本文選題：居家維護(hù) + PICC　； 參考：《廣西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的(1)提高PICC帶管腫瘤患者的自我管理能力及導(dǎo)管維護(hù)依從性;(2)探索居家維護(hù)模式在PICC帶管腫瘤出院患者中應(yīng)用的方法;(3)分析居家維護(hù)模式在PICC帶管腫瘤出院患者中應(yīng)用的效果。方法選取2015年5月~2016年7月在廣西醫(yī)科大學(xué)第一附屬醫(yī)院腫瘤科住院的217例PICC帶管腫瘤出院患者,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。兩組患者均予常規(guī)健康宣教及隨訪。在患者出院間歇期,返院組予以返院進(jìn)行導(dǎo)管維護(hù),居家組由患者家屬居家進(jìn)行導(dǎo)管維護(hù)。比較兩組患者自置管至拔管期間,導(dǎo)管維護(hù)的依從性、導(dǎo)管留置時(shí)間、患者自我管理能力、PICC導(dǎo)管相關(guān)并發(fā)癥發(fā)生率(張力性水泡、導(dǎo)管脫出、導(dǎo)管堵塞、穿刺口感染、過敏性皮炎、導(dǎo)管相關(guān)性血流感染、深靜脈血栓)及出院間歇期兩組患者因?qū)Ч芫S護(hù)往返醫(yī)院花費(fèi)的時(shí)間及路費(fèi)、患者對(duì)PICC專項(xiàng)護(hù)理服務(wù)的滿意度。。結(jié)果(1)在隨訪的過程中,返院組6例死亡,2例轉(zhuǎn)院治療,1例失去聯(lián)系而失訪;居家組3例死亡,1例轉(zhuǎn)院治療,1例失去聯(lián)系而失訪,1例中途退出;兩組納入對(duì)象共剩余202例,其中返院組127例,居家組75例。(2)202例PICC帶管腫瘤出院患者的總導(dǎo)管留置時(shí)間為27371導(dǎo)管日。其中127例返院組總導(dǎo)管留置時(shí)間為16895導(dǎo)管日,發(fā)生PICC導(dǎo)管相關(guān)性并發(fā)癥88例(69.3%),發(fā)生率為5.21/1000導(dǎo)管日。其中張力性水泡發(fā)生2例(1.6%),發(fā)生率為0.12/1000導(dǎo)管日;導(dǎo)管脫出發(fā)生10例(7.9%),發(fā)生率0.59/1000導(dǎo)管日;穿刺口感染14例(11.0%),發(fā)生率0.83/1000導(dǎo)管日;過敏性皮炎28例(22.0%),發(fā)生率1.66/1000導(dǎo)管日;導(dǎo)管相關(guān)性血流感染2例(1.6%),發(fā)生率0.12/1000導(dǎo)管日;深靜脈血栓30例(23.6%),發(fā)生率1.78/1000導(dǎo)管日;導(dǎo)管堵塞2例(1.6%),發(fā)生率0.12/1000導(dǎo)管日。75例居家組總導(dǎo)管留置時(shí)間為10476導(dǎo)管日,發(fā)生picc導(dǎo)管相關(guān)性并發(fā)癥62例(82.7%),發(fā)生率5.92/1000導(dǎo)管日。其中張力性水泡發(fā)生8例(10.7%),發(fā)生率為0.76/1000導(dǎo)管日;導(dǎo)管脫出發(fā)生17例(22.7%),發(fā)生率為1.62/1000導(dǎo)管日;穿刺口感染13例(17.3%),發(fā)生率為1.24/1000導(dǎo)管日;過敏性皮炎7例(9.3%),發(fā)生率為0.67/1000導(dǎo)管日;導(dǎo)管相關(guān)性血流感染0例(0.0%),發(fā)生率為0.00/1000導(dǎo)管日;深靜脈血栓16例(21.3%),發(fā)生率為1.53/1000導(dǎo)管日;導(dǎo)管堵塞1例(1.3%),發(fā)生率0.10/1000導(dǎo)管日。(3)通過對(duì)兩組患者自置管至拔管期間的隨訪發(fā)現(xiàn),患者對(duì)picc專項(xiàng)護(hù)理服務(wù)的滿意度、患者自我管理能力、出院間歇期患者因?qū)Ч芫S護(hù)往返醫(yī)院花費(fèi)的時(shí)間、路費(fèi),導(dǎo)管維護(hù)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(jì)學(xué)意義(p0.05);張力性水泡及導(dǎo)管脫出的發(fā)生率,返院組優(yōu)于居家組,差異有統(tǒng)計(jì)學(xué)意義(p0.05);導(dǎo)管堵塞、穿刺口感染、導(dǎo)管相關(guān)性血流感染、深靜脈血栓發(fā)生率及導(dǎo)管留置時(shí)間,居家組與返院組無(wú)統(tǒng)計(jì)學(xué)差異(p0.05)。(4)通過對(duì)兩組患者前三次導(dǎo)管維護(hù)的并發(fā)癥及依從性的隨訪發(fā)現(xiàn),張力性水泡、導(dǎo)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(jì)學(xué)意義(p0.05);其他導(dǎo)管相關(guān)性并發(fā)癥及導(dǎo)管維護(hù)依從性無(wú)統(tǒng)計(jì)學(xué)差異(p0.05)。(5)經(jīng)過對(duì)兩組患者從第四次導(dǎo)管維護(hù)至拔管期間的隨訪發(fā)現(xiàn),過敏性皮炎的發(fā)生率及導(dǎo)管維護(hù)依從性,居家組優(yōu)于返院組,差異有統(tǒng)計(jì)學(xué)意義(p0.05);其他導(dǎo)管相關(guān)性并發(fā)癥無(wú)統(tǒng)計(jì)學(xué)差異(p0.05)。結(jié)論(1)居家維護(hù)模式在picc帶管腫瘤出院患者中的應(yīng)用可以提高導(dǎo)管維護(hù)的依從性、患者自我管理能力及患者對(duì)picc專項(xiàng)護(hù)理服務(wù)的滿意度;可以降低導(dǎo)管相關(guān)的過敏性皮炎的發(fā)生率,不會(huì)增高穿刺口感染、導(dǎo)管相關(guān)性血流感染、導(dǎo)管堵塞、深靜脈血栓的發(fā)生率;對(duì)導(dǎo)管留置時(shí)間沒有影響;可以節(jié)約患者及其家屬因?qū)Ч芫S護(hù)往返醫(yī)院的時(shí)間和路費(fèi),減輕患者負(fù)擔(dān)。(2)居家維護(hù)模式在PICC帶管腫瘤出院患者中的應(yīng)用還需要進(jìn)一步完善,尤其加強(qiáng)對(duì)患者及其家屬前期培訓(xùn)及考核,進(jìn)而減少相關(guān)并發(fā)癥的發(fā)生率。(3)居家維護(hù)模式在PICC帶管腫瘤出院患者中的應(yīng)用在規(guī)范化培訓(xùn)及患者家屬操作熟練的前提下,是可行的,具有一定的臨床推廣意義。
[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 .

【學(xué)位授予單位】：廣西醫(yī)科大學(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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