毛燕琴 朱霞明 陆茵

摘要：目的  觀察应用PDCA模式结合艾宾浩斯遗忘曲线理论开展的血液病PICC置管后健康教育模式在患者导管自我管理能力方面的应用效果。方法  选择2018年1～6月在我科行PICC置管的73例血液病患者设为对照组，2018年7～12月在我科行PICC置管的71例血液病患者设为观察组，对照组PICC置管后进行常规健康教育，观察组在对照组基础上应用PDCA模式开展健康教育，并根据艾宾浩斯遗忘曲线规律在置管当天、第2天、1周、1个月给予多形式的强化健康教育，比较两组在PICC置管后导管自我管理能力及留置导管期间并发症发生情况。结果  观察组患者在导管的日常观察、对维护的依从性、导管的管理信心、异常情况处理、信息获取、日常生活和运动管理等方面评分均高于对照组，差异有统计学意义（P<0.05）;观察组在导管留置期间并发症发生率为5.63%，低于对照组的20.55%，差异有统计学意义（P<0.05）。结论  以PDCA管理模式为理论框架，结合艾宾浩斯遗忘曲线理论特点所构建的健康教育模式能有效提高血液病PICC置管患者带管的健康知识水平，进而增强其对导管的自我防护和管理能力，降低置管后相关并发症的发生，具有一定的临床指导意义。

关键词：血液病;PDCA;艾宾浩斯遗忘理论;PICC置管;自我管理能力

中图分类号：R473.73                               文献标识码：A                                 DOI：10.3969/j.issn.1006-1959.2020.19.060

文章编号：1006-1959（2020）19-0183-03

Abstract：Objective  To observe the effect of the application of the PDCA model combined with the Ebbinghaus forgetting curve theory on the post-intubation health education model of PICC for blood diseases in patients with catheter self-management ability.Methods  73 patients with hematological diseases who underwent PICC catheterization in our department from January to June 2018 were selected as the control group， and 71 patients with hematological diseases who underwent PICC catheterization in our department from July to December 2018 were selected as the observation group. The control group was given routine health education after PICC was placed in the tube， and the observation group was given health education based on the PDCA model on the basis of the control group， and was given on the day， the second day， one week， and one month according to the Ebbinghaus forgetting curve law various forms of intensive health education were conducted to compare the self-management ability of the catheter after PICC catheterization and the occurrence of complications during the catheterization period between the two groups.Results  The observation group had higher scores on catheter daily observation， compliance with maintenance， catheter management confidence， handling of abnormal situations， information acquisition， daily life and exercise management， etc.，the difference was statistically significant（P<0.05）; The incidence of complications in the observation group during catheter indwelling was 5.63%， which was lower than 20.55% in the control group，the difference was statistically significant （P<0.05）.Conclusion  Taking the PDCA management model as the theoretical framework and combining the characteristics of Ebbinghaus forgetting curve theory to construct a health education model could effectively improve the level of health knowledge of PICC patients with blood diseases， thereby enhancing their self-protection and management of catheters ability to reduce the occurrence of related complications after intubation had certain clinical guiding significance.

Key words：Blood diseases;PDCA;Ebbinghaus forgetting theory;PICC intubation;Self-management ability

经外周静脉穿刺置入中心静脉导管（peripheraiiy inserted central catheter，PICC）因其操作简单、安全、留置时间长等特点，已成为血液病患者静脉化疗的主要方式[1]。在PICC留置期间的各个阶段均可能会发生导管相关并发症，但主要发生在置管后1个月内，发生率约为5%～20%[2]，其发生原因大部分是由于患者未完全掌握导管相关知识或缺乏导管自我管理知识[3]。在置管后对患者进行的健康教育，由于记忆遗忘的特征性，宣教后患者即遗忘了一部分的宣教内容，降低了患者在PICC导管自我维护和管理方面的认知，在一定程度上影响了患者对导管的自我管理能力，从而增加了患者在 PICC 留置过程中并发症的发生概率[4]。……