【作者】 孙晶；

【导师】 陶育纯；

【作者基本信息】 吉林大学 ， 公共卫生， 2014， 硕士

【摘要】 目的：评价正压静脉留置针肝素钠稀释液封管和生理盐水封管两种封管方式的封管效果，并比较二者的差异，探讨临床工作者可否使用生理盐水代替肝素钠稀释液封管。方法：研究对象是2014年1月～2014年8月在齐齐哈尔医学院第二附属医院心血管内三科住院的患者409例，按照住院病历单双号分为干预组和对照组，其中干预组（肝素钠稀释液封管组）207例，对照组（生理盐水封管组）202例。观察比较两组5天内患者静脉留置针的堵管率、平均留管时间、静脉炎发生率、出血率等情况。结果：两组入院时年龄、性别、婚姻状况、高血压史、吸烟史等方面差异均无统计学意义（P>0.05），两组患者的文化程度和职业类型均有差异（P<0.05）。两种封管方式平均留管时间比较具有统计学意义（t=13.658, P<0.001），其中肝素钠稀释液封管组平均留管时间为151.23±26.21h，最长留管时间为194h，最短为117h，生理盐水封管组平均留管时间为121.71±16.53h，最长留管时间为144h，最短80h；两种封管方式堵管发生率差异无统计学意义（2=1.285，P=0.257），其中肝素封管组9例患者留置针发生堵塞，堵管率为4.3％；生理盐水封管组14例患者留置针发生堵塞，堵管率为6.9％；两种封管方式静脉炎发生率比较无统计学意义（2=0.367，P=0.545），其中肝素封管组患者16例发生静脉炎，静脉炎发生率为7.7％；生理盐水封管组患者19例发生静脉炎，静脉炎发生率为9.4％；两种封管方式出血率比较具有统计学意义（2=16.513，P<0.001），其中肝素封管组出血例数为35例，出血率为16.9％，生理盐水封管组出血例数为9例，出血率为4.5％。结论：肝素封管法相对于生理盐水封管法虽能有效的延长留置针留置时间，但提高了皮肤黏膜的出血发生率；肝素封管法与生理盐水封管法在降低堵管率和静脉炎发生率方面无明显差异。提示临床护士对于临床上需要长期进行静脉输液的患者，综合正压静脉针肝素钠稀释液和生理盐水两种封管方式的综合效益，充分考虑有效性、安全性，建议选择生理盐水代替肝素钠稀释液封管。更多还原

【Abstract】 OBJECTIVE：To evaluate the sealed tube effects of positive intravenous catheter heparindilution and physiological saline, at the same time, comparing the differences betweenof them, in the end to investigate the possibility of using physiological saline insteadof heparin dilution sealed tube in clinic.METHODS：Between January2014and August2014,409patients in The Second AffiliatedHospital of Qiqihar Medical University of cardiovascular internal medicine, which wereselected by odd or even number and were divided into two groups, intervention groupand control group. The intervention group (sodium heparin dilution sealing tube group)was207cases, the control group (physiological saline sealing tube group) was202cases.We observed the catheter plugging, the average indwelling time, phlebitis incidence rateand bleeding rate and so on.RESULTS：The age, sex, marital status, history of hypertension, smoking history of two groupswas no significant difference of on admission (P>0.05), the educational level andoccupational types were different between two groups. The averaged indwelling time oftwo kinds of sealing tube methods was statistically significant (t=13.658, P <0.001),which the averaged indwelling time was151.23±26.21hours in the sealing tube groupwith heparin sodium diluent. The longest indwelling time was194hours and the shortestindwelling time was117hours. The averaged indwelling time was121.71±16.53hours inthe sealing tube group with normal saline. The longest indwelling time was144hours andthe shortest indwelling time was80hours. The rate of blocking the blood vessel between two sealing tube methods was no significant difference (2=1.285, P=0.257). Which9patients were catheter clogging in the sealing tube group with heparin sodium diluent.Blocking the tube was4.3%;14patients were catheter clogging in the sealing tube groupwith normal saline. Blocking the tube was6.9%; The partial phlebitis of two kinds ofsealing tube methods was no statistically significant (2=0.367, P=0.545), Which16patients had phlebitis in the sealing tube group with heparin sodium diluent. The phlebitiswas7.7%;19patients had phlebitis in the sealing tube group with normal saline. Thephlebitis9.4%; The bleeding rate of two kinds of sealing tube methods was statisticallysignificant (2=16.513, P<0.001), Which35patients were bleeding in the sealing tubegroup with heparin sodium diluent. The bleeding rate was16.9%;9patients were bleedingin the sealing tube group with normal saline. The bleeding rate was4.5%.CONCLUSIONS：Compared with the method of sealing tube with saline, although the method of sealingtube with heparin fluid can effectively extend the indwelling catheter time, butincrease the incidence of skin and mucous membrane bleeding. Compared the methodof sealing tube with heparin fluid and the method of sealing tube with saline, there wasno significant difference in reducing the rate of blocked tubes and incidence of phlebitis. Toclinical patients needs long-term intravenous infusion, considering the comprehensive benefitsof two sealing tube methods with positive intravenous needles heparin dilution and saline,efficacy and safety. We recommend that clinical nurses should choose saline insteadof heparin dilution sealed tube.更多还原