【摘要】：研究背景心導(dǎo)管射頻消融術(shù)(Radiofrequency catheter ablation)目前已成為心律失常最有效的治療方法,在臨床應(yīng)用廣泛。然而術(shù)后醫(yī)護(hù)人員因過(guò)度關(guān)注出血及血腫等血管并發(fā)癥,忽視了患者因長(zhǎng)時(shí)間臥床及制動(dòng)而造成的軀體及心理問(wèn)題,使患者自理能力受限,增加了腰背酸痛、肢體麻木、食欲下降、排尿困難等負(fù)性效應(yīng),產(chǎn)生焦慮、煩躁等負(fù)性心理,大大降低了術(shù)后患者的舒適度。經(jīng)股靜脈路徑行心導(dǎo)管射頻消融術(shù)后出血危險(xiǎn)性低,不需過(guò)長(zhǎng)臥床時(shí)間來(lái)保障其安全,患者可以提早解除制動(dòng)及下床活動(dòng),有利于促進(jìn)術(shù)后患者的早期康復(fù)。研究目的本研究旨在通過(guò)對(duì)消融術(shù)后患者實(shí)施早期活動(dòng)的護(hù)理干預(yù),探討既能促進(jìn)患者舒適,又不增加血管并發(fā)癥發(fā)生風(fēng)險(xiǎn)的安全有效的活動(dòng)方案,以提高術(shù)后患者的舒適度,提升患者自理能力及恢復(fù)信心,減少術(shù)后生理及心理不適,減少護(hù)理人員床邊照護(hù)時(shí)間,節(jié)省人力,同時(shí)也為早期活動(dòng)的臨床實(shí)踐提供有利的循證依據(jù)。研究方法選取2016年3月-12月廣州市某三級(jí)甲等綜合性醫(yī)院心血管內(nèi)科經(jīng)股靜脈穿刺行射頻消融術(shù)的患者120例作為觀察對(duì)象。將符合入選標(biāo)準(zhǔn)的患者隨機(jī)分為對(duì)照組和試驗(yàn)A、B組,每組40例。對(duì)照組采用常規(guī)護(hù)理方法,術(shù)后患肢制動(dòng)4h,臥床8h后下地行走;試驗(yàn)A組術(shù)后患肢制動(dòng)4h后下地行走;試驗(yàn)B組術(shù)后床上體位改變,4h后下地行走。在規(guī)定時(shí)間點(diǎn)評(píng)估各組患者的腰背酸痛程度、舒適度、焦慮及血管并發(fā)癥發(fā)生情況。研究結(jié)果三組患者一般統(tǒng)計(jì)學(xué)資料無(wú)顯著差異(P0.05);各組的出血及血腫等血管并發(fā)癥的發(fā)生率比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);試驗(yàn)A組及試驗(yàn)B組的術(shù)后腰背疼痛強(qiáng)度顯著低于對(duì)照組;試驗(yàn)B組術(shù)后肢體麻木、入睡困難、食欲下降、排尿困難等舒適相關(guān)并發(fā)癥發(fā)生率最低,其次為試驗(yàn)A組,對(duì)照組發(fā)生率最高;干預(yù)前后三組患者的焦慮及舒適度評(píng)分差異有統(tǒng)計(jì)學(xué)意義(P0.05),對(duì)照組的整體舒適度評(píng)分最低,焦慮評(píng)分最高;與對(duì)照組相比,試驗(yàn)B組的整體舒適狀況最好。研究結(jié)論經(jīng)股靜脈心導(dǎo)管射頻消融患者術(shù)后早期活動(dòng)是安全可行的,不會(huì)增加穿刺部位血管并發(fā)癥的發(fā)生率,且能顯著提高術(shù)后患者的舒適度;通過(guò)早期活動(dòng)的護(hù)理干預(yù),降低了因限制性體位及臥床時(shí)間過(guò)長(zhǎng)而導(dǎo)致的相關(guān)不適的發(fā)生率,減少了術(shù)后患者的痛苦;術(shù)后開(kāi)始床上體位改變,4h下床活動(dòng)的護(hù)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.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R473.5

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