抬高擺位對下肢骨折患者術後舒適及水腫成效探討

The Effect of Elevation on Post-operative Comfort and Edema in Patients with a Lower Extremity Fracture Operation

本研究目的是探討下肢骨折患者抬高擺位對術後舒適及水腫成效探討。研究設計前瞻性研究，採縱貫性、類實驗研究法、立意取樣。樣本取自南部某區域醫院下肢為非開放性骨折，且採半身麻醉行開放性復位固定手術者，共收得實驗組與對照組各25人。實驗組以具冰敷、減壓及高度固定之多功能復健枕輔助工具協助患肢抬高，介入時間入院時、術前、術後8小時和術後第1天、第2天與第3天早上8點共6次，一次至少抬高2小時，對照組則給予普通枕頭。研究工具：VAS視覺類比量表、足部周長測量。資料以百分比、平均值、標準差、獨立樣本 t 檢定。結果顯示實驗組於入院時，術前、術後8小時和術後第1天、第2天、第3天舒適程度全都較對照組高，均具顯著性差異（p=0.00＊），顯示實驗組較對照組能有效提升術後舒適度；足部周長變化，實驗組較對照組直徑減少，顯示水腫程度改善但不具顯著性。結果發現，下肢骨折患者術後以多功能復健枕抬高肢體，術後舒適程度提升、水腫改善。本研究結果可推廣至其它因手術後導致影響肢體舒適度及水腫。透過多功能復健枕高度固定，達到末梢血液回流增加、減壓肢體腫脹，並提供護理人員及家屬在提供冰敷實的方便性，同時也能衛教達到一致性，是值得臨床廣為推廣。

The objective of this study is to evaluate the effect of elevation on the post-operative comfort and edema in patients after a lower extremity fracture operation. We adopted prospective, longitudinal, and quasi-experimental research with purposive sampling. A total of fifty subjects were used for the experimental and control groups. Each group had twenty-five subjects. For the experimental group, we elevated the fractured extremity with multi-functional and auxiliary rehabilitative pillows for at least two hours at the periods of admission, pre-operation, eight hours after the operation, the first day after the operation, and at eight o'clock in the morning on the second and third day. For the control group, we just gave general pillows. The visual-analogue scale (VAS) and measurement of the girth of shin were conducted. The percentage, mean value, standard deviation and T-test were used for analysis. The results showed that the patients in the experimental group were more comfortable than those in the control group during the periods of admission, pre-operation, eight hours after the operation, and on the first, second and third days after the operation, all of which showed significant differences in total VAS comfortable scores (P=0.00*). The girth of shin decreased more in the experimental group than in the control group. The edema was improved but not significantly.Therefore, the multi-functional rehabilitative pillows can increase the level of comfort and help improve the edema in patients after lower extremity fracture operations. The results of this study can also be used in patients with discomfort and edema caused by other extremity operations. Besides, the nursing staff can achieve consistency and convenience in the health education through the utilization of multi-functional rehabilitative pillows, which are worth popularizing clinically.