护理干预对心脏内科患者体位性低血压的影响研究

目的:观察护理措施对体位性低血压患者血压的变化情况.方法:选取体位性低血压住院患者82例,随机分为实验组42例和对照组40例,两组在治疗原发病的同时给予生麦或丹参注射液治疗.对照组给予常规护理,实验组在此的基础上实施全面的护理干预.比较3周后两组患者不适症状改善效果和血压的变化情况.结果:实验组护理干预后,患者头昏头晕、恶心呕吐、心慌不适、晕厥、视物模糊症状改善,直立位和卧位血压差值下降,差异均有统计学意义(P＜0.05):两组干预后比较,差异均有统计学意义(P＜0.05).结论:护理干预可使体位性低血压患者血压直立位和卧位差值变化缩小,不适症状发生率下降,有助于提高患者的生活质量.     

护理干预对颈髓损伤后患者直立性低血压的影响

目的探讨护理干预对颈髓损伤患者术后直立性低血压的影响。方法将129例颈髓损伤患者按住院号单双数分为对照组（63例）和干预组（66例）,均予常规护理。干预组在此基础上采用弹力绷带、腹带、吹气球和体位练习的早期护理干预。结果两组术后直立性低血压发生率比较,差异有统计学意义（P〈0.01）。结论颈髓损伤患者早期使用弹力绷带、腹带并进行吹气球、体位练习,能有效减少直立性低血压发生,促进患者康复。     

改良三步下床法预防腰椎术后患者首次下床直立性低血压

目的探讨三步下床法预防腰椎术后患者直立性低血压的效果。方法将腰椎手术患者264例随机分成对照组和干预组各132例,对照组按照常规护理,干预组在护士指导和协助下按照改良三步下床法完成术后首次下床活动,比较两组直立性低血压发生情况。结果对照组患者术后首次下床直立性低血压发生率显著高于干预组,差异有统计学意义(P0.01)。结论腰椎术后患者首次下床时采用改良三步下床法,可有效预防直立性低血压发生,避免护理不良事件发生。     

对精神病人体位性低血压的干预护理

对精神病人体位性低血压的干预护理空军获鹿医院张秀贤，张雪琴在精神病人的治疗过程中，由于药物所引起的毒副反应，以及病人体质的变化，常发生体位性低血压，心动过速或过缓，毛细血管扩张，血压降低，静脉血栓形成等心血管系统疾病［１］。笔者通过对住院的１５６例精...     

蛋白尿患者高血压治疗的研究进展

蛋白尿是肾脏疾病进展和并发心血管疾病的重要危险因素,降低尿蛋白可延缓肾功能减退并降低心血管事件发生的危险性。而血压升高在慢性肾脏病的进展中也起着重要作用,近来所有的指南都推荐蛋白尿患者血压控制的靶目标为低于130／80mmHg以达到最大的肾脏和心血管保护作用。大量研究证明作用于肾素-血管紧张素系统的药物（如血管紧张素转换酶抑制剂和血管紧张素受体拮抗剂）有独立于降压之外的降低蛋白尿的作用,因此可作为蛋白尿患者的一线高血压治疗药物,若应用这类药物后血压仍不达标,可在此基础上加用利尿剂或其他高血压药物。血管紧张素转换酶抑制剂与血管紧张素受体拮抗剂或其他类型药物（如非二氢吡啶类钙离子通道阻断剂或醛固酮受体拮抗剂）联合应用可进一步减少尿蛋白。     

护理干预对高血压合并冠心病的疗效研究

目的:探讨综合护理干预对高血压合并冠心病患者血压控制效果及护理满意度的影响。方法:选取我院心内科2010年7月～2012年2月收治高血压合并冠心病患90例,采用随机数字表法分为常规护理组和综合护理组,每组各45例;分别采用常规护理干预和综合护理干预措施;比较两组患者血压控制率及护理满意度等。结果:常规护理组和综合护理组患者血压控制例数分别为24例,38例;血压控制率分别为53.3%,84.4%;综合护理组患者血压控制率较常规护理组明显提高,组间比较差异显著(P<0.05);综合护理组患者沟通交流、服务态度、日常护理、病房环境及整体评价等护理满意度均明显高于常规护理组,组间比较差异显著(P<0.05)。结论:高血压合并冠心病患者综合护理干预应用能够有效改善血压水平,提高血压临床控制率及护理满意度。     

护理干预对颈髓损伤后患者直立性低血压的影响

目的 探讨护理干预对颈髓损伤患者术后直立性低血压的影响.方法 将129例颈髓损伤患者按住院号单双数分为对照组(63例)和干预组(66例),均予常规护理.干预组在此基础上采用弹力绷带、腹带、吹气球和体住练习的早期护理干预.结果 两组术后直立性低血压发生率比较,差异有统计学意义(P＜0.01).结论 颈髓损伤患者早期使用弹力绷带、腹带并进行吹气球、体位练习,能有效减少直立性低血压发生,促进患者康复.     

体位适应性训练对髋关节置换术后体位性低血压的护理干预研究

目的 探讨体位适应性训练对髋关节置换术后体位性低血压的护理干预效果。方法 选择2017年8月至2018年8月于我科进行髋关节置换术的56例病人进行前瞻性研究,采用随机数字表法将其分为对照组和研究组,每组28例,研究组的病人采用体位适应性训练的方式,对照组采用传统的护理模式。观察两组病人手术前后的血压变化,比较两组体位性低血压的发生率以及其对术后护理的满意率。结果 研究组共2例（2/28,7.14%）发生体位性低血压,对照组共8例（8/28,28.57%）发生体位性低血压,两组体位性低血压的发生率比较,差异有统计学意义（χ²=4.383,P=0.036）。研究组总满意度为96.43%（27/28）,对照组总满意度为67.86%（19/28）,两组病人的满意度比较,差异有统计学意义（χ²=7.791,P=0.005）。结论 髋关节置换术后体位适应性训练的方法效果确切,有利于减少病人术后并发症的发生,减少病人的不适,对病人的快速康复有重要意义。     

护理干预对社区高血压患者遵医行为的影响

目的:探讨护理干预对社区高血压患者遵医行为的影响及体会。方法:随机抽取社区高血压患者100例,对其进行为期一年的社区护理干预,包括健康教育、用药指导、自我血压监测、饮食干预、心理干预和运动干预,在护理前后对患者进行问卷调查和血压测量。结果:护理干预1年后随访,100例患者均成功随访,患者对高血压预防控制措施的认知情况均得到显著改善,自我监测血压、按时服药、定期随诊、合理膳食、坚持运动和戒烟戒酒的比例均显著提高。患者的体质量、收缩压、舒张压均较干预前有显著的降低。结论:通过有效的护理干预措施,可显著增强其遵医行为的执行能力,改变患者不良生活方式,降低患者血压水平,改善其健康相关行为。     

枸橼酸西地那非对男性勃起功能障碍合并使用抗高血压药物的患者血压、心率的影响

在高血压患者中，很多男性患有勃起功能障碍（ED），西地那非对这些长期服用抗高血压药治疗患者的血压、心率有影响吗？Zusman RM等进行的相关研究有助于对此问题的进一步了解，研究者将1685例病程6个月以上的ED患者按其以往是否使用抗高血压药物（利尿剂、β受体阻制剂，α受体阻制剂，血管紧张素转化酶抑制剂，     

The mechanism of adverse events associated with terazosin: an analysis of the Veterans Affairs cooperative study

PURPOSE: We determined the mechanism of adverse events associated with alpha1-blockers for treating benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: We randomized 1,229 men with clinical BPH at 31 Veterans Affairs medical centers into equal treatment groups, including those who received placebo, terazosin, finasteride, and combined terazosin and finasteride therapy, respectively. Adverse events were captured at all study visits during our 1-year study. Our current review of adverse events is limited to patients randomized to the placebo and terazosin groups. We compared the incidence of orthostatic blood pressure change, postural symptoms and orthostatic hypotension in men who were normotensive and hypertensive at baseline, respectively. We also determined the association of changes in systolic blood pressure with the incidence of treatment related adverse events. RESULTS: The treatment related rates of dizziness, asthenia, postural hypotension and syncope were 19%, 6%, 6% and 1%, respectively. Of these adverse events only postural hypotension was associated with orthostatic blood pressure changes. The incidence of asthenia, dizziness and postural hypotension was not significantly greater in patients with a systolic blood pressure decrease of 5 or greater and less than 5 mm. Hg, respectively. CONCLUSIONS: Dizziness and asthenia are not associated with changes in blood pressure, suggesting that these treatment related adverse events associated with alpha1-blockers are not related to vascular events. Designing a subtype selective alpha1 antagonist that has less effect on blood pressure may not result in marked improvement in tolerability over commercially available alpha1-blockers.     

合并体位性低血压对维持性血液透析患者预后的影响

目的评估体位性低血压（OH）对维持性血液透析患者预后的指示意义。方法分析评估2004—2007年62例维持性血液透析患者OH与其他因素导致患者死亡的关系。参试患者进入试验时一般状态稳定,每次血液透析治疗前连续进行5次血压测定。OH定义：从卧位变为立位后肱动脉收缩压下降大于20mmHg（1mmHg=0．133kPa）或舒张压下降大于10mmHg。结果62例患者中,35．5％（22／62）存在不同程度的OH。在平均（35．0±47．6）周（1～140周）的随访期间,共记录到7例患者死亡。使用多变量COX比例危险率回归模型分析表明患者年龄、存在OH和既往有脑血管基础疾病史是患者远期预后（死亡）的独立预测因素。同时,使用Kaplan—Meier生存分析法判断所有参试患者存在和不存在OH的远期预后,发现差异均有统计学意义。结论血液透析患者开始出现OH是标志患者远期预后（各种原因导致死亡）的独立指示因素。     

护理干预对妊娠高血压综合征患者血压水平和分娩方式的影响

目的探讨护理干预对妊娠高血压综合征患者血压水平和分娩方式的影响。方法72例妊娠高血压综合征患者按随机数表法分为观察组和对照组各36例,观察组给予全面规范化护理干预,对照组采用常规护理,比较两组治疗后血压水平变化情况和对分娩方式的影响。结果观察组治疗后血压改善明显优于对照组（P〈0．05）,且观察组产妇自然分娩率明显高于对照组（P〈0．05）。结论对妊娠高血压综合征患者进行全面规范化的护理干预,可明显增强降压效果,提高产妇自然分娩率,值得临床推广应用。     

Are elderly haemodialysis patients at risk of falls and postural hypotension?

BACKGROUND: The numbers of older people on haemodialysis is rising. As aging and renal failure are risk factors for autonomic failure and haemodialysis involves significant fluid shifts we hypothesized that older patients would be susceptible to hypotensive events between dialysis sessions. Postural hypotension is a risk factor for falls. Falls are debilitating and a leading cause of morbidity and mortality in the elderly. AIM: To investigate whether postural hypotension and symptoms of hypotension and falls are common in older haemodialysis patients. METHODS: All 47 patients from a single unit aged 70 or over were asked about falls in the previous year and about symptoms that could be due to hypotension (syncope, presyncope, dizziness) between dialysis sessions. Twenty-three patients underwent pre- and post-dialysis orthostatic blood pressure measurement, 18 had 44 hour ambulatory blood pressure recording and 10 subjects had full autonomic function testing. RESULTS: Of 47 patients interviewed, 20 reported syncope/pre-syncope, 34 reported dizziness and 14 recalled at least one fall in the previous year. 8/23 had orthostatic hypotension pre-dialysis and 16/23 post-dialysis. Mean 44-hour blood pressure was 134/68 (+/- 21/9) with no nocturnal dip. Autonomic function was abnormal in all 10 subjects tested. CONCLUSIONS: Elderly haemodialysis patients have a high incidence of hypotensive symptoms between dialysis sessions, recalled falls in the previous year and significant postural hypotension post-dialysis. Physicians supervising elderly haemodialysis patients should ask about symptoms between dialysis sessions and explore the possibility of hypotensive events in symptomatic patients.     

Orthostatic hypotension occurs frequently in the first hour after anesthesia

Symptoms of orthostatic intolerance are common after general anesthesia and are associated with an increased risk of postoperative morbidity. The contribution of orthostatic hypotension (OH) has not been well defined. We conducted a head-up tilt test on patients after general anesthesia for minor surgery to assess the incidence of and risk factors for OH after general anesthesia. One-hundred-four patients were enrolled and were prospectively divided into four groups: older female, older male, young female, and young male. The incidence of OH was 76.0%, 72.0%, 45.5%, and 62.5% respectively and was associated with increasing age (P < 0.05) and posttest dizziness (P < 0.05). Body mass index, preoperative blood pressure, ASA class, anesthetic duration, IV fluid administration, and use of analgesics and antiemetics in the postanesthetic care unit were not different in subjects who demonstrated OH compared with those with a normotensive response. Subjects with OH after general anesthesia did not increase their heart rate and diastolic blood pressure with a head-up tilt which may have been caused by persistent effects of anesthetics on reflex cardiovascular control and/or bedrest-induced dysregulation of reflex cardiovascular control. We conclude that OH is common after general anesthesia for minor surgery and may be the major cause of postoperative orthostatic intolerance. IMPLICATIONS: Orthostatic hypotension, a failure to maintain blood pressure on assuming an upright posture, is common after general anesthesia for minor surgery and may be the major cause of postoperative orthostatic intolerance.     

美容式小切口腋臭110例综合护理干预

目的:探讨对美容式小切口腋臭患者进行综合护理干预的效果。方法:将200例患者随机分为干预组110例及对照组90例。对照组实施常规护理,干预组在常规护理的基础上实施综合护理干预。结果:干预组术前一天、术中心率、血压较对照组平稳(P0.05),术后并发症发生率明显低于对照组(P0.05)。结论:对美容式小切口腋臭实施综合护理干预,可明显减轻患者围手术期紧张恐惧情绪,掌握健康教育知识,有效降低并发症的发生率,减轻患者痛苦,提高生活质量,提高对护理工作的满意度。     

Clinical effects of L-threo-3,4-dihydroxyphenylserine on orthostatic hypotension in hemodialysis patients

Orthostatic hypotension is one of the major factors interfering with everyday activities in hemodialysis patients, but there has been no effective agent for treating it. In order to clarify the clinical effects of L-threo-3,4-dihydroxyphenylserine (L-DOPS) on orthostatic hypotension of hemodialysis patients, we conducted a randomized, double-blind comparative trial. 149 regular hemodialysis patients with orthostatic hypotension were randomly allocated to three groups and L-DOPS at doses of 400 mg, 200 mg or placebo was orally administrated to each group 30 min before starting every hemodialysis for 4 weeks. Changes of blood pressure (BP) in orthostatic hypotension immediately after completion of hemodialysis and symptoms related to orthostatic hypotension were compared between the three groups. In the 400-mg group, systolic and diastolic BP after standing increased significantly and the drop of mean BP after standing was also reduced compared with pretreatment levels. No such changes were observed in the placebo group. Fatiguability, malaise/weakness, dizziness and light-headed feeling, the interdialytic symptoms commonly observed in hemodialysis patients who developed orthostatic hypotension, were improved to a significant extent in the L-DOPS group compared with the placebo group. In particular, the improvement was more remarkable for the L-DOPS 400-mg group than the placebo group in patients with diabetic nephropathy, lower systolic BP after standing, and the long duration type of orthostatic hypotension. The incidence of adverse events was comparable between the three groups, and all recovered after discontinuation of L-DOPS or concomitantly administered drugs, or without any treatment. These findings indicate that L-DOPS taken before hemodialysis prevents orthostatic hypotension in patients undergoing hemodialysis, and is also effective for the interdialytic symptoms related to orthostatic hypotension.     

护理干预对原发性高血压患者的干预效果分析

目的观察护理干预对原发性高血压患者的疗效,为原发性高血压患者的治疗和护理提供循证依据。方法对笔者所在医院采用综合护理干预措施进行干预护理的152例原发性高血压患者的资料回顾分析,并选择同期未采取护理干预的120例原发性高血压患者为对照组,比较两组患者治疗效果及护理满意度。结果干预组患者血压控制率明显高于对照组,其焦虑、抑郁水平明显低于对照组,且患者依从性、知晓率和满意度比较亦明显高于对照组（P均〈0.01）。结论科学有效的护理干预措施可提高临床疗效及护理满意度。     

综合疗法用于治疗顽固性高血压效果观察

目的：观察综合疗法用于治疗顽固性高血压的临床效果。方法被试对象100例，实施药物治疗＋生活方式干预＋穴位埋线综合疗法，治疗4周后进行疗效评定，对治疗前后的血压情况进行比较，数据进行统计学处理（t检验）。结果综合疗法实施前后，患者的收缩压与舒张压下降幅度均具有非常显著性差异（均P＜0.01）。结论对于顽固性的高血压实施综合治疗可收到良好的治疗效果。     

慢性肾衰竭颈动脉内-中层增厚及相关因素的分析

目的：探讨慢性肾衰竭颈动脉粥样硬化的发病率及其相关因素。方法：对71例非透析的慢性肾衰竭（CRF）患者用彩超测定其颈动脉内-中层（IMT）厚度,同时测定血炎症因子、前白蛋白（PA）、肾功能、血脂、年龄、血压及中医证型对他们与IMT的关系进行分析。结果：非透析CRF患者颈动脉IMT增厚阳性率38.03%,IMT增厚组炎性因子高于不增厚组（P〈0.01）,PA低于不增厚组（P〈0.05）,IMT增厚组的年龄（P〈0.05）、高血压例数（P〈0.05）均高于不增厚组,而Scr、BUN、尿酸及血脂两组差异均无统计学意义（P〉0.05）,各中医证型IMT增厚率差异无统计学意义（均P〉0.05）。结论：本组38.03%患者有颈动脉IMT增厚,说明非透析的CRF患者存在明显的动脉粥样硬化,颈动脉IMT增厚除与微炎症状态、低血PA有密切关系外,还与高血压和年龄有明显的关系,而与Scr、BUN、尿酸及血脂无明显关系,IMT增厚与中医证型亦无明显关系。