不同护理方式对下肢深静脉血液回流及舒适度的影响

摘要

Objective To investigate the effects of different nursing methods in deep venous reflux of low limbs and patient comfort so as to prevent postoperative venous stasis,leg swelling and deep vein thrombosis (DVT) of low limbs following endovenous laser treatment(EVLT) and to find comfortable and effective nursing methods for earlier rehabilitation. Methods A total of 180 patients with primary deep venous insufficiency undergoing elective EVLT were randomly divided into 6 groups with different nursing methods of supine resting position, 10,20,30-degree leg elevation,ankle dorsiflexion exercise and ankle ring movement. Color Doppler ultrasonograph(ACUSON CV-70.SIMENS) was used to detect deep venous reflux indexes including peak velocity(Vp),average speed(Va) and blood flow(BF). Patient comfort was also assessed by linea visual analogue scales(0- 10). Results The scores of deep venous reflux,from the lowest to the highest,were as follows: supine resting group,groups with 10,20,30-degree leg elevation,ankle dorsiflexion exercise group and ankle ring movement group. The reflux speeds were positively correlated with the scores. The scores of patient comfort,from the highest to the lowest,were as follows:30-degree leg elevation group,20-degree leg elevation group,ankle dorsiflexion exercise group and ankle ring movement group and supine resting group. Further analysis showed that the highest patient comfort and venous reflux speed were observed in the patients with 20-degree leg elevation,ankle dorsiflexion exercise and ankle ring movement. Conclusion The nursing method of 20-degree leg elevation with ankle dorsiflexion exercise or ankle ring movement can be a most effective and comfort nursing approach in preventing DVT after EVLT. Nursing methods in preventing DVT after EVLT; the balance between deep venous reflux and patient comfort.%目的 探讨不同护理方式对患者深静脉血液回流及舒适度的影响,以预防静脉腔内激光治疗术后并发症.方法 将180例原发性下肢深静脉功能不全择期行静脉腔内激光治疗(endovenous laser treatment,EVLT)的患者按随机数字法分为6组,采用平卧静息、下肢抬高10°、下肢抬高20°、下肢抬高30°、足踝主动背屈、主动环转等6种不同护理方式,采用西门子ACUSON CV-70彩色超声多普勒仪检测下肢深静脉血液回流状态,包括血流峰速度、平均速度和血流量.0～10级线性视觉模拟评分法检测人体舒适度(逆向评分).结果 深静脉血液回流的分值由低到高依次为:平卧静息组、下肢抬高10°组、下肢抬高20°组、下肢抬高30°组、足踝主动背屈组与足踝主动环转组,得分越高,回流速度越快.舒适度评分由高到低依次为:下肢抬高30°组、下肢抬高20°组、足踝主动背屈组、足踝主动环转组与平卧静息组,得分越低,舒适度越高.进一步分析显示,下肢抬高20°、足踝主动背屈、足踝主动环转的患者其舒适度最高、静脉回流速度最快(P<0.01).结论 静脉腔内激光治疗术后患者下肢抬高20°,同时指导患者进行足踝主动背屈、环转运动为最有效及舒适的护理方式,值得在临床推广应用.