乳腺癌患者PICC置管后集束化护理策略构建及效果评价

发布时间：2018-04-15 11:27

本文选题：乳腺癌 + PICC置管　；参考：《河北大学》2017年硕士论文

【摘要】：目的:本研究通过循证基础上构建预防乳腺癌患者PICC置管后并发症的集束化护理策略,探讨临床更为行之有效的并发症预防策略,从而提高临床医护人员对并发症的预防能力,降低其发生率,为今后护理人员护理此类病人提供理论依据。方法:参照相关文献,提出问题并循证原因,通过查阅大量文献,构建乳腺癌患者PICC置管后集束化护理策略;采用非随机同期对照研究设计,通过便利取样的方法于2016年7月~2016年10月在河北大学附属医院乳腺外科进行样本的选择。在一病区中纳入68例行PICC置管的乳腺癌患者为实验组,在二病区中纳入68例行PICC置管的乳腺癌患者为对照组。两病区收治的病人病种无差异,为同一医疗组负责治疗,治疗方式和病人护理无差异。置管由获得PICC置管证书的护理人员进行操作,日常维护由责任护士操作,护士穿刺技术和置管维护无差异。对照组采取常规护理措施,实验组采取包括规范穿刺技术、标准化导管维护、置管后健康教育等一系列集束化护理策略,比较两组患者并发症的发生率。结果:1.干预前,两组患者在性别、年龄、身高、体重、WBC、PLT、乳腺癌分期、手术方式等一般资料,差异均无统计学意义(P0.05)。2.两组患者置管情况比较结果显示两组间置管部位(肘上/肘下)(右臂/左臂)、置管静脉、置管方法、导管置入长度、体外导管剩余长度均无统计学差异,P0.05。3.对照组共有20例患者发生并发症,发生率为29.41%;实验组有8例患者发生并发症,发生率为11.76%。经卡方检验,差异有统计学差异。(2c=6.476,P0.05)。4.两组患者中静脉炎和静脉血栓的发生率差异有统计学差异,P0.05。导管相关血流感染、导管异位、渗血的发生率两组无统计学差异,P0.05。结论:本研究制定了以规范穿刺技术、标准化导管维护、置管后健康教育为主体的集束化护理策略,经临床研究证实,集束化护理策略科学、合理、可行,值得临床通过本文的研究表明,集束化护理策略可以明显的降低乳腺癌患者PICC置管后总并发症以及静脉炎和静脉血栓等相关并发症的发生率,对临床护理起到了积极的指导作用。集束化护理尚处于发展阶段,对于预防乳腺癌患者PICC置管后导管行管血流感染,导管异位及渗血的发生仍需进一步研究。
[Abstract]:Objective: to establish a cluster nursing strategy for the prevention of complications after PICC catheterization in breast cancer patients on the basis of evidence, and to explore more effective prevention strategies for complications, so as to improve the prevention ability of clinical medical staff.To reduce its incidence and provide theoretical basis for nursing staff to care for such patients in the future.Methods: referring to the relevant literature, putting forward the questions and evidence-based reasons, by consulting a large number of literatures, constructing the cluster nursing strategy after PICC catheterization in breast cancer patients, adopting a non-randomized simultaneous controlled study design,Samples were selected from July 2016 to October 2016 in the Department of Breast surgery, affiliated Hospital of Hebei University.68 breast cancer patients with PICC catheterization in one ward and 68 breast cancer patients with PICC catheterization in two areas were treated as experimental group and control group.There was no difference in the type of disease between the two groups, but there was no difference in treatment, treatment and patient care for the same medical group.The catheterization was operated by the nurses who obtained the certificate of PICC indwelling, the routine maintenance was operated by the responsible nurses, and there was no difference between the nursing puncture technique and the catheterization maintenance.The control group adopted routine nursing measures, the experimental group adopted a series of cluster nursing strategies, including standardized puncture technique, standardized catheter maintenance, health education after catheterization, and compared the incidence of complications between the two groups.The result is 1: 1.Before intervention, there was no significant difference between the two groups in sex, age, height, weight, breast cancer staging, operation methods and other general data.The results of two groups showed that there was no significant difference between the two groups (right arm / inferior elbow (right arm / left arm), catheterization, catheterization, length of catheterization, residual length of extracorporeal catheter (P0.05.3).There were 20 cases of complications in the control group (29.41%) and 8 cases in the experimental group (11.76%).By chi-square test, the difference was statistically significant.There was significant difference in the incidence of phlebitis and venous thrombosis between the two groups (P 0.05).There was no significant difference between the two groups in the incidence of catheter-related blood flow infection, ectopic catheterization and bleeding (P 0.05).Conclusion: a cluster nursing strategy based on standardized puncture technique, standardized catheter maintenance and health education after catheterization was established. It was proved by clinical research that cluster nursing strategy was scientific, reasonable and feasible.It is worthy of clinical study in this paper that cluster nursing strategy can significantly reduce the incidence of total complications after PICC catheterization, phlebitis and venous thrombosis in patients with breast cancer.It plays a positive role in guiding clinical nursing.Cluster nursing is still in the developing stage. To prevent the infection of catheter blood flow after PICC catheterization in breast cancer patients, the occurrence of catheter ectopic and bleeding still needs further study.
【学位授予单位】：河北大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R473.73

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