【作者】 刘洋；

【导师】 沙丽艳；

【作者基本信息】 大连医科大学 ， 护理学， 2017， 硕士

【摘要】 研究目的1.探索抗阻运动对透析中低血压发生频率、血压及血压变异性的干预效果;2.了解抗阻运动对血透患者透析清除率的影响,包括尿素、肌酐、血磷等;3.探索抗阻运动对血液透析患者生活质量的改善情况。研究方法运用方便抽样法选取大连市某三级甲等医院两所透析室频繁发生透析低血压的维持性血液透析80例患者作为研究对象,入组后经过随机数字表法将患者分为实验组和对照组,实验组40例,对照组40例。对照组接受透析中心的常规护理,透析过程中每1h测量一次血压,血流量180~280ml/min,透析液温度36~37°C,饮食指导,相关并发症的预防指导等;实验组在常规护理的基础上,接受为期12周的抗阻运动。干预措施:给予每周3次,共计12周(36次)的运动干预,每次进行血液透析前5分钟的热身运动和血液透析后5分钟的放松运动,以及约30分钟的间断透析中抗阻运动干预(上机开始计时,间断进行运动,约每20分钟进行3分钟的抗阻运动训练,共10次运动,直至透析结束),随时观察患者的不适症状。12周干预结束后,研究者对患者的干预前和干预过程中透析低血压发生频率、收缩压、舒张压、血压变异性,干预前和干预后透析清除率相关的生化指标(血钙、血磷、尿素、肌酐)、生活质量相关数据进行统计并评价。结果12周干预结束时,共77例患者完成本研究。结果显示:1.抗阻运动干预期间,实验组透析低血压的发生率显著低于对照组,差异有统计学意义(P<0.05)。同时,患者接受相关护理干预措施的次数显著减少,如调节钠浓度,降低血流速度,调节温度(P<0.05)。2.抗阻运动干预期间,实验组患者透析前血压值(收缩压和舒张压)显著低于对照组,差异有统计学意义(P<0.01)。同时干预期间,实验组患者透析中最低血压值(收缩压和舒张压)均显著高于对照组,差异有统计学意义(P<0.01)。3.抗阻运动干预期间,实验组患者收缩压血压变异性显著低于对照组(P<0.05),两组患者舒张压血压变异性差异不明显。2组收缩压SD和CV比较差异有统计学意义(收缩压SD:t=-4.72,P=0.000;收缩压CV:t=-4.356,P=0.000),而舒张压SD与舒张压CV两组比较差异无统计学差异(P>0.05)。4.12周抗阻运动可以增加尿素、肌酐、血磷的清除,但差异无统计学意义(P>0.05)。5.12周抗阻运动干预后,实验组和对照组在心理方面的社会功能和心理健康维度,差异有统计学意义,实验组得分高于对照组(t=2.131-2.617,P<0.05)。结论1.抗阻运动干预可显著降低维持性血液透析患者透析低血压发生频率,并减少其接受相关护理干预措施的次数。2.抗阻运动干预可以降低患者血压变异度,稳定血压。3.抗阻运动干预可以提高血液透析频繁低血压患者生活质量中的社会功能及心理健康维度。4.抗阻运动干预可以作为常规的护理干预方法来改善患者透析低血压的情况,值得临床推广应用。更多还原

【Abstract】 Objective1.To explore the effect of a 12-week intradialytic resistant exercise on intradialytic hypotension frequency、blood pressure and blood pressure variability;2.To analysis the effects of resistant exercise on dialysis clearance,including urea、creatinine、blood calcium and blood phosphorus;3.To analysis the effects of resistant exercise on quality of life.MethodsIn the trial,we recruited 80 patients who underwent IDH frequently from 2hemo-dialysis centers.The data were collected from September 2015 to March 2016.They were at random divided into two groups by using random number table,intervention group(n=40)and control group(n=40).The control group received normal care,including: the dialysis duration was 4h per session,three times per week,with the blood flow from 180 to 280ml/min,dialysate temperature was 36℃~37℃,related diet guide and prevention instruction of complications and so on;while the intervention group receive 12 weeks’ resistant exercise except for the normal care.The specific resistant exercise: 3 times per week for 12 weeks(overall 36 times).The intervention include 5 minutes warm-up,5 minutes relax exercise and approximately 30 minutes discontinuous intradialytic resistant exercise,paying attention to uncomfortable symptoms at any time.Blood pressure and IDH were recorded during every dialysis.The IDH,blood pressure,blood pressure variability,dialysis clearance,quality of life were assessed prior to and at the end of the program.ResultAfter 12 weeks resistant exercise,overall 77 patients finished the trial,results are as follows:1.The outcome of IDH: There were significant differences in IDH accidents(P=0.000).There were significant differences between intervention group and control group on IDH accidents during the intervention period(P<0.05).At the same time,12weeks’ resistant exercise is benefit to reducing related nursing intervention times,for example,adjusting dialysate sodium concentration,reducing blood flow rate and adjusting dialysate temperature(P<0.01).2.The outcome of blood pressure: During the 12 weeks’ intervention,there were differences in both pre-dialysis SBP and DBP between the two groups,the blood pressure of intervention group were lower than that of control group(P<0.01).As well as,the lowest blood pressure of intervention group were higher than that of control group(P<0.01).3.The outcome of BPV: During the 12 weeks’ intervention,the blood pressure of intervention group was lower than that of control group,there were significant differences in systolic blood pressure SD and CV between the two groups(systolic blood pressure SD:t =-4.72,P =0.000;systolic blood pressure CV:t =-4.356,P=0.000),while there were no differences in diastolic blood pressure SD and CV between the two groups(P>0.05).4.The outcome of dialysis clearance: resistant exercise could increase the clearance of urea、creatinine and blood phosphate,but the differences were not significant(P>0.05).5.The outcome of life quality: After 12 weeks’ intervention,there were significant differences in two dimensions in the terms of psychology,social function and mental health between the two groups.In the intervention group,the score of mental health and social function were obviously higher than those of the control group(t = 2.131-2.617,P<0.05).Conclusion1.12 weeks’ resistant exercise could reduce hemodialysis patients IDH accident srate and related-IDH nursing intervention methods.2.12 weeks’ resistant exercise could improve hemodialysis patients’ blood pressure,reduce blood pressure variability and stable blood pressure.3.12 weeks’ resistant exercise could improve hemodialysis patients’ social-function and mental-health dimensions of life quality.Resistant exercise could be regarded as a common nursing care in the hemodialysis care,and it is worthy of promoting and implementation.更多还原