【作者】 赵芳；

【导师】 董新寨；

【作者基本信息】 山西医科大学 ， 护理（专业学位）， 2023， 硕士

【摘要】 目的:本研究通过中医芳香疗法联合穴位按摩对气滞血瘀型创伤性四肢骨折患者围手术期焦虑情绪、疼痛水平及气滞血瘀中医临床证候进行干预,观察临床干预效果,探究此方案的有效性与安全性,为在临床更好地推广和应用芳香疗法联合穴位按摩的操作提供理论参考与经验。方法:本实验为类实验研究,采取便利抽样的方法选取研究对象,选取2022年5～12月山西省某所三级甲等医院创伤骨科住院的四肢骨折患者106名,用抛硬币法将两个病区随机分组,将1～10病房设立为对照组、11～20病房为干预组,两组各选取53例研究对象,最终86例患者完成整个研究。在干预之前(入院24h内)采用一般资料调查表、状态焦虑量表、疼痛视觉模拟量表、中医证候积分量表,来对患者进行基线评估。于手术前1日至出院时进行干预(避开术日),对照组使用常规治疗,观察组在常规治疗的基础上加用芳香疗法联合中医穴位按摩法进行干预,分别于术日晨与出院时再次采用状态焦虑量表、疼痛视觉模拟量表及中医证候积分量表对干预效果进行评估。结果:(1)干预之前两组干预对象的一般资料、焦虑情绪、疼痛水平、中医证候积分相比较,差异均无统计学意义(P>0.05)。(2)经过重复测量方差分析,患者的焦虑情绪在干预前、术日晨与出院时的不同时间点及使用不同干预方式方面存在交互作用(F=29.265,P<0.001),进一步分析各因素的简单效应,与入院时相比,手术前患者的焦虑情绪明显升高,出院时,两组患者焦虑情绪均有所下降,这说明随着患者逐渐康复,其焦虑情绪也在逐渐减轻。两个时间点的干预组的焦虑水平均低于对照组(P<0.05),这说明中医芳香疗法联合穴位按摩可以使创伤骨折围手术期患者放松,缓解其焦虑情绪。(3)经过重复测量方差分析,患者的疼痛程度在干预前、术日晨与出院时的不同时间点及使用不同干预方式方面存在交互作用(F=11.747,P<0.001),故进一步分析各因素的简单效应。患者的疼痛水平是随着时间的推移是逐渐降低的,对照组与干预组在术日晨疼痛程度无统计学差异(P>0.05),出院时的疼痛水平有统计学差异(P<0.05),芳香疗法联合穴位按摩在减轻创伤性骨折患者术后疼痛方面有显著作用。(4)经过重复测量方差分析,患者的气滞血瘀临床症状在干预前、术日晨与出院时的不同时间点及使用不同干预方式方面存在交互作用(F=97.447,P<0.001),进一步分析各因素的简单效应显示,对照组与干预组,在出院时的分值有统计学差异(P<0.05),这说明中医芳香疗法联合穴位按摩可以有效减少创伤骨折围手术期患者的气滞血瘀证临床症状。结论:芳香疗法联合穴位按摩可以有效缓解创伤性骨折患者围手术期的术前术后焦虑情绪、降低术后疼痛水平以及显著改善围手术期气滞血瘀的症状,可以为创伤性四肢骨折患者围手术期焦虑情绪的管理提供参考和依据。更多还原

【Abstract】 Objective:In this study,patients with perioperative traumatic fractures accompanied by anxiety(syndrome of qi stagnation and blood stasis)were interfered by aromatherapy combined with acupoint massage of traditional Chinese medicine.The clinical effect of intervention was observed,the effectiveness and safety of this program was explored,and theoretical reference and experience were provided for better promotion and application of the operation of aromatherapy combined with acupoint massage in clinic.Methods:This study is a quasi-experimental study,which adopts the method of convenient sampling to select the research objects.106 patients with limb fracture who are hospitalized in the orthopedics department of a third-grade Grade-A hospital in Shanxi Province from May to December 2022 are selected,and the two wards are randomly divided by coin toss method.Wards 1～10 are set as the control group,and wards 11～20 are set as the intervention group.There were 53 subjects in each group,and 86 patients completed the study.Before the intervention(within 24 hours of admission),baseline assessment of patients was performed using the general data questionnaire,state anxiety scale,visual analog scale of pain,and TCM syndrome Score scale.The intervention was performed from 1 day before surgery to the time of discharge(avoiding the operation day),the control group received conventional treatment,and the observation group received aromatherapy combined with acupoint massage of traditional Chinese medicine on the basis of conventional treatment.The state anxiety scale,pain visual simulation scale and TCM syndrome Score scale were used again on the morning of the operation day and at the time of discharge to evaluate the intervention effect.Results:(1)Before intervention,the general information,anxiety,pain level and TCM syndrome scores of the two groups were compared,and the differences were not statistically significant(P>0.05).(2)Through repeated measure variance analysis,anxiety of patients had an interaction at different time points and different intervention methods(F=29.265,P<0.001),so the simple effect of each factor was further analyzed.Compared with the time of admission,the anxiety of the patients before the operation was significantly higher,and the anxiety of the patients in both groups decreased at the time of discharge,indicating that the anxiety of the patients was gradually alleviated as they gradually recovered.The anxiety level of the intervention group was lower than that of the control group at both time points(P>0.05).(3)Through repeated measurement variance analysis,the pain emotion of patients had an interaction at different time points and different intervention methods(F=11.747,P<0.001),so the simple effect of each factor was further analyzed.The pain level of patients was gradually decreased with the passage of time.There was no statistical difference between the control group and the intervention group in the morning of the operation day(P>0.05),and the pain level at discharge was statistically different(P<0.05).(4)Through repeated measurement variance analysis,the clinical symptoms of qi stagnation and blood stasis of patients had interaction at different time points and different intervention methods(F=97.447,P<0.001).Further analysis of the simple effects of each factor showed that there were statistical differences between the control group and the intervention group in the score at discharge(P<0.05).Conclusion:Aromatherapy combined with acupoint massage can effectively relieve preoperative and postoperative anxiety,reduce postoperative pain,improve sleep quality and significantly improve perioperative symptoms of qi stagnation and blood stasis in patients with traumatic fractures.更多还原