【作者】 张楠；

【导师】 张春舫；

【作者基本信息】 河北大学 ， 护理学， 2017， 硕士

【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(P>0.05)。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,P>0.05。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,P<0.05)。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,P<0.05。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,P>0.05。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。更多还原

【Abstract】 Objectives:This study was to establish bundles of care strategy for the prevention of complications after PICC cathetering in breast cancer patients under the concept of evidence-based medicine,and to investigate more effective complications preventative measures,in order to improve the coping capability in clinical medical workers in lowering the complication incident rate,and to provide theoretical evidence for further nursing services of relevant patients.Methods:Referring to relevant literatures,we put forward questions and synthesise evidence,construct of bundles of care for patients with breast cancer after peripherally inserted central catheters,Subjects from the breast surgery department at the affiliated hospital of Hebei University were recruited in this non-randomized concurrent controlled study by convenience sampling.68 breast cancer patients with PICC cathetering from the 1st ward were taken as experimental group,and 68 subjects with the same condition from the 2nd ward were set as control group.There was no difference in diagnosis of patients from two wards,and the patients shared the same medical team,therapeutic methods and nursing cares.The catheter operated by nursing staff who receive the peripherally inserted central catheters,and the routine maintenance performed by nursing who has no difference between the technique of nurse puncture and the maintenance of the catheterization.Conventional nursing measures were given to the control group,while the nursing team for experimental group was trained a series of clustering nursing measures,such as relevant knowledge,specified injection techniques,standardized catheter maintenance and post-cathetering health education.Then the incidence rates of complications from two groups were compared.Results:1.Before the intervention,there were no statistical significances between two groups of patients in general information as gender,age,height,weight,WBC,PLT,Staging of breast cancerand Operation mode.(P>0.05).2.There was no statistical significance in the cathetering sites(up/down the elbow)(right/left arm),catheter venous,catheter length,catheter method and in vitro catheter remaining length.(P<0.05)3.Complications were observed in 20 subjects in control group with an incident rate of 29.41% and 8 subjects in control group with an incident rate of 11.76%.Statistical significance was found2c test(c2 =6.476,P<0.05).4.The incident rates for phlebitis and venous thrombosis were significantly different in two groups(P<0.05).There were no significant differences in cathetering-related infection,catheter misplacement and errhysis between two groups(P>0.05).Conclusion:This study developed a nursing strategy to standardize health education technology,standardized puncture catheter maintenance,after catheter as the main body,clinical research shows that nursing strategy of scientific,reasonable and feasible,and is worthy of clinical promotion.The research results showed that the nursing strategy can reduce the PICC of breast cancer patients and the total complications of phlebitis and venous thrombosis related complications after the incidence of the guiding role of clinical nursing.Cluster nursing is still in the developing stage.Further research is needed to prevent the infection of catheter,bloodstream,catheter and blood flow after PICC catheterization in breast cancer patients.更多还原