【摘要】：研究背景心導管射頻消融術(Radiofrequency catheter ablation)目前已成為心律失常最有效的治療方法,在臨床應用廣泛。然而術后醫(yī)護人員因過度關注出血及血腫等血管并發(fā)癥,忽視了患者因長時間臥床及制動而造成的軀體及心理問題,使患者自理能力受限,增加了腰背酸痛、肢體麻木、食欲下降、排尿困難等負性效應,產(chǎn)生焦慮、煩躁等負性心理,大大降低了術后患者的舒適度。經(jīng)股靜脈路徑行心導管射頻消融術后出血危險性低,不需過長臥床時間來保障其安全,患者可以提早解除制動及下床活動,有利于促進術后患者的早期康復。研究目的本研究旨在通過對消融術后患者實施早期活動的護理干預,探討既能促進患者舒適,又不增加血管并發(fā)癥發(fā)生風險的安全有效的活動方案,以提高術后患者的舒適度,提升患者自理能力及恢復信心,減少術后生理及心理不適,減少護理人員床邊照護時間,節(jié)省人力,同時也為早期活動的臨床實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的患者120例作為觀察對象。將符合入選標準的患者隨機分為對照組和試驗A、B組,每組40例。對照組采用常規(guī)護理方法,術后患肢制動4h,臥床8h后下地行走;試驗A組術后患肢制動4h后下地行走;試驗B組術后床上體位改變,4h后下地行走。在規(guī)定時間點評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。研究結果三組患者一般統(tǒng)計學資料無顯著差異(P0.05);各組的出血及血腫等血管并發(fā)癥的發(fā)生率比較差異無統(tǒng)計學意義(P0.05);試驗A組及試驗B組的術后腰背疼痛強度顯著低于對照組;試驗B組術后肢體麻木、入睡困難、食欲下降、排尿困難等舒適相關并發(fā)癥發(fā)生率最低,其次為試驗A組,對照組發(fā)生率最高;干預前后三組患者的焦慮及舒適度評分差異有統(tǒng)計學意義(P0.05),對照組的整體舒適度評分最低,焦慮評分最高;與對照組相比,試驗B組的整體舒適狀況最好。研究結論經(jīng)股靜脈心導管射頻消融患者術后早期活動是安全可行的,不會增加穿刺部位血管并發(fā)癥的發(fā)生率,且能顯著提高術后患者的舒適度;通過早期活動的護理干預,降低了因限制性體位及臥床時間過長而導致的相關不適的發(fā)生率,減少了術后患者的痛苦;術后開始床上體位改變,4h下床活動的護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.
【學位授予單位】：南方醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R473.5

【參考文獻】

中國期刊全文數(shù)據(jù)庫 前10條

1 王曉明;;冠心病患者介入治療術后舒適改變的原因分析和護理[J];中國衛(wèi)生標準管理;2015年14期

2 李麗華;肖丹;;舒適護理在射頻消融術治療陣發(fā)性室上性心動過速中的應用[J];中國衛(wèi)生標準管理;2015年10期

3 王玉婷;朱濤;;臨床焦慮評估量表的類別與合理選擇[J];西部醫(yī)學;2014年12期

4 劉紅彬;宋春麗;任巧彥;;抑郁和焦慮與心律失常[J];醫(yī)學與哲學(B);2014年07期

5 李惠;鐘夢飛;李春雨;林少娟;;心血管疾病介入治療術后出現(xiàn)尿潴留的相關因素以及護理對策分析[J];中國醫(yī)藥指南;2014年16期

6 王文;朱曼璐;王擁軍;吳兆蘇;高潤霖;孔靈芝;胡盛壽;;《中國心血管病報告2012》概要[J];中國循環(huán)雜志;2013年06期

7 賈若雅;程敏;常蕓;;經(jīng)股動脈射頻消融患者術后早期體位干預及下床活動的效果[J];解放軍護理雜志;2013年07期

8 黃德嘉;張澍;;心律失常的藥物治療——問題和挑戰(zhàn)[J];中華心律失常學雜志;2012年06期

9 呂素紅;胡學慧;劉榮琴;;Kolcaba K的舒適理論及實踐應用[J];河北醫(yī)藥;2012年21期

10 肖澤萍;張?zhí)旌?;焦慮障礙精神病理內(nèi)表型特征及其早期識別和優(yōu)化治療研究進展[J];上海交通大學學報(醫(yī)學版);2012年09期

，

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