居家维护模式在PICC带管肿瘤出院患者中的安全性和有效性研究

发布时间：2018-05-08 05:21

本文选题：居家维护 + PICC　；参考：《广西医科大学》2017年硕士论文

【摘要】：目的(1)提高PICC带管肿瘤患者的自我管理能力及导管维护依从性;(2)探索居家维护模式在PICC带管肿瘤出院患者中应用的方法;(3)分析居家维护模式在PICC带管肿瘤出院患者中应用的效果。方法选取2015年5月~2016年7月在广西医科大学第一附属医院肿瘤科住院的217例PICC带管肿瘤出院患者,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。两组患者均予常规健康宣教及随访。在患者出院间歇期,返院组予以返院进行导管维护,居家组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、患者自我管理能力、PICC导管相关并发症发生率(张力性水泡、导管脱出、导管堵塞、穿刺口感染、过敏性皮炎、导管相关性血流感染、深静脉血栓)及出院间歇期两组患者因导管维护往返医院花费的时间及路费、患者对PICC专项护理服务的满意度。。结果(1)在随访的过程中,返院组6例死亡,2例转院治疗,1例失去联系而失访;居家组3例死亡,1例转院治疗,1例失去联系而失访,1例中途退出;两组纳入对象共剩余202例,其中返院组127例,居家组75例。(2)202例PICC带管肿瘤出院患者的总导管留置时间为27371导管日。其中127例返院组总导管留置时间为16895导管日,发生PICC导管相关性并发症88例(69.3%),发生率为5.21/1000导管日。其中张力性水泡发生2例(1.6%),发生率为0.12/1000导管日;导管脱出发生10例(7.9%),发生率0.59/1000导管日;穿刺口感染14例(11.0%),发生率0.83/1000导管日;过敏性皮炎28例(22.0%),发生率1.66/1000导管日;导管相关性血流感染2例(1.6%),发生率0.12/1000导管日;深静脉血栓30例(23.6%),发生率1.78/1000导管日;导管堵塞2例(1.6%),发生率0.12/1000导管日。75例居家组总导管留置时间为10476导管日,发生picc导管相关性并发症62例(82.7%),发生率5.92/1000导管日。其中张力性水泡发生8例(10.7%),发生率为0.76/1000导管日;导管脱出发生17例(22.7%),发生率为1.62/1000导管日;穿刺口感染13例(17.3%),发生率为1.24/1000导管日;过敏性皮炎7例(9.3%),发生率为0.67/1000导管日;导管相关性血流感染0例(0.0%),发生率为0.00/1000导管日;深静脉血栓16例(21.3%),发生率为1.53/1000导管日;导管堵塞1例(1.3%),发生率0.10/1000导管日。(3)通过对两组患者自置管至拔管期间的随访发现,患者对picc专项护理服务的满意度、患者自我管理能力、出院间歇期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,居家组与返院组无统计学差异(p0.05)。(4)通过对两组患者前三次导管维护的并发症及依从性的随访发现,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无统计学差异(p0.05)。(5)经过对两组患者从第四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无统计学差异(p0.05)。结论(1)居家维护模式在picc带管肿瘤出院患者中的应用可以提高导管维护的依从性、患者自我管理能力及患者对picc专项护理服务的满意度;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因导管维护往返医院的时间和路费,减轻患者负担。(2)居家维护模式在PICC带管肿瘤出院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,进而减少相关并发症的发生率。(3)居家维护模式在PICC带管肿瘤出院患者中的应用在规范化培训及患者家属操作熟练的前提下,是可行的,具有一定的临床推广意义。
[Abstract]:Objective ( 1 ) To improve the self - management ability and the compliance of catheter maintenance in patients with patients with tumor discharge in patients with patients with tumor discharged from patients who were discharged . ( 3 ) To analyze the effect of home maintenance mode in patients discharged from patients discharged from the hospital . Methods The patients were discharged from the hospital from May 2015 to July 2016 . The patients were treated with catheter maintenance . The patients were discharged from the hospital from May to July 2016 . The patients were discharged from the hospital . The patients were discharged from the hospital . The patients were discharged from the hospital . The patients were discharged from the hospital . The time and the cost of the catheter were maintained and the satisfaction of the patients was satisfied . Results ( 1 ) In the course of follow - up , 6 cases died , 2 cases were transferred to hospital , 1 case lost contact , 3 cases died , 1 case was transferred to hospital , 1 case lost contact and 1 case withdrew . There were 202 cases in the two groups , including 127 cases of return hospital and 75 cases of home group . ( 2 ) The total catheter retention time was 27371 catheter days in 202 patients with CPHD . The incidence rate was 5.21 / 1000 catheter days , and the incidence rate was 5.21 / 1000 catheter days . The incidence rate was 0 . 12 / 1000 catheter days ; the incidence rate was 0 . 12 / 1000 catheter days ; the incidence rate was 0 . 12 / 1000 catheter day ; the incidence rate was 0 . 12 / 1000 catheter day ; the incidence rate was 0 . 67 / 1000 catheter day ; the catheter - related bloodstream infection was 0 cases ( 0 . 0 % ) , the incidence rate was 0 . 00 / 1000 catheter day ; the incidence rate was 0 . 12 / 1000 catheter day ; the catheter - related bloodstream infection occurred in 16 cases ( 21.3 % ) . ( 3 ) There was no statistical difference between the patients ' satisfaction with picc ' s special nursing service , the incidence of patients ' self - management ability , the incidence of catheter - related bloodstream infection , the incidence of deep vein thrombosis and catheter retention time , the incidence of catheter - related bloodstream infection , the incidence of deep vein thrombosis and catheter retention time , the incidence of catheter - related bloodstream infection , deep vein thrombosis and catheter retention time . Conclusion ( 1 ) The application of home maintenance mode in patients with discharge of picc tube tumors can improve the compliance of catheter maintenance , the rate of patients ' self - management ability and the patient ' s satisfaction with the special nursing service for picc . Conclusion ( 1 ) Home maintenance mode can reduce the incidence of catheter - related allergic dermatitis , reduce the incidence of catheter - related bloodstream infection , catheter occlusion , deep vein thrombosis , and reduce the incidence of related complications .

【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R473.73

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