俞素琴+++郭海珍

[摘要] 目的 探討洗必泰敷料治疗在经外周静脉置入中心静脉导管（peripherally inserted central catheter，PICC）局部感染护理中的效果。 方法 选取2013年12月～2015年12月期间在我院确诊治疗的PICC相关性局部感染患者100例，依据随机数表法随机分为洗必泰组和碘伏组，每组50例，碘伏组患者给予碘伏湿敷换药治疗，洗必泰组患者给予洗必泰敷料换药治疗，采用酶联免疫吸附法（enzyme-linked immunosorbent，ELISA）检测血清降钙素原（proclacitonin，PCT）、C反应蛋白（c-reactive protein，CRP）水平，统计分析所有患者治疗疗效、换药次数、导管留置和治愈时间及治疗前后血清PCT、CRP、白细胞计数（white blood cell count，WBC）水平。 结果 洗必泰组患者治疗有效率明显高于碘伏组，差异有统计学意义（P<0.05）；洗必泰组患者换药次数和治愈时间明显短于碘伏组，前者导管留置时间明显长于后者，差异有统计学意义（P<0.05）；洗必泰组患者治疗后血清PCT、CRP、WBC水平明显低于碘伏组，差异有统计学意义（P<0.05）。 结论 洗必泰敷料治疗可有效提高PICC相关性局部感染患者的治疗疗效，能够有效改善机体的炎症状态和减少换药次数，且可有效延长导管留置时间，值得临床作进一步推广。

[关键词] 洗必泰敷料；经外周静脉置入中心静脉导管；局部感染；导管留置时间

[中图分类号] R473.73 [文献标识码] B [文章编号] 1673-9701（2016）34-0153-04

Study on the effect of chlorhexidine dressing in PICC local infection nursing

YU Suqin GUO Haizhen

Department of General Oncology， Hangzhou Cancer Hospital， Hangzhou 310002， China

[Abstract] Objective To investigate the effect of chlorhexidine dressing on local infection nursing by peripherally inserted central catheters（PICC）. Methods 100 patients with PICC in our hospital from December 2013 to December 2015 were selected. According to the random number table method， they were randomly divided into chlorhexidine group and iodophor group， with 50 patients in each group. The patients in the iodophor group were given iodophor wet dressing treatment， and the patients in the chlorhexidine group were given chlorhexidine dressing treatment. The levels of serum procalcitonin（PCT） and c-reactive protein（CRP） were detected by enzyme-linked immunosorbent assay （ELISA）， and the curative effects， number of dressing， catheter retention time and healing time， and the levels of serum PCT， CRP and white blood cell count（WBC） before and after the treatment were statistically analyzed. Results The effective rate of treatment in the chlorhexidine group was significantly higher than that in the iodophor group， and the difference was statistically significant （P<0.05）； the time of dressing and healing time in the chlorhexidine group were significantly shorter than those in the iodophor group， and the catheter retention time of the former was significantly longer than the latter. The difference was statistically significant（P<0.05）； the levels of serum PCT， CRP and WBC were significantly lower in the chlorhexidine group than in the iodophor group， and the differences were statistically significant（P<0.05）. Conclusion The treatment of chlorhexidine dressing can effectively improve the efficacy of the treatment of PICC-related local infection. It can effectively improve the inflammation of the body and reduce the number of dressing， and can effectively prolong the catheter retention time， which is worthy of further clinical promotion.

[Key words] Chlorhexidine dressing； Central venous catheter via peripheral vein； Local infection； Catheter retention time

经外周静脉穿刺中心静脉导管（PICC）是一种从周围静脉导入且末端位于中心静脉的深静脉置管技术，为肿瘤患者提供了一条安全、无痛、便捷的输液通路，因其操作简单、安全、导管留置时间长等特点而被广泛应用于临床，但置管后穿刺点周围皮肤局部感染至今仍然是置管护理中的主要问题之一，也是导管计划外拔管的主要原因之一，给临床护理工作带来很多困扰[1]。目前，针对穿刺点感染治疗除了加强换药、严密观察外，多采用碘伏等湿敷于感染部位上，可有效缓解患者的感染症状，但仍有部分患者未能有效杀灭感染菌，影响疗效和置管效果[2]。对此，本研究通过给予患者洗必泰敷料换药治疗，探讨其对患者疗效和置管时间的影响，现报道如下。……