本文選題：乳腺癌 + PICC置管�。� 參考：《河北大學(xué)》2017年碩士論文

【摘要】：目的:本研究通過循證基礎(chǔ)上構(gòu)建預(yù)防乳腺癌患者PICC置管后并發(fā)癥的集束化護(hù)理策略,探討臨床更為行之有效的并發(fā)癥預(yù)防策略,從而提高臨床醫(yī)護(hù)人員對(duì)并發(fā)癥的預(yù)防能力,降低其發(fā)生率,為今后護(hù)理人員護(hù)理此類病人提供理論依據(jù)。方法:參照相關(guān)文獻(xiàn),提出問題并循證原因,通過查閱大量文獻(xiàn),構(gòu)建乳腺癌患者PICC置管后集束化護(hù)理策略;采用非隨機(jī)同期對(duì)照研究設(shè)計(jì),通過便利取樣的方法于2016年7月~2016年10月在河北大學(xué)附屬醫(yī)院乳腺外科進(jìn)行樣本的選擇。在一病區(qū)中納入68例行PICC置管的乳腺癌患者為實(shí)驗(yàn)組,在二病區(qū)中納入68例行PICC置管的乳腺癌患者為對(duì)照組。兩病區(qū)收治的病人病種無差異,為同一醫(yī)療組負(fù)責(zé)治療,治療方式和病人護(hù)理無差異。置管由獲得PICC置管證書的護(hù)理人員進(jìn)行操作,日常維護(hù)由責(zé)任護(hù)士操作,護(hù)士穿刺技術(shù)和置管維護(hù)無差異。對(duì)照組采取常規(guī)護(hù)理措施,實(shí)驗(yàn)組采取包括規(guī)范穿刺技術(shù)、標(biāo)準(zhǔn)化導(dǎo)管維護(hù)、置管后健康教育等一系列集束化護(hù)理策略,比較兩組患者并發(fā)癥的發(fā)生率。結(jié)果:1.干預(yù)前,兩組患者在性別、年齡、身高、體重、WBC、PLT、乳腺癌分期、手術(shù)方式等一般資料,差異均無統(tǒng)計(jì)學(xué)意義(P0.05)。2.兩組患者置管情況比較結(jié)果顯示兩組間置管部位(肘上/肘下)(右臂/左臂)、置管靜脈、置管方法、導(dǎo)管置入長度、體外導(dǎo)管剩余長度均無統(tǒng)計(jì)學(xué)差異,P0.05。3.對(duì)照組共有20例患者發(fā)生并發(fā)癥,發(fā)生率為29.41%;實(shí)驗(yàn)組有8例患者發(fā)生并發(fā)癥,發(fā)生率為11.76%。經(jīng)卡方檢驗(yàn),差異有統(tǒng)計(jì)學(xué)差異。(2c=6.476,P0.05)。4.兩組患者中靜脈炎和靜脈血栓的發(fā)生率差異有統(tǒng)計(jì)學(xué)差異,P0.05。導(dǎo)管相關(guān)血流感染、導(dǎo)管異位、滲血的發(fā)生率兩組無統(tǒng)計(jì)學(xué)差異,P0.05。結(jié)論:本研究制定了以規(guī)范穿刺技術(shù)、標(biāo)準(zhǔn)化導(dǎo)管維護(hù)、置管后健康教育為主體的集束化護(hù)理策略,經(jīng)臨床研究證實(shí),集束化護(hù)理策略科學(xué)、合理、可行,值得臨床通過本文的研究表明,集束化護(hù)理策略可以明顯的降低乳腺癌患者PICC置管后總并發(fā)癥以及靜脈炎和靜脈血栓等相關(guān)并發(fā)癥的發(fā)生率,對(duì)臨床護(hù)理起到了積極的指導(dǎo)作用。集束化護(hù)理尚處于發(fā)展階段,對(duì)于預(yù)防乳腺癌患者PICC置管后導(dǎo)管行管血流感染,導(dǎo)管異位及滲血的發(fā)生仍需進(jìn)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.
【學(xué)位授予單位】：河北大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R473.73

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