上肢康复操在维持性血液透析患者中的应用研究

doi:10.3761/j.issn.0254-1769.2022.21.002

摘要/Abstract

摘要：

目的评价上肢康复操在维持性血液透析患者中的应用效果。方法选取2021年10月—12月于山东省某三级甲等医院血液净化中心行维持性血液透析治疗的患者77例，按随机数字表分为试验组38例和对照组39例，试验组在常规护理的基础上进行上肢康复操训练，对照组只接受常规护理。分别比较干预前和干预3个月后两组的双手握力、肩关节活动度、动静脉内瘘血流量及非内瘘侧头静脉直径。结果试验组36例、对照组38例完成研究。干预前两组双手握力、肩关节活动度、动静脉内瘘血流量及非内瘘侧头静脉直径比较，差异无统计学意义（P>0.05）;干预后试验组与对照组比较，内瘘侧握力（t=-2.350，P=0.022）、非内瘘侧握力（t=-3.693，P<0.001），内瘘侧肩关节外展（t=-2.468，P=0.016）、外旋（t=-5.167，P<0.001）、内旋（t=-2.059，P=0.043），动静脉内瘘血流量（t=-2.020，P=0.047）、非内瘘侧头静脉直径（t=-5.229，P<0.001）均增加，差异具有统计学意义。结论上肢康复操训练有助于改善维持性血液透析患者的上肢功能及维护动静脉内瘘。

关键词: 维持性血液透析, 动静脉内瘘, 握力, 肩关节活动度, 运动, 护理, 随机对照试验

Abstract:

Objective To evaluate the effect of upper limb rehabilitation exercises on maintenance hemodialysis patients. Methods A total of 77 patients who received maintenance hemodialysis treatment in the blood purification center from October to December 2021 were selected and divided into a control group（n=39） and an experimental group（n=38） according to random number table. The experimental group received the upper limb rehabilitation training on the basis of routine nursing care，and the control group only received routine nursing care. The hand grip strength，range of shoulder motion，arteriovenous fistula blood flow，and cephalic vein diameter on the non arteriovenous fistula side were compared between the 2 groups before and 3 months after the intervention. Results Before the intervention，there was no significant difference between the 2 groups in hand grip strength，range of shoulder motion，blood flow of arteriovenous fistula and the diameter of cephalic vein on the non arteriovenous fistula side（P>0.05）. After the intervention，the grip strength on the side of arteriovenous fistula（t=-2.350，P=0.022），grip strength on the side of non arteriovenous fistula（t=-3.693，P<0.001），abduction of shoulder joint on the side of arteriovenous fistula（t=-2.468，P=0.016），external rotation（t=-5.167，P<0.001），internal rotation（t=-2.059，P=0.043），blood flow of arteriovenous fistula（t=-2.020，P=0.047） and diameter of cephalic vein on the side of non arteriovenous fistula（t=-5.229，P<0.001） in the experimental group increased，compared with those in the control group，and the difference was statistically significant. Conclusion Rehabilitation exercises for upper limbs can help to improve the upper limb function and maintain arteriovenous fistula in maintenance hemodialysis patients.

Key words: Maintenance Hemodialysis, Arteriovenous Fistula, Grip Strength, Range of Shoulder Motion, Exercise, Nursing Care, Randomized Controlled Trial

范晓波, 姜艳萍, 张晓燕, 李春梅, 李倩倩, 崔莉. 上肢康复操在维持性血液透析患者中的应用研究[J]. 中华护理杂志, 2022, 57(21): 2572-2577.

FAN Xiaobo, JIANG Yanping, ZHANG Xiaoyan, LI Chunmei, LI Qianqian, CUI Li. Application of upper limb rehabilitation exercise in maintenance hemodialysis patients[J]. Chinese Journal of Nursing, 2022, 57(21): 2572-2577.

图/表 4

表1 两组一般资料比较

Table 1 Basic information of the 2 groups of patients

表2 两组双手握力比较（kg，$\bar{x} \pm s$）

Table 2 Comparison of hand grip strength between 2 groups（kg，$\bar{x} \pm s$）

表3 两组肩关节活动度比较（°，$\bar{x} \pm s$）

Table 3 Comparison of the range of shoulder motion between 2 groups（°，$\bar{x} \pm s$）

表4 两组动静脉内瘘血流量和非内瘘侧头静脉直径比较（$\bar{x} \pm s$）

Table 4 Comparison of AVF blood flow and cephalic vein diameter on the non-arteriovenous fistula side between 2 groups（$\bar{x} \pm s$）

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