本文關(guān)鍵詞： 維持性血液透析 透析低血壓 抗阻運動　出處：《大連醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：研究目的1.探索抗阻運動對透析中低血壓發(fā)生頻率、血壓及血壓變異性的干預(yù)效果;2.了解抗阻運動對血透患者透析清除率的影響,包括尿素、肌酐、血磷等;3.探索抗阻運動對血液透析患者生活質(zhì)量的改善情況。研究方法運用方便抽樣法選取大連市某三級甲等醫(yī)院兩所透析室頻繁發(fā)生透析低血壓的維持性血液透析80例患者作為研究對象,入組后經(jīng)過隨機數(shù)字表法將患者分為實驗組和對照組,實驗組40例,對照組40例。對照組接受透析中心的常規(guī)護理,透析過程中每1h測量一次血壓,血流量180~280ml/min,透析液溫度36~37°C,飲食指導(dǎo),相關(guān)并發(fā)癥的預(yù)防指導(dǎo)等;實驗組在常規(guī)護理的基礎(chǔ)上,接受為期12周的抗阻運動。干預(yù)措施:給予每周3次,共計12周(36次)的運動干預(yù),每次進行血液透析前5分鐘的熱身運動和血液透析后5分鐘的放松運動,以及約30分鐘的間斷透析中抗阻運動干預(yù)(上機開始計時,間斷進行運動,約每20分鐘進行3分鐘的抗阻運動訓(xùn)練,共10次運動,直至透析結(jié)束),隨時觀察患者的不適癥狀。12周干預(yù)結(jié)束后,研究者對患者的干預(yù)前和干預(yù)過程中透析低血壓發(fā)生頻率、收縮壓、舒張壓、血壓變異性,干預(yù)前和干預(yù)后透析清除率相關(guān)的生化指標(biāo)(血鈣、血磷、尿素、肌酐)、生活質(zhì)量相關(guān)數(shù)據(jù)進行統(tǒng)計并評價。結(jié)果12周干預(yù)結(jié)束時,共77例患者完成本研究。結(jié)果顯示:1.抗阻運動干預(yù)期間,實驗組透析低血壓的發(fā)生率顯著低于對照組,差異有統(tǒng)計學(xué)意義(P0.05)。同時,患者接受相關(guān)護理干預(yù)措施的次數(shù)顯著減少,如調(diào)節(jié)鈉濃度,降低血流速度,調(diào)節(jié)溫度(P0.05)。2.抗阻運動干預(yù)期間,實驗組患者透析前血壓值(收縮壓和舒張壓)顯著低于對照組,差異有統(tǒng)計學(xué)意義(P0.01)。同時干預(yù)期間,實驗組患者透析中最低血壓值(收縮壓和舒張壓)均顯著高于對照組,差異有統(tǒng)計學(xué)意義(P0.01)。3.抗阻運動干預(yù)期間,實驗組患者收縮壓血壓變異性顯著低于對照組(P0.05),兩組患者舒張壓血壓變異性差異不明顯。2組收縮壓SD和CV比較差異有統(tǒng)計學(xué)意義(收縮壓SD:t=-4.72,P=0.000;收縮壓CV:t=-4.356,P=0.000),而舒張壓SD與舒張壓CV兩組比較差異無統(tǒng)計學(xué)差異(P0.05)。4.12周抗阻運動可以增加尿素、肌酐、血磷的清除,但差異無統(tǒng)計學(xué)意義(P0.05)。5.12周抗阻運動干預(yù)后,實驗組和對照組在心理方面的社會功能和心理健康維度,差異有統(tǒng)計學(xué)意義,實驗組得分高于對照組(t=2.131-2.617,P0.05)。結(jié)論1.抗阻運動干預(yù)可顯著降低維持性血液透析患者透析低血壓發(fā)生頻率,并減少其接受相關(guān)護理干預(yù)措施的次數(shù)。2.抗阻運動干預(yù)可以降低患者血壓變異度,穩(wěn)定血壓。3.抗阻運動干預(yù)可以提高血液透析頻繁低血壓患者生活質(zhì)量中的社會功能及心理健康維度。4.抗阻運動干預(yù)可以作為常規(guī)的護理干預(yù)方法來改善患者透析低血壓的情況,值得臨床推廣應(yīng)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 擄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.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R473.5

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