[Effects of head posture on oxygenation saturation, comfort, and dyspnea in patients with liver cirrhosis-related ascites].

BACKGROUND: Chronic liver disease and cirrhosis are collectively ranked as the ninth most prevalent cause of death in Taiwan. Ascites is the most common comorbidity associated with liver cirrhosis. Different body postures affect pulmonary ventilation and arterial oxygen partial pressure. Thus, ensuring proper body posture in patients is an important clinical nursing intervention that significantly affects the recovery of patients. 背景: 肝硬化合併腹水對患者影響是多面的，一旦合併症引發呼吸困難或其他不適情形，病人生活品質會大受影響，在生理、心理與社會各層面皆出現負面的衝擊。 METHODS: A quasi-experimental study design was used. A total of 252 participants were recruited from a medical centre hospital in Taiwan. Participants were allocated randomly into three groups of bed-elevation angles: 15 degrees, 30 degrees, and 45 degrees. The physiological indices were measured at 5, 10, 15, 20, 25, and 30 minutes in order to investigate the change in oxygenation saturations that were attributable to the different angles. Data were analyzed using descriptive statistics. The generalized estimating equation (GEE) was used for statistical analysis, with the level of significance set at: α = .05. RESULTS: After controlling for confounding variables, the results showed that patients in the three groups earned similar scores for the degree of difficulty in the oxygen values. The supine group earned significantly different scores than the other two groups in terms of blood oxygen values related to time to change the angle of the three groups at five minutes after adjusting the angle (p < .01). This study found no differences among the three groups in terms of comfort. In terms of breathing, this study found a significant difference between 45-degree and 15-degree supine dyspnea (p < .05). Therefore, patients with ascites at 15 degrees supine and with better access to better oxygen saturation had superior results to their peers at 30 degrees and 45 degrees supine. Furthermore, this group was less likely to perceive breathing difficulties. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The results of this study may guide health education and care for nurses in order to improve the quality of care for patients with chronic liver disease / cirrhosis with concomitant ascites. 結論／實務應用: 研究結果可作為照護腹水病人，改變臥位時的參考，在考量病情下，提供適當適切的臥位及調整床頭角度，使病人氧合及舒適程度更趨於穩定狀態，減少合併症的發生。