穴位按摩对妇科患者腹腔镜术后疼痛缓解的效果评价

发布时间：2018-03-05 12:25

本文选题：穴位按摩　切入点：妇科　出处：《锦州医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的本研究通过对妇科行腹腔镜手术的患者进行穴位按摩,分析讨论穴位按摩干预对妇科患者腹腔镜手术后心率、血压、疼痛的影响,为临床医护人员提供有价值的干预手段,加快患者术后康复,提高生活质量。方法本研究选择2015年6月至2016年5月在锦州市妇婴医院妇科病房进行腹腔镜手术治疗的患者192例,分为两组,对照组和试验组,每一组96例患者。对照组患者手术后仅仅进行常规护理,而试验组患者手术后除了常规的护理外还要在手术后的6h和12h进行穴位按摩,每次约30min。分别评估两组患者术后6h干预前、术后6h、12h干预后的视觉模拟评分(VAS)、心率值和血压值及术后6h、12h干预后的功能活动评级(FAS)。采用统计学分析工具SPSS 20.0对一般资料进行χ2检验和非参数秩和检验;对VAS评分、心率值及血压值进行两独立样本t检验、重复测量方差分析;对FAS评级进行非参数秩和检验。结果1、估计样本量192例,试验进程中剔除16例,最终纳入176例,对照组88例,试验组88例。2、采取两独立样本t检验,对两组患者术后6h干预前VAS评分、心率值及血压值进行比较,差异均无统计学意义(P0.05)。3、选取重复测量方差分析,对两组患者术后6h干预前、后及术后12h干预后三个时间点的VAS评分、心率值、血压值进行对比。VAS评分、心率值和血压值的组内效应都有显著性差异(P0.05),可以认为不同时间(术后6h干预前、术后6h干预后、术后12h干预后)的疼痛水平不相同,也就是说三者伴随时间而改变;除了心率以外,VAS评分和血压值的组间效应具有显著性差异(P0.05),可以为不同的干预类型(试验组、对照组)缓解患者手术后疼痛及稳定血压的效果不同,而对心率的影响没有差别;VAS评分、心率值、血压值的组内因素和组间因素间的交互差异有显著性差异(P0.05),可认为组内因素和组间因素间具有交互作用,也就是说三者伴随时间的改变态势不同。4、选取t检验进行两组术后6h干预后、术后12h干预后的VAS评分和血压值的对比,差异均有统计学意义(P0.05);而两组术后6h干预后的心率比较,差异无统计学意义(P0.05),术后12h干预后的心率比较,差异有统计学意义(P0.05)。5、采用非参数秩和检验,对两组患者术后6h干预后、12h干预后的FAS评级进行比较,差异有统计学意义(P0.05)。结论1、妇科腹腔镜术后患者普遍存在一定的疼痛反应。2、穴位按摩对降低患者手术后的疼痛程度是有效的。3、穴位按摩能够稳定患者血压的波动。患者心率对穴位按摩不敏感,但连续两次不同时点的穴位按摩后,心率在一定程度上得到稳定。
[Abstract]:Objective to analyze the effect of acupoint massage on heart rate, blood pressure and pain in gynecological patients undergoing laparoscopic surgery. Methods from June 2015 to May 2016, 192 patients undergoing laparoscopic surgery in gynecological ward of Jinzhou Gynecology Hospital were divided into two groups: control group and experimental group. There were 96 patients in each group. The patients in the control group received routine nursing only after operation, while the patients in the test group received acupoint massage at 6 and 12 hours after operation, in addition to routine nursing care. Each time was about 30 mins. The patients in the two groups were evaluated before the intervention 6 hours after operation. Visual analogue score (VAS), heart rate (HR) and blood pressure (BP), and functional activity rating (FASA) after intervention at 6 h and 12 h after intervention were evaluated by 蠂 2 test and nonparametric rank sum test using statistical analysis tool SPSS 20.0, and VAS scores were evaluated. The heart rate and blood pressure were tested by two independent samples t test, repeated measurement analysis of variance, nonparametric rank sum test for FAS rating. Results 1. The estimated sample size was 192 cases, 16 cases were excluded in the course of the trial, 176 cases were included in the trial process, and 88 cases in the control group. Two independent samples t test were used to compare the VAS score, heart rate value and blood pressure value before intervention 6 hours after operation in the trial group (n = 88). There was no significant difference between the two groups (P 0.05). ANOVA was used to analyze the repeated measurement of variance before intervention 6 hours after operation between the two groups. There were significant differences in VAS score, heart rate value, blood pressure value, heart rate value and blood pressure value between the three time points after the intervention at 12 hours after operation (P 0.05), which could be considered as different time (before 6 h intervention and 6 h after operation). The pain levels were different after 12 hours of intervention, which means that the three groups changed with time. There was a significant difference in the effects of VAS score and blood pressure value between groups except heart rate (P 0.05), which could be different types of intervention (trial group, P < 0.05). In control group, the effect of relieving pain and stabilizing blood pressure after operation was different, but there was no difference in VAS score and heart rate value on heart rate. There was a significant difference between the intra-group factors and inter-group factors of blood pressure value (P 0.05), which could be regarded as the interaction between intra-group factors and inter-group factors. That is to say, the change of time was different among the three groups. T test was selected to compare the VAS score and blood pressure of the two groups after 6 h intervention and 12 h postoperatively, the difference was statistically significant (P 0.05), while the heart rate after 6 h intervention was compared between the two groups. The difference was not statistically significant (P 0.05), but there was no significant difference in heart rate between the two groups after 12 h intervention. The non-parametric rank sum test was used to compare the FAS ratings of the two groups after 12 h intervention. Conclusion 1. There is a general pain response of the patients after gynecological laparoscopy. Acupoint massage is effective to reduce the degree of pain after operation. Acupoint massage can stabilize the fluctuation of blood pressure in patients with gynecological laparoscopy. Heart rate is not sensitive to acupoint massage, But after two successive acupoints massage at different points, the heart rate is stabilized to some extent.
【学位授予单位】：锦州医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R248.3

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