综合护理措施预防腹腔镜术后直立性低血压的效果

Effect of comprehensive nursing measures on the orthostatic hypotension prevention of patients after laparoscopic surgery

目的探讨通过综合护理措施预防腹腔镜手术后患者发生直立性低血压的方法。方法将2011年1—10月行腹腔镜手术后患者186例患者按随机原则分为观察组和对照组，各93例。观察组采用综合性身体训练；对照组下床前进行常规护理指导。观察两组患者出现直立性低血压的情况。结果观察组术后首次下床的立位即刻收缩压［（128±10）mmHg比（106±8）mmHg］和舒张压［（73±8）mmHg比（54±6）mmHg］明显高于对照组，差异均有统计学意义（t值分别为16.57,18.32；P＜0.05），两组心率比较［（80±11）次/min比（83±11）次/min］，差异无统计学意义（t=1.86，P＞0.05）。立位3min时测量的收缩压、舒张压和心率，两组比较差异均无统计学意义（t值分别为1.24,1.81,1.51；P＞0.05）。观察组和对照组直立性低血压的发生率分别为7.5%和13.9%，观察组明显低于对照组。对照组患者伴随直立性低血压而发生的其他症状，如头晕、视物模糊、恶心呕吐、胸闷心慌、耳鸣、意识丧失等也显著高于观察组。结论综合性身体训练方法能够有效预防腹腔镜手术后直立性低血压的发生，提高围手术期护理质量。

Objective To explore the methods of comprehensive nursing measures on the orthostatic hypotension prevention of patients after laparoscopic surgery. Methods Totals of 186 patients hospitalized in the department of gynecology, PLA general hospital from February to October 2011 to receive laparoscopic surgery were randomly divided into two groups with 93 cases in each group. The experimental group received the comprehensive body exercise （CBE） , while the control group received routine nursing instruction before they got out of bed. The occurrence of orthostatic hypotension in both groups were observed. Results When the patients got out of bed to a standing position for the first time, their systolic and diastolic blood pressure were measured immediately, and these in the experimental group were significantly higher than that in the control group [ （ 128 ± 10 ）mm Hg vs （ 106 ± 8 ）mm Hg, （73 ± 8 ）mm Hg vs （ 54 ±6 ） mm Hg ], with statistically significant differences （ t = 16.57,18.32 ; P 〈 0.05）. While no significant difference was found in the heart rates between two groups [ （80 ±11 ） beats/min vs（83 ± 11 ） beats/min （t = 1.86, P 〉 0.05 ）. The systolic blood pressure, diastolic blood pressure and heart rate of two groups in standing position for 3 minutes, no significant difference was found （t = 1.24,1.81,1.51 ;P 〉 0.05 ）. The incidence of orthostatic hypotension was 13.9% in the control group, while that was 7. 5% in the experimental group. Meanwhile, the other symptoms related with ortbostatic hypotension such as dizziness, blurred vision, nausea and vomiting, chest suppression, palpitation, tinnitus, loss of consciousness and so on in experimental group were less than that in control group. Conclusions The comprehensive body exercise （CBE） can effectively prevent the occurrence of orthostatic hypotension for patients after laparoscopic surgery, and improve the pre-operative care quality.