经股动脉穿刺冠状动脉造影术后卧床时间的临床研究

[目的]探讨经股动脉穿刺冠状动脉造影术后卧床和穿刺侧肢体制动的最佳时间.[方法]将200例经股动脉穿刺冠状动脉造影并无严重并发症的病人随机分为两组.对照组给予术后常规护理;实验组砂袋压迫穿刺点4 h～6 h,6 h后穿刺侧肢体可以左右旋转,小腿自由屈伸或取对侧卧位.如果病人不习惯平卧位排尿可以变换体位甚至下床排尿,12 h后可以下床自由活动.[结果]两组病人伤口出血率比较无统计学意义,但术后排尿困难、睡眠障碍、腰酸背痛、腹胀等并发症发生率比较有统计学意义.[结论]实验组术后护理效果优于对照组,减少术后穿刺侧肢体制动和卧床时间,可减少病人的痛苦及并发症的发生.     

经股动脉穿刺冠状动脉造影术后卧床时间的临床研究

[目的]探讨经股动脉穿刺冠状动脉造影术后卧床和穿刺侧肢体制动的最佳时间。[方法]将200例经股动脉穿刺冠状动脉造影并无严重并发症的病人随机分为两组。对照组给予术后常规护理；实验组砂袋压迫穿刺点4h～6h，6h后穿刺侧肢体可以左右旋转．小腿自由屈伸或取对侧卧位。如果病人不习惯平卧位排尿可以变换体位甚至下床排尿，12h后可以下床自由活动。[结果]两组病人伤口出血率比较无统计学意义，但术后排尿困难、睡眠障碍、腰酸背痛、腹胀等并发症发生率比较有统计学意义。[结论]实验组术后护理效果优于对照组，减少术后穿刺侧肢体制动和卧床时间，可减少病人的痛苦及并发症的发生。     

经皮冠状动脉内介入治疗术后病人卧位及卧床时间研究

目的探讨经皮冠状动脉内介入治疗 (PCI)术后病人的卧床类型及卧床时间对病人舒适度及并发症的影响。方法将病人分为A、B两组 ,A组为对照组 ,术后采用常规医嘱进行护理 ,穿刺点弹性绷带包扎并且用 1kg沙袋压迫 8h ,保持术侧肢体制动 ,平卧 2 4h后下床活动 ;B组为实验组 ,术后床头抬高 30°,穿刺点弹性绷带包扎 ,术侧肢体伸直可水平移动 ,根据病人需要且无血管并发症者取术侧卧位、仰卧位、半卧位交替 ,12h下床活动。结果两组病人术后并发症的发生率无差异 ,而不良反应B组病人明显少于A组。结论B组的护理方法提高病人的舒适度 ,减少心理压力及并发症的发生     

肝癌介入术后患者卧床体位及卧床时间研究

目的探讨肝癌介入治疗术后患者的卧床体位及卧床时间对患者舒适度、不良反应及并发症的影响。方法将200例患者随机分为实验组和对照组,每组各100例。实验组术后采用低过敏弹性粘贴固定绷带包扎穿刺点,术侧肢体可微弯曲,取抬高床头15～30°或任何舒适卧位交替,术后4h下床活动;对照组术后采用弹性绷带包扎穿刺点,并且用1kg砂袋压迫6h。术侧肢体伸直平卧8h后下床活动。结果实验组与对照组患者舒适度有显著差异(P<0.05);两组患者除恶心及食欲差外,其他不良反应皆存在有统计学意义(均P<0.05),故实验组术后胃肠道不良反应的发生情况总体而言低于对照组。而两组术后并发症的发生率无统计学差异(P>0.05)。结论实验组的护理方法缩短了患者手术后卧床时间,减少了术后不适及胃肠道不良反应,有助于提高护理质量。     

肝穿术后两种不同卧位的比较

目的探讨肝脏穿刺活检术后患者的合适体位。方法肝脏穿刺活检术后患者60例,分为对照组和试验组各30例,对照组采用术后平卧并沙袋压迫穿刺处8h;试验组术后卧床6h,床头抬高30°,取消沙袋压迫穿刺处。测量两组患者的血压、脉搏1次/h,并观察穿刺点疼痛、排尿困难、出血、腰背酸痛等情况。结果对照组与试验组在穿刺点疼痛、出血、低血压等方面无显著差异(P>0.05);在能否进食、有无排尿困难、腰背酸痛等方面差异非常显著(P<0.01)。结论术后卧床6h,床头抬高30°,取消沙袋压迫穿刺处,不仅不会增加肝脏穿刺活检术后患者并发症的发生率,而且可减少患者的不适感。     

经皮冠状动脉内介入治疗术后患者卧位及卧床时间的研究

目的:探讨经皮冠状动脉内介入治疗(PC I)术后患者的卧位及卧床时间对患者舒适度及并发症发生率的影响。方法:将140例PC I术后患者随机分为对照组和实验组,对照组60例,穿刺点弹性绷带包扎并用1kg沙袋压迫8h,术侧肢体制动24h后下床活动;实验组80例,术后床头抬高30°,穿刺点弹性绷带包扎,术侧肢体伸直可水平移动,患者侧卧位与平卧位交替,12h后下床活动。结果:两组术后并发症发生率无明显差异(P>0.05),但实验组患者舒适度明显优于对照组(P<0.05)。结论:经皮冠状动脉内介入术后采取抬高床头30°、侧卧位与平卧位交替、早期下床活动可提高患者的舒适度,且不增加术后并发症发生率。     

应用血管闭合器后不同制动时间对病人舒适度的影响

目的探讨经皮冠状动脉内介入治疗术中应用血管闭合器后病人术侧肢体制动时间。方法将60例病人作为对照组，术后穿刺点用弹性绷带包扎并且用1kg沙袋压迫6h，术侧肢体制动8h，12h后下床活动；观察组80例病人术后穿刺点用弹性绷带包扎，并且用1kg沙袋压迫4h，术侧肢体制动4h，4h后床上活动，观察10min，伤口无渗血即可下床活动。观察比较两组病人舒适度(如腰背酸痛、烦躁、排尿困难、睡眠差)，及穿刺点局部血管并发症的发生率。结果两组病人穿刺点局部血管并发症发生率无显著性差异，但舒适度方面差异有统计学意义。结论经皮腔内冠状动脉介入治疗术中应用血管闭合器缝合止血．病人术侧肢体制动时间可缩短为4h。     

股动脉介入术后固定器的研制与临床应用

经皮冠状动脉成形术 (PTCA)、选择性冠脉造影术 (SCA)及冠脉支架 (STEVT)植入术是当前心血管疾病介入检查和治疗的常用技术 ,但术后最易出现穿刺点出血和局部血肿。据文献报道 ,经皮冠状动脉介入治疗术后出血并发症发生率为3%～ 5 % [1] ,6 9%的出血并发症位于股动脉穿刺部位[2 ] 。为防止出血、血肿形成 ,穿刺点加压包扎 ,砂袋持续压迫 8h ,术后常规平卧位并术侧肢体制动 2 4h ,冠状动脉内支架植入术后需平卧位 4 8h ,术侧肢体制动 2 4h[3 ] 。由于病人的身体长时间处于强迫伸直位 ,限制了活动 ,病人容易引起精神紧张、焦虑、烦躁、失…     

单纯冠状动脉造影术后2 h活动方法及其对患者的影响

目的探讨单纯冠状动脉造影术后2h床上活动及床旁排尿的方法及其对患者的影响。方法50例冠脉造影术患者作为对照组，采用传统方法，即患者术侧肢体保持伸直并严格制动6h，去除沙袋后术侧下肢可平移，12h可半卧位，24h床旁活动。实验组50例，在对照组的基础上，术后2h开始，根据患者需要在按压穿刺点的同时协助患者侧卧10～15min；对要求床旁排尿患者可在按压穿刺点同时协助患者坐或立于床旁排尿，12h可半卧位，24h床旁活动。结果两组术后24h均无穿刺点出血、血肿发生，但实验组无1例发生排尿困难或导尿，舒适度差、焦虑、失眠发生率也明显少于对照组。结论在护理人员协助下，单纯冠脉造影术后2h床上适当活动及在床旁排尿是安全、可行的，能够明显改善患者术后排尿困难及舒适度差、焦虑、失眠等不适。     

经皮股动脉介入术后穿刺点压迫制动带的研制

冠状动脉造影是当今诊断冠心病的金标准，冠状动脉内球囊扩张术、支架术已是临床上治疗冠心病的常规方法。但穿刺点皮下血肿及假性动脉瘤是常见的并发症。为了防止穿刺点出血，在术后需用砂袋压迫穿刺点止血长达6h之久，术侧肢体12h不能弯曲。因此，患者心理压力大，担心砂袋移位，鉴此，我科自行设计一种穿刺点压迫制动带，现介绍如下。     

经皮冠状动脉内支架置入术后早期体位干预的效果

目的探讨对经皮冠状动脉内支架置入术后患者早期进行体位干预，以改善患者卧床排尿困难、腰背酸痛、睡眠障碍等并发症时，对穿刺部位有无影响。方法将121例患者分为观察组（60例）和对照组（61例），对择期经股动脉行冠状动脉内支架置入术动脉鞘管拔除后，在手术肢体约束期间内发生卧床排尿困难、腰背酸痛、睡眠障碍的患者实施体位干预，采用改变患者以往术后绝对平卧位的方法，在护士的指导、协助下，采取半坐卧位、侧卧位的方法。结果实施体位干预后，床上排尿困难、腰背酸痛、失眠等并发症的发生显著少于对照组（p〈0.05），2组术后压迫带移位以及穿刺部位出血比较差异无统计学意义（p〉0.05）。结论动脉鞘管拔除后，在手术肢体约束期间内改变患者的卧位，均能有效改善患者的卧位舒适度和睡眠质量，解除床上排尿困难，使患者处于较佳的身心康复状态，而且不会因此导致穿刺部位出血的发生。     

DSA化疗后患肢制动时间探讨

目的:为减轻DSA化疗后并发症及病人不适感,探讨DSA化疗后术肢制动时间与股动脉穿刺出血的关系。方法:对240例次行DSA化疗者随机分为实验组及对照组。实验组采用术后穿刺处绷带加压包扎24 h、砂袋压迫6 h、下肢制动6～12 h后病人可轻微活动。对照组采取穿刺处绷带包扎后绝对卧床24 h、下肢直伸制动、砂袋压迫6 h。对PT、APTT、TT、PLT、BP指标进行观察分析,对术后出现穿刺处出血、术肢麻木、腰背酸痛、尿潴留进行总结对照。结果:二组病人术后穿刺处出血发生率无显著性差异,x2=0.696 P>0.05,而两组术后并发症及不良反应存在显著性差异。结论:对无凝血机制障碍、无高血压及单侧股动脉无反复穿刺者,术后术肢制动6～12 h即可达到止血目的。     

无肝素冠状动脉造影术后患者安全性及舒适度的研究

为减少血栓栓塞并发症,常规冠状动脉造影术(coronary artery angiography,CAG)中使用肝素3000 U,术后为避免穿刺血管并发症,术肢还必须用弹力绷带和砂袋加压包扎6~8 h,并卧床制动12~24 h[1],长时间的术肢制动和卧床致使患者对CAG产生恐惧心理,大部分的患者术后感到腰背部疼痛难     

Effect of positioning on back pain after coronary angiography

BACKGROUND: Coronary angiography is a routine cardiac diagnostic procedure in Hong Kong. Patients are restricted to bedrest after the procedure due to potential vascular complications from using a femoral approach. Many patients are required to remain on bedrest for up to 24 hours after the procedure. The effects of reducing this bedrest time is still under investigation. In the meantime, nursing interventions aimed at decreasing patient discomfort due to prolonged bedrest are feasible to implement. AIMS: The aims of this study were to evaluate the severity of back pain related to bedrest duration after coronary angiography and to compare the effects of changing patients' position in bed on their perceptions of back pain and on vascular complications. METHODS: An experimental design was used, with patients randomly assigned either to a control or experimental group. The control group received the usual care, remaining supine and flat for 8-24 hours, with the affected leg straight. The experimental group changed their body position hourly, varying between supine, right side-lying, and left side-lying during the first 7 hours after coronary angiography. RESULTS: A total of 419 patients participated in the study (control, n = 213; experimental, n = 206). Regardless of group assignment, back pain intensity increased with longer time on bedrest. In addition, the control group reported higher levels of pain at all five assessment times. Vascular complications in terms of bleeding at the femoral site were not significantly different between the control and experimental groups. CONCLUSION: The study findings suggest that patients may be able safely to change their position in bed earlier in the post-coronary angiography period than currently recommended in practice protocols. Changing position in bed may also reduce back pain, promote physical comfort, and possibly reduce patients' negative feelings toward coronary angiography.     

Ambulation after femoral sheath removal in percutaneous coronary intervention: a prospective comparison of early vs. late ambulation

Aim and objectives. To investigate if ambulation four hours after sheath removal can replace ambulation 10 hours or more after sheath removal with regard to puncture site complications after percutaneous coronary interventions and to examine patient comfort in both groups. Background. Early ambulation after percutaneous coronary intervention may facilitate earlier hospital discharge. Whether this approach is safe, is unknown. Design. A non‐randomised comparative study. Methods. Percutaneous coronary intervention was performed by femoral approach. Registered nurses of the ward removed the sheath and haemostasis was achieved by manual compression. After bed rest with a compression bandage for four hours, the patients in the early ambulation group were ambulated. The patients in the control group stayed in bed till the next morning. Primary study endpoint was the composition of puncture site complications: haematoma, bleeding, false aneurysm and arteriovenous fistula. Secondary endpoints were occurrence of vasovagal collapse after mobilisation, back pain and problems with voiding. Results. In the early ambulation group (n = 329) the total number of complications was nine (2·7%), vs. six (3·0%) in the control group (n = 202). The complication rate in the early ambulation group is not increased compared to the control group (test for non‐inferiority p = 0·002). Hence non‐inferiority is accepted and practical equivalence shown. There were no statistically significant differences concerning patient comfort between the groups. Conclusions. Early ambulation four hours after femoral sheath removal is feasible and safe. The incidence of puncture site complications in the early ambulation group is not increased in comparison with the group with prolonged bed rest. Relevance to clinical practice. Patients could possibly be discharged earlier after percutaneous coronary intervention, allowing percutaneous coronary intervention in an ambulant setting. Further research should confirm these findings and extend the research to the effect of various closure devices in early ambulation and on patients’ well‐being.     

肝癌介入治疗术后不同卧床时间的探讨

目的探讨肝癌患者介入治疗术后24h内的最佳卧床时间,以减少并发症。方法将63例住院肝癌患者随机分为对照组和实验组,采取不同的卧床时间进行术后护理,观察记录穿刺点出血、腰背部疼痛、尿潴留的例数。结果2组在穿刺点出血方面无显著性差异,但术后腰背部疼痛和尿潴留2组有显著性差异。结论肝癌患者介入治疗术后卧床12h是安全的,且能提高患者的舒适度。     

PTCA术后不同卧床及制动时间对患者舒适度的影响

目的：探讨PTCA术后不同卧床及制动时间对患者舒适度的影响。方法：将232例行PTCA术患者随机分为实验组105例和对照组127例,两组采取相同护理措施,实验组术后卧床制动6h,对照组按介入术后常规卧床制动24h,观察两组患者床上活动后穿刺点出血、血肿发生率及对舒适度的影响。结果：两组在拔管后6h、24h无1例出现穿刺点出血、局部血肿。两组在腰酸疼痛、失眠等舒适程度方面比较有显著性差异（P〈0.05,P〈0.01）。结论：在严密监测生命体征,注意饮食护理的前提下,拔管6h后进行床上活动可提高患者舒适度。