居家维护模式在PICC带管肿瘤出院患者中的应用

发布时间：2018-05-01 13:38

本文选题：居家维护 + 返院维护　；参考：《广东医学》2017年17期

【摘要】：目的探讨居家维护模式在经外周静脉置入中心静脉导管(PICC)带管出院肿瘤患者中的应用效果。方法选取217例PICC带管出院肿瘤患者,按照患者及其家属意愿分为返院组和居家组,其中返院组136例,居家组81例。返院组予常规健康教育并在出院期间返院进行导管维护,居家组予常规健康教育并在出院期间由患者家属居家进行导管维护。比较两组患者自置管至拔管期间,导管维护的依从性、导管留置时间、PICC导管相关并发症发生率及因导管维护往返医院花费的时间及路费。结果 (1)在随访过程中,返院组失访9例,居家组失访6例,两组纳入对象共剩余202例,其中返院组127例,居家组75例。(2)通过对两组患者自置管至拔管期间的随访发现:患者因导管维护往返医院花费的时间、路费,导管维护的依从性及过敏性皮炎的发生率,居家组优于返院组,差异有统计学意义(P0.05);张力性水泡及导管脱出的发生率,返院组优于居家组,差异有统计学意义(P0.05);导管堵塞、穿刺口感染、导管相关性血流感染、深静脉血栓发生率及导管留置时间,居家组与返院组差异无统计学意义(P0.05)。(3)通过对两组患者前3次导管维护的随访发现:张力性水泡、导管脱出、穿刺口感染的发生率,返院组优于居家组,差异有统计学意义(P0.05);其他导管相关性并发症及导管维护依从性差异无统计学意义(P0.05)。(4)经过对两组患者从第4次导管维护至拔管期间的随访发现:过敏性皮炎的发生率及导管维护依从性,居家组优于返院组,差异有统计学意义(P0.05);其他导管相关性并发症差异无统计学意义(P0.05)。结论 (1)居家维护模式在PICC带管出院肿瘤患者中的应用可以提高导管维护的依从性;可以降低导管相关的过敏性皮炎的发生率,不会增高穿刺口感染、导管相关性血流感染、导管堵塞、深静脉血栓的发生率;对导管留置时间没有影响;可以节约患者及其家属的时间和花费,减轻患者负担。(2)居家维护模式在PICC带管出院肿瘤患者中的应用还需要进一步完善,尤其加强对患者及其家属前期培训及考核,减少并发症的发生率,保证患者安全。
[Abstract]:Objective to investigate the effect of home-based maintenance in patients with tumor discharged from hospital with central venous catheter (PICC) via peripheral vein. Methods 217 patients with PICC discharged from hospital with tube were divided into two groups according to the wishes of the patients and their families: the group of returning to hospital (136 cases) and the group of home (81 cases). The patients in the home group were given routine health education and the catheter maintenance was carried out during the period of discharge, while in the home group the routine health education was given and the catheter maintenance was carried out at home by the family of the patient during the discharge period. The compliance of catheter maintenance, the time of catheter indwelling and the incidence of complications associated with PICC catheter were compared between the two groups. Results 1) during the follow-up, there were 9 cases in the return group, 6 cases in the home group, and 202 cases in the two groups, among which 127 cases were in the hospital group. In the home group, 75 patients were followed up during intubation to extubation. It was found that the patients in the home group were better than those in the return group because of the time spent by the catheter maintenance, the travel expenses, the compliance of the catheter maintenance and the incidence of allergic dermatitis. The incidence of tension blisters and ductal prolapse was higher in the return group than in the home group, and the difference was statistically significant (P 0.05). The incidence of deep venous thrombosis and catheter indwelling time, there was no significant difference between home group and return group. The return group was superior to the home group. The difference was statistically significant (P 0.05); there was no significant difference in other catheter related complications and catheter maintenance compliance (P 0.05). After follow-up of the two groups from the fourth catheter maintenance to the extubation period, it was found that allergic dermatitis occurred. Rate and compliance with catheter maintenance, The difference between home group and hospital group was statistically significant (P 0.05), but there was no significant difference in other catheter-related complications (P 0.05). Conclusion (1) the application of home-based maintenance mode in patients with tumor discharged with PICC tube can improve the compliance of catheter maintenance, reduce the incidence of duct-related allergic dermatitis, and do not increase puncture orifice infection and catheter-related blood flow infection. Catheter blockage, incidence of deep venous thrombosis; no effect on catheter retention time; can save time and cost of patients and their families. The application of home-based maintenance mode in patients with tumor discharged from hospital with PICC tube needs to be further improved, especially to strengthen the training and examination of patients and their families, to reduce the incidence of complications and to ensure the safety of patients.
【作者单位】：广西医科大学第一附属医院肿瘤科;广西医科大学第一附属医院护理部;广西卫生职业技术学院护理系;
【分类号】：R473.2

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