降低經股動脈執行心導管術後病人腰背不適感之改善專案

A Project to Reduce Back Discomfort in Post-percutaneous Coronary Intervention Patients

張毓琳(Yu-Lin Chang) ； 舒婉娟(Wan-Chuan Su)

《臺大護理雜誌》 15卷2期 (2019/07) Pp. 187-202

https://doi.org/10.6740/NTUHJN.201907_15(2).0017

摘要

背景：經股動脈執行心導管術後，為預防穿刺部位出血等合併症，病人需長時間臥床及活動受限，導致肌肉酸痛不適，使心跳及血壓上升，增加心臟負荷。目的：降低經股動脈執行心導管術後病人腰背不適感。解決方案：經現況分析發現導因為：臥床時間太長、現存翻身輔具不合適、缺乏臥床期間改善腰背不適之活動指引、護理師缺乏相關教育訓練；因此，本專案修訂照護流程：縮短病人臥床時間、製作翻身小枕、與物理治療師共同設計臥床期間活動指引並製成護理指導單張及舉辦教育訓練。結果：改善後，經股動脈執行心導管術後病人腰背不適平均分數由6.96分降至2.66分（0-10分），且腰背不適發生率由90.9%降至58.6%，有效改善病人之不適，使病人獲得更舒適的導管術後照護。結論：建議未來能持續進行更多實證驗證，以提升病人舒適度及臨床護理照護品質。

關鍵字

心導管術後 ； 腰背不適

並列摘要

To prevent complications after percutaneous coronary intervention (PCI) via femoral access, such as bleeding from the puncture site, patients are restricted to bedrest and limited activity for a period. This leads to muscle soreness, elevated heart rate and blood pressure, and increased myocardial workload. This project aimed to reduce back discomfort after PCI. Major causes of back pain we identified included long bedrest time, no suitable positioning tools, no guidelines for improving back discomfort during the bedridden period, and lack of relevant education and training for nursing staff. Therefore, the following solutions were proposed: revising the postoperative nursing process to shorten bedrest duration, designing supportive pillows, setting guidelines for activities during the bedridden period with physical therapists, and holding continuing education sessions. After implementing these interventions, the main score of back discomfort in patients receiving PCI through femoral access decreased from 6.96 to 2.66 (0-10 points). The incidence of back discomfort decreased from 90.90% to 58.60%. The results show that the interventions improved back discomfort effectively and provided more comfortable postoperative care.

並列關鍵字

post-percutaneous coronary intervention ； back discomfort