叶丽云等

[摘要] 目的 探讨多汗患者经外周穿刺置入中心静脉导管（PICC）隐性脱管的护理干预效果。 方法 选择2013年1～12月在河北医科大学第二医院呼吸一科住院并接受PICC导管留置的患者，根据随机原则将符合标准的100例患者分为两组，各50例。对照组采用PICC留置导管常规护理方法，观察组应用改变固定方式及换药频率的护理方法。观察两组患者的隐性脱管发生率、经济费用、患者护理满意度及焦虑改善情况。 结果 观察组和对照组隐性脱管总发生率（10%比28%）比较，差异有统计学意义（χ2=5.07，P < 0.05）；观察组和对照组经济费用[（996.50±48.7）比（1044.96±46.1）元]比较，差异有统计学意义（t = 4.34，P < 0.05）；观察组和对照组护理满意度（96%比52%）比较，差异有统计学意义（χ2=6.72，P < 0.05）；护理后，观察组SAS评分[（50.1±11.3）分]低于对照组[（61.8±10.5）分]（t = 11.24，P < 0.05）及护理前[（64.1±8.2）分]（t = 12.69，P < 0.05）。 结论 改变固定方式及换药频率的护理方法能明显降低多汗患者PICC隐性脱管的发生率，减少经济费用，提高患者的护理满意度及改善患者的焦虑状况，值得临床护理推广应用。

[关键词] 经外周穿刺置入中心静脉导管；隐性脱管；多汗患者；护理干预

[中图分类号] R473.5 [文献标识码] A [文章编号] 1673-7210（2015）06（b）-0113-03

Analysis of nursing intervention effect on recessive pipe in sweaty patients with peripherally inserted central catheter

YE Liyun WANG Boli LIU Yan ZHANG Lingli LI Honglin

The First Department of Respiration Medicine， the Second Hospital of Hebei Medical University， Hebei Province， Shijiazhuang 050000， China

[Abstract] Objective To investigate the effect of nursing intervention on recessive pipe in sweaty patients with peripherally inserted central catheter （PICC）. Methods 100 patients accepted PICC of the First Department of Respiration Medicine in the Second Hospital of Hebei Medical University from January to December 2013 were selected and randomly divided into two groups， 50 cases in each group. The control group was given PICC catheter routine nursing care， the observation group was given fixed frequency， dressing change method. Incidence rate of recessive pipe， economic cost， nursing satisfaction of patients， anxiety improvement of patients between two groups were observed. Results Total incidence rate of recessive pipe between observation group and control group （10% vs 28%） was compared， with statistical difference （χ2=5.07， P < 0.05）； the economic cost between observation group and control group [（996.50±48.7） vs （1044.96±46.1） yuan] was compared， with statistical difference （t = 4.34， P < 0.05）； nursing satisfaction between observation group and control group （96% vs 52%） was compared， with statistical difference （χ2=6.72， P < 0.05）； after nursing care， SAS score of observation group [（50.1±11.3） scores] was lower than that of control group [（61.8±10.5） scores]（t = 11.24， P < 0.05） and before nursing care [（64.1±8.2） scores]（t = 12.69，P < 0.05） respectively. Conclusion Change of fixation method and dressing frequency can significantly reduce the incidence rate of recessive pipe of PICC， reduce the cost， improve nursing satisfaction of patients and improve the anxiety of patients， it is worthy of popularization and application in clinical nursing.

[Key words] Peripherally inserted central catheter； Recessive pipe； Sweaty patient； Nursing intervention

经外周穿刺置入中心静脉导管（peripherally inserted central catheter，PICC）是由外周静脉（贵要静脉、肘正中静脉、头静脉）穿刺插管，其尖端位于上腔静脉或锁骨下静脉的导管[1-5]。主要应用于以下情况：有缺乏外周血管通道倾向者；需长期静脉输液、反复输血或血制品者；输注刺激性强的药物，如化疗等；输注高渗性或黏稠性液体，如胃肠外营养液、脂肪乳等。在应用过程中导管脱管是最常见的并发症之一，其发生率为5%～31%[6]。PICC导管脱出严重影响导管的使用，是导管维护的难点。笔者前期研究[7]已发现，多汗患者较少汗患者更容易发生PICC导管隐性脱管，且不易被发现，关于多汗患者的PICC导管隐性脱管循证依据目前研究较少，也没有一个固定的关于隐性脱管的定义。本研究中笔者通过对观察组患者的PICC导管采取预防性护理……