Influencce Of Different Body Positions On Micro-circulation For Patients Wigh Lower Extremities Atherosclerosis Disease

Lower extremities atherosclerosis disease(LEAD) is an acute or chronic ischemic disease mainly caused by hardening of the arteries leading to lower limb artery intimae thickening, vascular lumen or occlusion. When the tissue of foot has microcirculation disturbance, tissue ischemia or hypoxia may occur and patients may feel pain. Then patients may droop their lower limb to alleviate pain. A study reports that the microcirculation of dorsum may be changed when patients with LEAD are in different body positions. Position training has been put forward in patients with LEAD both in surgical nursing and the guidelines(2015) of lower limb arteriosclerosis occlusion. However, because of the content which how long to maintain a body position is not detail and the guideline is not strong. Furthermore, the study conclusion is not consistent about the effect of body position on microcirculation of foot for patients with LEAD in foreign country. Moreover, as far as we know, there are few studies about body position and microcirculation for patients with LEAD and also not find the study about the change of microcirculation of foot during a period of time when patients are in a body position.Objective To detect the influence of supine position, sitting position, sitting upright with dependent leg and lower limb evaluation position on microcirculation of foot for patients with LEAD. And to analys is the change of microcirculation and factors along with the time when patients are in a best body position(Transcutaneous Oxygen is highest in four body positions). And to provide empirical basis for afford an appropriate position nursing.Methods Convenience sampling method was used to choose 90 patients with LEAD from May 2014 to December 2015 in first affiliated hospital of Chongqing medical university(there are 60 patients are used to detect the microcirculation change in four body positions; the other patients are used to analysis the change of microcirculation along with the time when patients are in a best body position).(1) After the general information was collected and then the Tc PO2, LDP and the score of pain were measured and compared in four different body positions in the morning when patients are the first day in hospital. And then the position was found which the microcirculation is higher than any other position.(2)A new 30 patients was collected and the Tc PO2 was detected in supine position. And then patients were told to change position from supine to the best body position. And we would supervise the change of Tc PO2 in 60 min. The supervis ion would be stopped, if patients could not maintain the position or the TcPO2 of dorsum of foot in best position is lower than that in supine position. The Tc PO2 and the time which patients maintained best position would be recorded. All date would be analysis by SPSS 19.0.Results(1)There were significant differences among the four body positions with respect to the Tc PO2 and LDP(P<0.01). Both the value of Tc PO2 and LDP in sitting upright with dependent leg were the higher than any other position.(1) The value of Tc PO2 was lower in supine position as comparing to sitting position(P<0.01), sitting upright with dependent leg(P<0.01) and The value of TcPO2 was higher in sitting upright with dependent leg than that in sitting position. However, the value of Tc PO2 was higher in supine position when comparing with lower limb evaluation position(P=0.028).(2)The value of LDP was lower in supine position as comparing to sitting position(P=0.023), sitting upright with dependent leg(P=0.008) and The value of LDP was higher in sitting upright with dependent leg than that in sitting position. However, the value of LDP was higher in supine position when comparing with lower limb evaluation position(P=0.266).(2) After patients dropped lower limb 5 min the value of TcPO2 achieved the top(34.4±15.9mmHg). After patients dropped lower limb 30 min the value of Tc PO2 was higher than that in supine position(P<0.05). However, there were no significant differences between the supine position and after dropping lower limb 40 min when comparing the value of TcPO2. The time of dropping lower limb would be shorted, if there are no without collateral circulation in limb or the artery was totally occluded or the patients feel not comfortable when they drop lower limb.Conclusion The microcirculation of foot will be influenced in four different body positions for patients with LEAD and the sitting upright with dependent leg position is the best body position. The appropriate time is 5min to 30 min when patients are in sitting upright with dependent leg position. However, patients are not suited to droop lower limb and give priority to with supine position, if there are no without collateral c irculation in limb or the artery was totally occluded or the patients feel not comfortable when they drop lower limb.