两种护理干预措施对老年截石位手术患者血压变化的影响
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摘要
目的
探讨实施下肢被动运动和医用弹力绷带两种护理干预措施对老年截石位手术患者放平下肢后血压、心率等指标的影响,并比较两种方法预防截石位体位改变性低血压的有效性。
方法
选取2009年2～9月期间在中国医科大学附属第一临床医院手术室行经尿道前列腺电切术(TURP)的老年患者90例,随机分为观察1组、观察2组和对照组各30例。手术结束后所有患者均采用单腿慢放,其中观察1组实施下肢被动运动；观察2组应用医用弹力绷带；对照组未实施护理干预。记录三组患者术毕放平下肢前(截石位)、放平一侧下肢即刻、放平双下肢即刻、放平双下肢1、3、5min时的血压、心率。
结果
被动运动组和弹力绷带组患者血压维持稳定,体位改变前后收缩压(SBP)、平均动脉压(MAP)无明显变化(P>0.05),且两组之间比较无显著性差异(P>0.05)；对照组患者放平下肢后SBP、MAP明显降低,与体位改变前及被动运动组和弹力绷带组比较均显著下降(P<0.01或P<0.05)；三组患者心率(HR)均出现增快(P<0.01或P<0.05)。
结论
实施下肢被动运动和医用弹力绷带两种护理干预措施,均可减轻老年截石位手术患者血压的波动程度,对预防截石位体位改变性低血压,保证患者围手术期安全有一定的实际意义。
Objective
To explore the influence of two different nursing interventions on blood pressure of elderly patients undergoing lithotomy position surgery. And to compare the effectiveness of two methods to prevent hypothension when position change.
Method
90 cases of gerontal patient treated by transurethral resection of prostate(TURP) from February 2009 to September in the fist hospital of China Medical University were randomly divided into the observation group 1, observation group 2, and control group with 30 patients in each. After surgery all patients were using one leg slow-release. In which observation group 1 implementation of the lower limb passive movement, observation group 2 applied medical elastic bandage, and the control group with no intervention. The blood pressure and heart rate of all patients at different time points were recorded. The time points including before flat lower extremities(lithotomy postion), flat side of the lower extremities immediately, flat lower extremities immediately, flat lower limbs 1、3、5min.
Results
Passive motion group and the elastic bandage group blood pressure remained stable. The systolic blood pressure(SBP), mean arterial pressure(MAP) with no significant change before and after the postural change (P>0.05).The blood pressure decreased significantly in control group compared with the before postural change level and passive motion group and the elastic bandage group (P<0.01或P<0.05); three groups of patients increased heart rate fast (P<0.01或P<0.05)
Conclusion
Implementation of the lower limb passive movement and medical elastic bandage can help to maintain the blood pressure in a normal level in elderly patients during lithotomy position surgery. Thus can prevent orthostatic hypotension and ensure the safety of patients in the perioperative period with a certain degree of practical significance.
探讨实施下肢被动运动和医用弹力绷带两种护理干预措施对老年截石位手术患者放平下肢后血压、心率等指标的影响,并比较两种方法预防截石位体位改变性低血压的有效性。
方法
选取2009年2～9月期间在中国医科大学附属第一临床医院手术室行经尿道前列腺电切术(TURP)的老年患者90例,随机分为观察1组、观察2组和对照组各30例。手术结束后所有患者均采用单腿慢放,其中观察1组实施下肢被动运动；观察2组应用医用弹力绷带；对照组未实施护理干预。记录三组患者术毕放平下肢前(截石位)、放平一侧下肢即刻、放平双下肢即刻、放平双下肢1、3、5min时的血压、心率。
结果
被动运动组和弹力绷带组患者血压维持稳定,体位改变前后收缩压(SBP)、平均动脉压(MAP)无明显变化(P>0.05),且两组之间比较无显著性差异(P>0.05)；对照组患者放平下肢后SBP、MAP明显降低,与体位改变前及被动运动组和弹力绷带组比较均显著下降(P<0.01或P<0.05)；三组患者心率(HR)均出现增快(P<0.01或P<0.05)。
结论
实施下肢被动运动和医用弹力绷带两种护理干预措施,均可减轻老年截石位手术患者血压的波动程度,对预防截石位体位改变性低血压,保证患者围手术期安全有一定的实际意义。
Objective
To explore the influence of two different nursing interventions on blood pressure of elderly patients undergoing lithotomy position surgery. And to compare the effectiveness of two methods to prevent hypothension when position change.
Method
90 cases of gerontal patient treated by transurethral resection of prostate(TURP) from February 2009 to September in the fist hospital of China Medical University were randomly divided into the observation group 1, observation group 2, and control group with 30 patients in each. After surgery all patients were using one leg slow-release. In which observation group 1 implementation of the lower limb passive movement, observation group 2 applied medical elastic bandage, and the control group with no intervention. The blood pressure and heart rate of all patients at different time points were recorded. The time points including before flat lower extremities(lithotomy postion), flat side of the lower extremities immediately, flat lower extremities immediately, flat lower limbs 1、3、5min.
Results
Passive motion group and the elastic bandage group blood pressure remained stable. The systolic blood pressure(SBP), mean arterial pressure(MAP) with no significant change before and after the postural change (P>0.05).The blood pressure decreased significantly in control group compared with the before postural change level and passive motion group and the elastic bandage group (P<0.01或P<0.05); three groups of patients increased heart rate fast (P<0.01或P<0.05)
Conclusion
Implementation of the lower limb passive movement and medical elastic bandage can help to maintain the blood pressure in a normal level in elderly patients during lithotomy position surgery. Thus can prevent orthostatic hypotension and ensure the safety of patients in the perioperative period with a certain degree of practical significance.
引文
1郜苏英,宋群,李平,等.前列腺电切术患者体位对血液动力学影响及护理.中华护理杂志,1994,29(1)：30-33.
2 Van Bogaert LJ. Prevention of post-spinal hypotension at elective cesarean section by wrapping of the lower limbs.Int J Gynaecolo Obstet,1998,61(3):233-238.
3 Miyabe M, Sonoda H, Namiki A. The effect of lithotomy position on arterial blood pressure after spinal anesthesia. Anesth Analg,1995,81(1):96-98.
4郭继龙,刁文波,汪清容,等.预注麻黄素预防老年硬膜外麻醉截石位放腿时低血压.中国临床药理学与治疗学,2003,8(6)：673-676.
5武立娟,陈桂芳,张彤彦.外科手术中体位的损伤及护理.泰山医学学院学报,2002,23(1)：265.
6苏兰若,高蕾.不同角度上身体位对前列腺手术患者血压变化的影响.中国实用护理杂志,2007,23(2)上旬版：16-17.
7赵玉英.老年人腰硬麻醉下截石位术后双下肢不同平放方法对血压影响的观察.护理实践与研究,2006,3(6)：26-27.
8牟红芳,薛秀华.前列腺电切术患者体位对血流动力学的影响.齐鲁护理杂志,2001,7(5)：343-344.
9陈哲颖,陈兆英.直肠癌根治术中下肢不同体位置放对患者循环呼吸的影响.护理学杂志,2005,20(24)外科版：36-37.
10程文华,王景阳.全麻下截石体位改变对老年病人血压和心率的影响.临床麻醉学杂志,2000,16(9)：464.
11马静,谷巧月.膀胱截石位术后下肢摆放方法对老年直肠癌患者血液动力学的影响.中华护理杂志,2007,42(9)：848-849.
12陆利萍,谢惠玲,王琼.应用组织粉碎器行钬激光前列腺切除术的手术配合.中华护理杂志,2005,40(6)：466467.
13李华萍,杨慧.弹力绷带在截石位摆置方法中的应用.现代护理,2007,13(24)：2316-2327.
14李志春,桂立辉.利用Excel实现对实验对象随机分组的应用.毒理学杂志,2005,19(3)：235-236.
15陈廖斌,顾洁夫,王华,等.足踝主、被动运动对下肢静脉回流的影响.中华骨科杂志,2001,21(3)：145-147.
16赵莹.老年前列腺患者术后主动和被动活动下肢对股静脉血流速度的影响.中国医药导报,2007,4(15)：33-34.
17 Sun HL,Ling QD,Sun WZ,et al.Lower limb wrapping prevents hypotension, but not hypothermia or shivering, after the introduction of epidural anesthesia for cesarean delivery.Anesth Analg,2004,99(1):241-244.
18 Rassler B, Mugge LO, Waurick S,et al. Efect of Surgical positioning and spinal anesthesia on lung function. Pneumologie,2001,55(1):31-37.
19池金凤,郭爱武,李风清.两种截石位摆放方法与术后并发症相关因素的对比.中华护理杂志,2001,36(3)：165-168.
20眭文庚译,曾因明校.体位改变对循环-呼吸的影响.国外医学麻醉学分册,1985,6(3)：10.
21 Gaffney FA, Bastian BC, Thal ER, et al. Passive leg raising does not produce a significant or sustained autotransfusion effect. J Trauma,1982,22:190-193.
22 Miyabe M, Sonoda H, Namiki A. The effect of lithotomy position on arterial blood pressure after spinal anesthesia. Anesth Analg,1995,81(1):96-98.
23于天超,林万春,赵立明.血压调控失常综合征及其护理.国外医学·护理学分册,2001,20(8)：380.
24赵仙芝,韩云.手术体位不当致并发症的原因分析及预防.护士进修杂志,1997,12(1)：35-36.
25丁晓芳.弹力绷带用于妇科术后预防下肢深静脉栓塞的临床观察.护理与康复,2008,7(5)：364-365
1 Halliwill JR, Hewitt SA, Joyner MJ, et al. Effect of various lithotomy positions on lower-extremity blood pressure. Anesthesiology,1998,89(6):1373-1376.
2郜苏英,宋群,李平，等.前列腺电切术患者体位对血液动力学影响及护理.中华护理杂志,1994,29(1)：30-33.
3赵玉英.老年人腰硬麻醉下截石位术后双下肢不同平放方法对血压影响的观察.护理实践与研究,2006,3(6)：26-27.
4陈灏珠,默克.老年病手册.第2版.北京：人民卫生出版社,1996.371-374.
5沈月秀.内科老年住院患者体位性低血压原因分析及护理干预.中国实用护理杂志,2004,20(4)下半月版47-48.
6 Rassler B, Mugge LO, Waurick S,et al. Efect of Surgical positioning and spinal anesthesia on lung function. Pneumologie,2001,55(1):31-37.
7牟红芳,薛秀华.前列腺电切术患者体位对血流动力学的影响.齐鲁护理杂志,2001,7(5)：343-344.
8池金凤,郭爱武,李风清.两种截石位摆放方法与术后并发症相关因素的对比.中华护理杂志,2001,36(3)：165-168.
9郭继龙,刁文波,汪清容,等.预注麻黄素预防老年硬膜外麻醉截石位放腿时低血压.中国临床药理学与治疗学,2003,8(6)；673-676.
10眭文庚译,曾因明校.体位改变对循环一呼吸的影响.国外医学麻醉学分册,1985,6(3)：10.
11 Miyabe M, Sonoda H, Namiki A. The effect of lithotomy position on arterial blood pressure after spinal anesthesia. Anesth Analg,1995,81(1):96-98.
12 Gaffney FA, Bastian BC, Thal ER, et al. Passive leg raising does not produce a significant or sustained autotransfusion effect. J Trauma,1982,22:190-193.
13于天超,林万春,赵立明.血压调控失常综合征及其护理.国外医学·护理学分册,2001,20(8)：380.
14赵仙芝,韩云.手术体位不当致并发症的原因分析及预防.护士进修杂志,1997,12(1)：35-36.
15陈明哲.心脏病学.第一版.北京：北京医科大学出版社,1999.1693-1694.
16陈天立.低血压对脑整体与局部的影响.综合临床医学,1997,13(1)：44-46.
17谢鎏宽,杨继震,顾佩霞.围手术期输血与低血压对直肠癌预后影响.中国现代医学杂志,1998,8(1)：63-65.
18武立娟,陈桂芳,张彤彦.外科手术中体位的损伤及护理.泰山医学学院学报,2002,23(1)：265.
19苏兰若,高蕾.不同角度上身体位对前列腺手术患者血压变化的影响.中国实用护理杂志,2007,23(2)上旬版：16-17.
20苏广英.截石位手术相关并发症的分析与护理对策.中国现代医生,2007,45(16)：133-140.
21陈哲颖,陈兆英.直肠癌根治术中下肢不同体位置放对患者循环呼吸的影响.护理学杂志,2005,20(24)外科版：36-37.
22程文华,王景阳.全麻下截石体位改变对老年患者血压和心率的影响.临床麻醉学志,2000,16(9)：464.
23马静,谷巧月.膀胱截石位术后下肢摆放方法对老年直肠癌患者血液动力学的影响.中华护理杂志,2007,42(9)：848-849.
24陆利萍,谢惠玲,王琼.应用组织粉碎器行钬激光前列腺切除术的手术配合.中华护理杂志,2005,40(6)：466——467.
25赵莹.老年前列腺患者术后主动和被动活动下肢对股静脉血流速度的影响.中国医药导报,2007,4(15)：33-34.
26陈廖斌,顾洁夫,王华,等.足踝主、被动运动对下肢静脉回流的影响.中华骨科杂志,2001,21(3)：145-147.
27李华萍,杨慧.弹力绷带在截石位摆置方法中的应用.现代护理,2007,13(24)：2316-2327.
28 Van Bogaert LJ. Prevention of post-spinal hypotension at elective cesarean section by wrapping of the lower limbs.Int J Gynaecolo Obstet,1998,61(3):233-238.
29 Sun HL,Ling QD,Sun WZ,et al.Lower limb wrapping prevents hypotension, but not hypothermia or shivering, after the introduction of epidural anesthesia for cesarean delivery. Anesth Analg,2004,99(1):241-244.
30陈莎莉,樊红,宋芳,等.下肢弹力绷带在腹腔镜胆囊切除术中的应用观察.护士进修杂志,2000,15,(12)：937-938.
31 Podoleanu C,Maggi R,Brignole M,et al.Lower limb and abdominal compression bandages prevent progressive orthostatic hypotension in elderly persons. J Am Coll Cardiol, 2006,48(7):1425-1432.
32曾举宏.心血管病治疗精要.第一版.北京：军事医学科学出版社,2004.590.
33胡美华,李利,顾秀娥.预防ICU患者深静脉血栓的护理进展.中国实用护理杂志,2007,23(8)下旬版73-75.
34 Borow M. Goldson H. Postoperative venous thrombosis:evaluation of five methods of treatment. Am J Surg.1981,141(2):245-252.
2 Van Bogaert LJ. Prevention of post-spinal hypotension at elective cesarean section by wrapping of the lower limbs.Int J Gynaecolo Obstet,1998,61(3):233-238.
3 Miyabe M, Sonoda H, Namiki A. The effect of lithotomy position on arterial blood pressure after spinal anesthesia. Anesth Analg,1995,81(1):96-98.
4郭继龙,刁文波,汪清容,等.预注麻黄素预防老年硬膜外麻醉截石位放腿时低血压.中国临床药理学与治疗学,2003,8(6)：673-676.
5武立娟,陈桂芳,张彤彦.外科手术中体位的损伤及护理.泰山医学学院学报,2002,23(1)：265.
6苏兰若,高蕾.不同角度上身体位对前列腺手术患者血压变化的影响.中国实用护理杂志,2007,23(2)上旬版：16-17.
7赵玉英.老年人腰硬麻醉下截石位术后双下肢不同平放方法对血压影响的观察.护理实践与研究,2006,3(6)：26-27.
8牟红芳,薛秀华.前列腺电切术患者体位对血流动力学的影响.齐鲁护理杂志,2001,7(5)：343-344.
9陈哲颖,陈兆英.直肠癌根治术中下肢不同体位置放对患者循环呼吸的影响.护理学杂志,2005,20(24)外科版：36-37.
10程文华,王景阳.全麻下截石体位改变对老年病人血压和心率的影响.临床麻醉学杂志,2000,16(9)：464.
11马静,谷巧月.膀胱截石位术后下肢摆放方法对老年直肠癌患者血液动力学的影响.中华护理杂志,2007,42(9)：848-849.
12陆利萍,谢惠玲,王琼.应用组织粉碎器行钬激光前列腺切除术的手术配合.中华护理杂志,2005,40(6)：466467.
13李华萍,杨慧.弹力绷带在截石位摆置方法中的应用.现代护理,2007,13(24)：2316-2327.
14李志春,桂立辉.利用Excel实现对实验对象随机分组的应用.毒理学杂志,2005,19(3)：235-236.
15陈廖斌,顾洁夫,王华,等.足踝主、被动运动对下肢静脉回流的影响.中华骨科杂志,2001,21(3)：145-147.
16赵莹.老年前列腺患者术后主动和被动活动下肢对股静脉血流速度的影响.中国医药导报,2007,4(15)：33-34.
17 Sun HL,Ling QD,Sun WZ,et al.Lower limb wrapping prevents hypotension, but not hypothermia or shivering, after the introduction of epidural anesthesia for cesarean delivery.Anesth Analg,2004,99(1):241-244.
18 Rassler B, Mugge LO, Waurick S,et al. Efect of Surgical positioning and spinal anesthesia on lung function. Pneumologie,2001,55(1):31-37.
19池金凤,郭爱武,李风清.两种截石位摆放方法与术后并发症相关因素的对比.中华护理杂志,2001,36(3)：165-168.
20眭文庚译,曾因明校.体位改变对循环-呼吸的影响.国外医学麻醉学分册,1985,6(3)：10.
21 Gaffney FA, Bastian BC, Thal ER, et al. Passive leg raising does not produce a significant or sustained autotransfusion effect. J Trauma,1982,22:190-193.
22 Miyabe M, Sonoda H, Namiki A. The effect of lithotomy position on arterial blood pressure after spinal anesthesia. Anesth Analg,1995,81(1):96-98.
23于天超,林万春,赵立明.血压调控失常综合征及其护理.国外医学·护理学分册,2001,20(8)：380.
24赵仙芝,韩云.手术体位不当致并发症的原因分析及预防.护士进修杂志,1997,12(1)：35-36.
25丁晓芳.弹力绷带用于妇科术后预防下肢深静脉栓塞的临床观察.护理与康复,2008,7(5)：364-365
1 Halliwill JR, Hewitt SA, Joyner MJ, et al. Effect of various lithotomy positions on lower-extremity blood pressure. Anesthesiology,1998,89(6):1373-1376.
2郜苏英,宋群,李平，等.前列腺电切术患者体位对血液动力学影响及护理.中华护理杂志,1994,29(1)：30-33.
3赵玉英.老年人腰硬麻醉下截石位术后双下肢不同平放方法对血压影响的观察.护理实践与研究,2006,3(6)：26-27.
4陈灏珠,默克.老年病手册.第2版.北京：人民卫生出版社,1996.371-374.
5沈月秀.内科老年住院患者体位性低血压原因分析及护理干预.中国实用护理杂志,2004,20(4)下半月版47-48.
6 Rassler B, Mugge LO, Waurick S,et al. Efect of Surgical positioning and spinal anesthesia on lung function. Pneumologie,2001,55(1):31-37.
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