集束化护理对预防血透患者血液透析导管相关并发症的影响

缪健丽　杨丽平　张秋萍

【摘要】 目的：通过对血透患者制定针对性集束化护理措施，观察集束化护理对导管相关并发症的影响。方法：通过对各种常见的留置透析导管相关并发症原因进行分析，针对存在的问题制定集束化护理措施。将246例留置透析导管患者采用随机数字表法分为两组，每组123例，其中试验组采用集束化护理，对照组采用常规护理，比较两组患者留置透析导管相关并发症的发生情况。结果：通过对8个相关因素分析，结果显示年龄、文化程度、收入水平、血糖水平等与并发症发生有一定的关系。试验组患者留置导管感染发生率为3.25%、脱管率为14.63%、导管阻塞发生率为4.07%；对照组分别为14.63%、30.89%、16.26%，差异均有统计学意义（P<0.05）。试验组和对照组患者的依从性分别为92.68%、87.80%，差异无统计学意义（P>0.05）。试验组和对照组留置导管平均时间分别为（35.40±5.20）、（28.40±5.30） d，试验组优于对照组，差异有统计学意义（P<0.05）。结论：对留置透析导管患者进行集束化护理，可有效降低导管相关并发症的发生率。

【关键词】 集束化护理； 留置透析导管； 并发症

The Effect of Cluster Nursing to Prevent the Dialysis Catheter Complication of Patient with Hemodialysis/MIAO Jian-li，YANG Li-ping，ZHANG Qiu-ping.//Medical Innovation of China，2017，14（19）：094-098

【Abstract】 Objective：To investigate the influence of cluster nursing on catheter related complications in hemodialysis patients.Method：The causes of complications related to the indwelling catheter were analyzed，and the cluster nursing measures were put forward in view of the existing problems.246 patients with indwelling dialysis catheter were divided into experimental group and control group，123 cases in each group，the experimental group was treated by cluster nursing，and the control group by routine nursing.The complications of indwelling catheter were compared between the two groups.Result：8 related factors were analysed，the results showed that age，education level，income level and blood sugar level were related to the complications.The catheter infection rate was 3.25%，the catheter removal rate was 14.63% and the catheter obstruction occurred rate was 4.07% of the experimental group；which were 14.63%，30.89%，16.26% of the control group，the differences were statistically significant（P<0.05）.The compliance of the experimental group and the control group were 92.68% and 87.80% respectively，there was no significant difference（P>0.05）.The time of indwelling dialysis catheter time of the experimental group was （35.40±5.20） days，which was better than control groups（28.40±5.30）days，the difference was statistic significant（P<0.05）.Conclusion：Cluster nursing can effectively reduce the incidence of catheter related complications in patients with indwelling dialysis catheter.

【Key words】 Cluster nursing； Indwelling dialysis catheter； Complications

First-authors address：The Peoples Hospital of Yuancheng District in Heyuan City，Heyuan 517000，China

doi：10.3969/j.issn.1674-4985.2017.19.027

血液透析是指将患者的体内的血液引流至体外，体内血液经过透析器，血液和透析液在一根根空心纤维内外，通过对流达到物质的交换，以清除體内的代谢废物，同时也可将体内多余的水分排出，维持机体电解质和酸碱的平衡状态，是治疗急慢性肾功能衰竭的主要方式。血管通路是保证患者的充分透析的首要条件和患者的“生命线”，理想的血管通路在患者进行血透时应有足够的血流量、穿刺方便、持久耐用及并发症少等特点[1-2]。有关研究表明，采用适当的护理模式可以有效地减少留置导管所引发的并发症的发生，其中又以集中化护理模式最为显著[3]。endprint