本文選題：居家維護 + 返院維護��； 參考：《廣東醫(yī)學》2017年17期

【摘要】：目的探討居家維護模式在經外周靜脈置入中心靜脈導管(PICC)帶管出院腫瘤患者中的應用效果。方法選取217例PICC帶管出院腫瘤患者,按照患者及其家屬意愿分為返院組和居家組,其中返院組136例,居家組81例。返院組予常規(guī)健康教育并在出院期間返院進行導管維護,居家組予常規(guī)健康教育并在出院期間由患者家屬居家進行導管維護。比較兩組患者自置管至拔管期間,導管維護的依從性、導管留置時間、PICC導管相關并發(fā)癥發(fā)生率及因導管維護往返醫(yī)院花費的時間及路費。結果 (1)在隨訪過程中,返院組失訪9例,居家組失訪6例,兩組納入對象共剩余202例,其中返院組127例,居家組75例。(2)通過對兩組患者自置管至拔管期間的隨訪發(fā)現(xiàn):患者因導管維護往返醫(yī)院花費的時間、路費,導管維護的依從性及過敏性皮炎的發(fā)生率,居家組優(yōu)于返院組,差異有統(tǒng)計學意義(P0.05);張力性水泡及導管脫出的發(fā)生率,返院組優(yōu)于居家組,差異有統(tǒng)計學意義(P0.05);導管堵塞、穿刺口感染、導管相關性血流感染、深靜脈血栓發(fā)生率及導管留置時間,居家組與返院組差異無統(tǒng)計學意義(P0.05)。(3)通過對兩組患者前3次導管維護的隨訪發(fā)現(xiàn):張力性水泡、導管脫出、穿刺口感染的發(fā)生率,返院組優(yōu)于居家組,差異有統(tǒng)計學意義(P0.05);其他導管相關性并發(fā)癥及導管維護依從性差異無統(tǒng)計學意義(P0.05)。(4)經過對兩組患者從第4次導管維護至拔管期間的隨訪發(fā)現(xiàn):過敏性皮炎的發(fā)生率及導管維護依從性,居家組優(yōu)于返院組,差異有統(tǒng)計學意義(P0.05);其他導管相關性并發(fā)癥差異無統(tǒng)計學意義(P0.05)。結論 (1)居家維護模式在PICC帶管出院腫瘤患者中的應用可以提高導管維護的依從性;可以降低導管相關的過敏性皮炎的發(fā)生率,不會增高穿刺口感染、導管相關性血流感染、導管堵塞、深靜脈血栓的發(fā)生率;對導管留置時間沒有影響;可以節(jié)約患者及其家屬的時間和花費,減輕患者負擔。(2)居家維護模式在PICC帶管出院腫瘤患者中的應用還需要進一步完善,尤其加強對患者及其家屬前期培訓及考核,減少并發(fā)癥的發(fā)生率,保證患者安全。
[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.
【作者單位】： 廣西醫(yī)科大學第一附屬醫(yī)院腫瘤科;廣西醫(yī)科大學第一附屬醫(yī)院護理部;廣西衛(wèi)生職業(yè)技術學院護理系;
【分類號】：R473.2

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