卧位康复训练预防腹腔镜脾脏切除术后患者直立性低血压的效果

Effect of rehabilitation training in lying position on preventing orthostatic hypotension in patients after laparoscopic splenectomy

目的:探讨卧位康复训练在预防腹腔镜脾脏切除术后患者直立性低血压中的应用效果。方法:采用便利抽样法,选取2019年5—10月郑州大学第一附属医院收治的66例腹腔镜脾脏切除术后患者为研究对象,按照入院先后顺序分为对照组和干预组,各33例。对照组术后实施常规护理,干预组在常规护理措施的基础上组建多学科康复团队实施卧位康复训练方案,制订腹腔镜脾脏切除术后患者不同康复阶段针对性康复训练内容及频率,形成完整康复训练管理流程。记录并比较两组患者直立性低血压发生情况、血压、心率、头晕评分。结果:最终共有效干预61例,其中干预组32例,对照组29例。干预组患者端坐位时的收缩压高于对照组,心率低于对照组,差异有统计学意义(t值分别为2.555、-2.152;P值分别为0.013、0.035)。干预组患者立位3 min内的收缩压及舒张压均高于对照组,心率、头晕评分低于对照组,差异有统计学意义(t值分别为2.745、2.414、-2.048、-2.339;P值分别为0.008、0.019、0.045、0.023)。干预组的直立性低血压发生率为3.13%(1/32),低于对照组的20.69%(6/29),差异有统计学意义(χ^2=4.620,P=0.032)。结论:卧位康复训练能降低腹腔镜全脾脏切除术后患者直立性低血压发生率,改善头晕症状,促进患者康复。

Objective To explore the effect of rehabilitation training in lying position on preventing orthostatic hypotension in patients after laparoscopic splenectomy.Methods A total of 66 patients after laparoscopic splenectomy who were admitted to the First Affiliated Hospital of Zhengzhou University from May 2019 to October 2019 were selected as the research objects by convenient sampling.According to the order of admission,they were divided into the control group and the intervention group,with 33 cases in each group.The control group received routine nursing after surgery.On the basis of routine nursing measures,the intervention group formed a multidisciplinary rehabilitation team to implement a rehabilitation training in lying position program,formulated the content and frequency of targeted rehabilitation training for patients after laparoscopic splenectomy at different rehabilitation stages and formed a complete rehabilitation training management process.The occurrence of orthostatic hypotension,blood pressure,heart rate and dizziness scores were recorded and compared between the two groups.Results In the end,a total of 61 cases were effectively intervened,including 32 cases in the intervention group and 29 cases in the control group.Systolic blood pressure in the sitting position of patients in the intervention group was higher than that in the control group and the heart rate was lower than that in the control group,and the differences were statistically significant(t=2.555,-2.152;P=0.013,0.035).The systolic blood pressure and diastolic blood pressure in standing position within 3 minutes of patients in the intervention group were higher than those in the control group,and heart rate and dizziness scores were lower than those of the control group,and the differences were statistically significant(t=2.745,2.414,-2.048,-2.339;P=0.008,0.019,0.045,0.023).The incidence of orthostatic hypotension in the intervention group was 3.13%(1/32),which was lower than 20.69%(6/29)in the control group,and the difference was statistically significant(x^2=4.620,P=0.032).Conclusions Rehabilitation training in lying position can reduce the incidence of orthostatic hypotension of patients after laparoscopic total splenectomy,improve dizziness symptoms and promote rehabilitation of patients.