本文選題：腸道術(shù)后 + 腸蠕動恢復��； 參考：《吉林大學》2016年碩士論文

【摘要】：目的:通過本研究,收集結(jié)直腸外科腹部腸道術(shù)后患者的病例,分析影響腸道術(shù)后腸蠕動功能恢復的影響因素,并尋找促進腸蠕動功能恢復的最佳護理方式,為臨床采用有效的護理措施提供科學依據(jù),確定并推廣安全、可行、有效的促進腸蠕動功能恢復的護理方式,為臨床護理事業(yè)的發(fā)展盡一份貢獻。方法:(1)收集2015年4月—2016年6月于吉林大學白求恩第一醫(yī)院結(jié)直腸外科住院部住院治療的患者病例。(2)自行設計護理措施觀察記錄表通過收集臨床患者資料和閱讀病歷的方式收集數(shù)據(jù)。(3)收集可能影響術(shù)后腸功能恢復的相關因素內(nèi)容包括年齡、性別、醫(yī)保形式、文化程度、營養(yǎng)狀況、主要基礎疾病(糖尿病、心臟病、高血壓、甲狀腺疾病)、提示胃腸道蠕動恢復的指標(腸鳴音的恢復時間,首次排氣時間、首次肛門排便時間、患者術(shù)后腹脹發(fā)生情況、傷口愈合情況以及并發(fā)癥發(fā)生情況)、采取促進腸蠕動功能恢復的護理措施(主要包括以下7方面:咀嚼口香糖,腹部熱敷、按摩,床上翻身,有效咳嗽、深呼吸,熱水足浴,早期下床活動,抬臀運動。)(4)對所收集的患者病例的護理干預進行描述分析。通過頻數(shù)分析法單因素分析,得出臨床應用頻繁的護理措施,再對這些護理措施進行單因素分析,即對護理措施的有效性進行分析,得出有效的、應用頻繁的單項護理措施。最后對所有相關因素進行多因素分析,得出影響腸道術(shù)后腸蠕動功能恢復的相關影響因素。結(jié)果:入選患者病例共232例,其中男性145例,女性87例;對入選患者病例所記錄的護理措施進行統(tǒng)計,其中采取咀嚼口香糖的127例,占總例數(shù)的54.74%;采取腹部熱敷、按摩的61例,占總例數(shù)的26.29%;采取床上翻身的166例,占總例數(shù)的71.55%;采取有效咳嗽、深呼吸的113例,占總例數(shù)的48.71%;采取熱水足浴護理方式的95例,占總數(shù)的40.95%;采取早期下床活動的132例;占總例數(shù)的56.9%;采取抬臀運動的患者數(shù)為111例,占總例數(shù)的47.84%。通過對七項護理措施組合頻數(shù)的計算,得出采用二、三種、四種護理措施的組合頻數(shù)較多。通過最高頻次法分析,以及結(jié)合臨床護理措施的可操作性以及患者的依從性,最后確定聯(lián)合應用咀嚼口香糖、床上翻身和早期下床活動為臨床比較常用的護理措施。腸功能恢復的單因素分析結(jié)果顯示:咀嚼口香糖、床上翻身、早期下床活動對腸蠕動的恢復影響差異具有統(tǒng)計學意義;床上翻身、早期下床活動對首次排氣的影響差異有統(tǒng)計學意義(P0.05);床上翻身對首次排便的影響差異有統(tǒng)計學意義(P0.05);早期下床活動對腹脹的影響差異有統(tǒng)計學意義(P0.05);床上翻身對腸功能恢復綜合指標的影響差異有統(tǒng)計學意義(P0.05)。腸功能各項指標的多因素Logistic回歸分析結(jié)果顯示:早期下床活動是腹脹以及腸蠕動恢復的影響因素;年齡、早期下床活動是首次排氣時間的影響因素;文化程度、麻醉時間、床上翻身以及早期下床活動是首次排便的影響因素;麻醉管理時間、聯(lián)合應用護理措施(咀嚼口香糖、床上翻身以及早期下床活動聯(lián)合應用)是胃腸評價綜合指標的影響因素;各項護理措施(咀嚼口香糖、床上翻身、早起下床活動等)對傷口愈合不良情況的發(fā)生、并發(fā)癥發(fā)生的無明顯影響,P0.05,無統(tǒng)計學意義。結(jié)論:(1)早期下床活動可以有效降低腹脹的發(fā)生率、促進腸蠕動以及縮短首次排氣、排便時間,而且可改善胃腸評價的綜合指標;(2)腹部腸道手術(shù)后患者術(shù)后給于假飼(咀嚼口香糖)有利于促進術(shù)后胃腸道功能恢復;(3)腹部腸道術(shù)后給于床上翻身的護理措施有利于提早首次排便時間,改善胃腸評價綜合指標,加速病人康復。(4)聯(lián)合護理方式(術(shù)后聯(lián)合應用咀嚼口香糖、床上翻身和早期下床活動三種護理措施)可促進腸道術(shù)后患者的腸功能恢復。(5)各項護理措施對術(shù)后并發(fā)癥的發(fā)生及傷口愈合不良情況的發(fā)生無明顯影響,為臨床安全、有效的護理干預措施。
[Abstract]:Objective: to collect the factors affecting the recovery of intestinal peristalsis after intestinal surgery, and to find the best nursing methods to promote the recovery of intestinal peristalsis, and to provide a scientific basis for the clinical use of effective nursing measures, to determine and promote the safety, feasibility and effective promotion of the intestine. The nursing mode of peristaltic function resumed to make a contribution to the development of clinical nursing. Methods: (1) collect patients hospitalized in the inpatient department of colorectal surgery in Bethune First Hospital of Jilin University from April 2015 to June 2016. (2) self designed nursing measure observation record table by collecting clinical patient data and reading medical records Collect data. (3) collect related factors that may affect the recovery of postoperative intestinal function, including age, sex, health care form, educational level, nutritional status, main underlying diseases (diabetes, heart disease, hypertension, thyroid disease), indicators of the recovery of gastrointestinal peristalsis (recovery time of enteric sound, first exhaust time, first anus) The time of the door defecation, the occurrence of abdominal distention, the healing of the wound and the occurrence of complications, and the nursing measures to promote the recovery of the intestinal peristaltic function (mainly including 7 aspects: chewing gum, abdominal hot compress, massage, bed turning, effective cough, deep breathing, hot water foot bath, early ambulation, hip lifting movement.) (4) (4) The nursing intervention of patient cases was described and analyzed. Through single factor analysis of frequency analysis, the frequent clinical nursing measures were obtained, and the single factor analysis of these nursing measures was carried out, that is, the effectiveness of nursing measures was analyzed, and effective and frequent single nursing measures were applied. Finally, all related factors were entered. The factors affecting the recovery of intestinal peristalsis after intestinal surgery were analyzed by multifactor analysis. Results: 232 patients were selected, including 145 males and 87 females, and 127 cases of chewing gum were recorded, including 127 cases of chewing gum, 54.74% of the total number of cases, and 61 of the abdominal hot compress and 61 massage. For example, 26.29% of the total number of cases, 166 cases in bed turning over, accounting for 71.55% of the total number of cases, 113 cases of effective coughing and deep breathing, accounting for 48.71% of the total number, 95 cases of foot bath nursing, accounting for 40.95% of the total, 132 cases of early bed down activities, 56.9% of the total number of cases, and 111 cases of hip lifting, which accounted for the total number of cases. The total example, accounting for the total example, accounted for the general example. The number of 47.84%., through the calculation of the frequency of the combination of seven nursing measures, showed that the combination of two, three, and four nursing measures was more frequent. Through the analysis of the highest frequency and the operability of the clinical nursing measures and the compliance of the patients, the combined use of chewing gum, the bed turn over and the early bed down activities were determined. The single factor analysis of the intestinal function recovery showed that the effects of chewing gum, bed turning on the bed and early bed activity on the recovery of intestinal peristalsis were statistically significant, and the effect of the bed turning on the first discharge was statistically significant (P0.05); the bed body turned over for the first time. The difference was statistically significant (P0.05); the effect of early bed off activity on abdominal distention was statistically significant (P0.05); there was a significant difference in the effect of the bed turning on the comprehensive index of intestinal function recovery (P0.05). The multiple factor Logistic regression analysis of various indexes of intestinal function showed that the early bed activity was abdominal distension and intestinal peristalsis. The influence factors of recovery; age, early bed off activity are the factors affecting the first exhaust time; education level, anesthesia time, bed turn over, and early bed off activities are the factors affecting the first defecation; anesthesia management time, combined application of nursing measures (chewing gum, bed turn over and early bed off activities) are the gastrointestinal reviews. The influence factors of the comprehensive price index; the nursing measures (chewing gum, bed turn over, early rise and down activity, etc.) have no significant influence on the occurrence of wound healing and the occurrence of complications, and there is no significant difference in P0.05. Conclusion: (1) early bed down activity can effectively reduce the incidence of abdominal distention, promote intestinal peristalsis and shorten the first row. Gas, defecation time, and can improve the comprehensive index of gastrointestinal evaluation; (2) after abdominal operation, the patients with false feeding (chewing gum) can promote the recovery of gastrointestinal function after operation; (3) the nursing measures to the bed on the bed after abdominal operation are beneficial to the first defecation time, improve the comprehensive index of gastrointestinal evaluation, and accelerate the patient. (4) combined nursing methods (three kinds of nursing measures combined with chewing gum, bed turn over and early bed off activity after operation) can promote the recovery of intestinal function of the patients after intestinal operation. (5) the nursing measures have no obvious influence on the occurrence of postoperative complications and the occurrence of bad wound healing, for clinical safety and effective nursing intervention. Measures.

【學位授予單位】：吉林大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R473.6

【引證文獻】

相關期刊論文 前1條

1 陳曉寧;;胃腸道手術(shù)后腹脹的護理[J];世界最新醫(yī)學信息文摘;2017年20期

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本文編號：1815971