黄乐毅

【摘要】 目的：觀察老年肿瘤患者外周静脉置入中心静脉导管（PICC）中采取PDCA护理模式在降低其相关性感染和不良事件发生率作用分析。方法：选取笔者所在医院肿瘤科2017年9月-2018年9月收治的以肿瘤为诊断留置PICC管道的老年患者60例，采取随机数字法将其分为对照组与PDCA组，每组30例。对照组采取常规护理干预，PDCA组采取PDCA护理模式。比较两组PICC相关性感染、不良事件发生率、PICC留置时间、护理满意度评分、PICC导管维护效果评分及PICC对日常生活的影响评分。结果：PDCA组不良事件发生率为3.33%，低于对照组的23.33%，PDCA组相关性感染发生率为0，低于对照组的16.67%，差异均有统计学意义（P<0.05）。PDCA组患者PICC留置时间、护理满意度、PICC导管维护效果及患者日常生活的影响评分均明显优于对照组，差异有统计学意义（P<0.05）。结论：在老年肿瘤患者置入PICC的相关护理中，采取PDCA护理模式干预可明显降低患者PICC相关性感染与不良事件的发生率，延长PICC留置时间，改善导管维护效果，减少导管对日常生活的影响，拉近护患关系，提高满意度。

【关键词】 PDCA护理模式; 老年肿瘤患者; 外周静脉置入中心静脉导管

doi：10.14033/j.cnki.cfmr.2019.18.029 文献标识码 B 文章编号 1674-6805（2019）18-00-03

【Abstract】 Objective：To observe the effect of PDCA nursing mode on reducing the incidence of related infections and adverse events in elderly patients with peripheral venous catheterization of central venous catheter（PICC）.Method：A total of 60 cases of elderly patients with tumor as diagnosis indent of PICC pipeline admitted to Oncology Department of our hospital from September 2017 to September 2018 were selected.They were divided into control group and PDCA group by random number method，with 30 cases in each group.The control group adopted routine nursing intervention，while the PDCA group adopted PDCA nursing mode.The PICC-related infections，incidence of adverse events，PICC retention time，nursing satisfaction score，PICC catheter maintenance effect score and PICC impact score on daily life were compared between the two groups.Result：The incidence of adverse events in the PDCA group was 3.33% lower than that in the control group（23.33%），and the incidence of related infections in the PDCA group was 0 lower than that in the control group（16.67%），the differences were statistically significant（P<0.05）.The PICC retention time，nursing satisfaction score，PICC catheter maintenance effect score and PICC impact score on daily life in PDCA group were significantly better than those in control group，the differences were statistically significant（P<0.05）.Conclusion：PDCA nursing intervention can significantly reduce the incidence of PICC-related infections and adverse events，prolong the duration of PICC detention，improve the effect of catheter maintenance，reduce the impact of catheter on daily life，close the relationship between nurses and patients，and improve satisfaction.

【Key words】 PDCA nursing model; Elderly cancer patients; Peripheral venous catheterization of central venous catheter

First-authors address：Guangzhou First Peoples Hospital，Guangzhou 510180，China

肿瘤患者常采用放化疗治疗，为减轻患者反复穿刺的痛苦，采用外周静脉植入中心静脉导管（PICC），有效地减轻了由于频繁穿刺给患者带来的创伤及痛苦[1]。但是在护理中，常遇到不良事件的发生，尤其是针对老年肿瘤患者，血管弹性降低，脆性增加，且因机体免疫能力严重下降的影响，常发生相关性感染[2]。不但增加患者治疗痛苦，更影响患者重复置管带来的经济损失，因此采取一定的护理干预以减少PICC置管相关问题，十分必要。PDCA循环管理是近年新型管理模式，分为4个阶段即计划（Plan）、实施（Do）、检查（Check）和处理（Action）[3]。选取2017年9月-2018年9月笔者所在医院肿瘤科收治的以肿瘤为诊断留置PICC管道的老年患者60例，部分患者采取PDCA护理干预模式，取得较好效果，现报道如下。……