medical records Collect data. (3) collect related factors that may affect the recovery of postoperative intestinal function, including age, sex, health care form, educational level, nutritional status, main underlying diseases (diabetes, heart disease, hypertension, thyroid disease), indicators of the recovery of gastrointestinal peristalsis (recovery time of enteric sound, first exhaust time, first anus) The time of the door defecation, the occurrence of abdominal distention, the healing of the wound and the occurrence of complications, and the nursing measures to promote the recovery of the intestinal peristaltic function (mainly including 7 aspects: chewing gum, abdominal hot compress, massage, bed turning, effective cough, deep breathing, hot water foot bath, early ambulation, hip lifting movement.) (4) (4) The nursing intervention of patient cases was described and analyzed. Through single factor analysis of frequency analysis, the frequent clinical nursing measures were obtained, and the single factor analysis of these nursing measures was carried out, that is, the effectiveness of nursing measures was analyzed, and effective and frequent single nursing measures were applied. Finally, all related factors were entered. The factors affecting the recovery of intestinal peristalsis after intestinal surgery were analyzed by multifactor analysis. Results: 232 patients were selected, including 145 males and 87 females, and 127 cases of chewing gum were recorded, including 127 cases of chewing gum, 54.74% of the total number of cases, and 61 of the abdominal hot compress and 61 massage. For example, 26.29% of the total number of cases, 166 cases in bed turning over, accounting for 71.55% of the total number of cases, 113 cases of effective coughing and deep breathing, accounting for 48.71% of the total number, 95 cases of foot bath nursing, accounting for 40.95% of the total, 132 cases of early bed down activities, 56.9% of the total number of cases, and 111 cases of hip lifting, which accounted for the total number of cases. The total example, accounting for the total example, accounted for the general example. The number of 47.84%., through the calculation of the frequency of the combination of seven nursing measures, showed that the combination of two, three, and four nursing measures was more frequent. Through the analysis of the highest frequency and the operability of the clinical nursing measures and the compliance of the patients, the combined use of chewing gum, the bed turn over and the early bed down activities were determined. The single factor analysis of the intestinal function recovery showed that the effects of chewing gum, bed turning on the bed and early bed activity on the recovery of intestinal peristalsis were statistically significant, and the effect of the bed turning on the first discharge was statistically significant (P0.05); the bed body turned over for the first time. The difference was statistically significant (P0.05); the effect of early bed off activity on abdominal distention was statistically significant (P0.05); there was a significant difference in the effect of the bed turning on the comprehensive index of intestinal function recovery (P0.05). The multiple factor Logistic regression analysis of various indexes of intestinal function showed that the early bed activity was abdominal distension and intestinal peristalsis. The influence factors of recovery; age, early bed off activity are the factors affecting the first exhaust time; education level, anesthesia time, bed turn over, and early bed off activities are the factors affecting the first defecation; anesthesia management time, combined application of nursing measures (chewing gum, bed turn over and early bed off activities) are the gastrointestinal reviews. The influence factors of the comprehensive price index; the nursing measures (chewing gum, bed turn over, early rise and down activity, etc.) have no significant influence on the occurrence of wound healing and the occurrence of complications, and there is no significant difference in P0.05. Conclusion: (1) early bed down activity can effectively reduce the incidence of abdominal distention, promote intestinal peristalsis and shorten the first row. Gas, defecation time, and can improve the comprehensive index of gastrointestinal evaluation; (2) after abdominal operation, the patients with false feeding (chewing gum) can promote the recovery of gastrointestinal function after operation; (3) the nursing measures to the bed on the bed after abdominal operation are beneficial to the first defecation time, improve the comprehensive index of gastrointestinal evaluation, and accelerate the patient. (4) combined nursing methods (three kinds of nursing measures combined with chewing gum, bed turn over and early bed off activity after operation) can promote the recovery of intestinal function of the patients after intestinal operation. (5) the nursing measures have no obvious influence on the occurrence of postoperative complications and the occurrence of bad wound healing, for clinical safety and effective nursing intervention. Measures.

【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R473.6

【引证文献】