本文選題：吐納法 + 穴位貼敷　； 參考：《中國中醫(yī)科學(xué)院》2017年碩士論文

【摘要】：[目的]基于肺與大腸相表里理論,通過觀察吐納法聯(lián)合穴位貼敷預(yù)防中老年髖部骨折臥床后便秘的臨床護(hù)理效果,探索預(yù)防中老年髖部骨折臥床后便秘的中醫(yī)特色護(hù)理方法,提高患者的舒適度及滿意度。[方法]本研究選取2016年4月23日至2017年3月10日期間中國中醫(yī)科學(xué)院望京醫(yī)院創(chuàng)傷一科中老年髖部骨折患者66例,經(jīng)隨機(jī)數(shù)字表分為對照組和試驗(yàn)組各33例。兩組患者均給予相同的入院健康宣教,同時(shí),試驗(yàn)組患者給予吐納法聯(lián)合穴位貼敷5天。穴位貼敷:采用中醫(yī)經(jīng)典的調(diào)味承氣方加減,中藥從我院藥房自取,大黃、芒硝各30g,玄參、麥冬、生地各25g,柴胡、桔梗、枳殼20g,當(dāng)歸、桃仁、紅花各15g混合后研磨成粉,取其中5 g兌75%的酒精調(diào)制成0.2cm×0.3cm的藥膏。針對中老年髖部骨折臥床后患者,入院24小時(shí)內(nèi)即開始給予第一次貼敷,每次敷8小時(shí),連續(xù)使用5日。吐納法:患者采取仰臥位,雙手掌根重疊于臍下,全身肌肉放松狀態(tài),將注意力集中于呼吸,口閉,鼻吸氣至腹部后,噘嘴圓唇吐“噓”音,勻吸慢呼。于完成穴位貼敷1小時(shí)內(nèi),午飯后半小時(shí),穴位貼敷8小時(shí)后藥物去除前的15分鐘,3次/日,15分鐘/次。15分鐘可分為第一個7分鐘呼吸吐納,間歇休息15分鐘后,進(jìn)行第二個8分鐘呼吸吐納。記錄兩組患者每分鐘腸鳴音次數(shù)、入院后第一次開始排便的時(shí)間(h)、Wexner便秘評分及其子項(xiàng)目評分、Bristol糞便性狀、Kolcaba的舒適狀況量表評分以及紐卡斯?fàn)栕o(hù)理服務(wù)滿意度量表評分比較(NSNS)。[結(jié)果]本課題入組病例66例,試驗(yàn)組和對照組共有6例研究對象脫落,其中,試驗(yàn)組有1例患者藥物敷臍使用當(dāng)日即出現(xiàn)臍周局部皮膚發(fā)癢發(fā)紅,敷臍藥物去除1小時(shí)后皮膚恢復(fù)正常;1例患者因入院第三日急診手術(shù)給于清潔灌腸;1例患者因自覺腹脹不易排便使用開塞露。對照組有2例患者自覺有便無力排出,使用甘油灌腸劑;1例患者因自行飲用促便藥茶飲中止。最終兩組各有30例患者進(jìn)行數(shù)據(jù)分析。1.兩組患者基線比較兩組患者在性別(P=0.601)、年齡(P=0.743)、骨折部位(P=0.299)、學(xué)歷(P=0.794)等方面,無統(tǒng)計(jì)學(xué)意義,P0.05,兩組具有可比性;2.兩組患者每分鐘腸鳴音次數(shù)與患者入院后第一次開始排便的時(shí)間(h)試驗(yàn)組患者的每分鐘腸鳴音次數(shù)多于對照組,有統(tǒng)計(jì)學(xué)意義,P=3.112X 10-6;試驗(yàn)組患者入院后第一次開始排便的時(shí)間提前于對照組,有統(tǒng)計(jì)學(xué)意義,P=1.469×10-4。3.兩組患者Wexner便秘癥狀評分及Wexner便秘癥狀評分子項(xiàng)目評分試驗(yàn)組患者的Wexner便秘癥狀評分低于對照組,有統(tǒng)計(jì)學(xué)意義,P=1.526 X 10-5;其中Wexner便秘癥狀評分子項(xiàng)目評分中試驗(yàn)組患者在大便次數(shù)(P=6.248×10-6)、排便困難程度(P=0.024)、排便不成功次數(shù)(P=4.536×10-4)、排便時(shí)間(P=0.002)評分均低于對照組,有統(tǒng)計(jì)學(xué)意義。Wexner便秘癥狀評分子項(xiàng)目中試驗(yàn)組和對照組患者在排空程度(不完全排空感P=0.109)、疼痛(腹痛P=0.089)方面,無統(tǒng)計(jì)學(xué)意義。4.兩組患者糞便性狀比較根據(jù)Bristol(bristol stool scale)大便性狀分類法,試驗(yàn)組患者Ⅳ型與V型占所有排便性狀的68.9%,對照組患者Ⅳ型與Ⅴ型占所有排便性狀的49%。5.Kolcaba的舒適狀況評分試驗(yàn)組患者的Kolcaba舒適狀況評分為76.90±8.20,對照組的Kolcaba舒適狀況評分為96.43±7.32,有統(tǒng)計(jì)學(xué)意義,P=9.851X 10-10。6.紐卡斯?fàn)栕o(hù)理服務(wù)滿意度評分試驗(yàn)組患者的紐卡斯?fàn)栕o(hù)理服務(wù)滿意度評分為82.33±6.56,對照組的紐卡斯?fàn)栕o(hù)理服務(wù)滿意度評分為68.23±7.66,有統(tǒng)計(jì)學(xué)意義,P=2.728 × 10-10。[結(jié)論]1.基于中醫(yī)理論肺與大腸相表里,運(yùn)用吐納法聯(lián)合穴位貼敷,可縮短中老年髖部骨折臥床后第一次排便的間隔時(shí)間,改善患者大便性狀,較好的預(yù)防患者骨折臥床后便秘的發(fā)生。2.吐納法聯(lián)合穴位貼敷是一套有效的預(yù)防中老年髖部骨折臥床后便秘的中醫(yī)特色護(hù)理干預(yù)方法,可以提高患者舒適度及滿意度。
[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.
【學(xué)位授予單位】：中國中醫(yī)科學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R473.6

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