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                      • 当前位置: 代写一篇论文多少钱 > 医学论文 > 带Cuff血透患者置管口周围皮肤管理改进分析

                        带Cuff血透患者置管口周围皮肤管理改进分析

                        时间:2019-03-20 13:23作者:秦钟媚 吴春霞 张丽宏
                        本文导读:这是一篇关于带Cuff血透患者置管口周围皮肤管理改进分析的文章,血液透析是终末期肾病患者的有效治疗手段。终末期肾病患者由于自身血管条件及心功能均较差,无法建立自体动静脉内瘘,因此必须依靠血透导管建立血管通路进行透析。

                          摘    要: 目的 探讨改良皮肤管理策略在预防带Cuff血透导管感染中的应用效果。方法 选取2017年1月—2018年5月在桂林市人民医院血液透析中心行血液透析治疗且使用带Cuff血透导管的患者作为研究对象。以2017年1—8月的60例患者作为对照组,给予常规护理;以2017年9月—2018年5月的62例患者作为观察组,在常规护理基础上给予改良皮肤管理。比较两组患者血透导管感染发生率、非计划性拔管率以及患者对护理工作的满意度。结果 观察组患者的血透导管感染率、非计划拔管率均低于对照组,且患者对护理工作的满意度比较优于对照组(P<0.05)。结论 改良皮肤管理能有效降低带Cuff血透导管患者的导管感染率及非计划拔管率,提高患者对护理工作的满意度,对提升临床护理质量有积极促进作用。

                          关键词: 血液透析; 长期导管; 导管相关感染; 皮肤护理;

                          XUEYETOUXISHIZHONGMOQISHENBINGHUANZHEDEYOUXIAOZHILIAOSHOUDUAN。ZHONGMOQISHENBINGHUANZHEYOUYUZISHENXUEGUANTIAOJIANJIXINGONGNENGJUNJIAOCHA,WUFAJIANLIZITIDONGJINGMAINEILOU,YINCIBIXUYIKAOXUETOUDAOGUANJIANLIXUEGUANTONGLUJINXINGTOUXI。DAOGUANNEIGANRANSHIXUEYETOUXIHUANZHEDECHANGJIANBINGFAZHENG,SHIDAOZHIHUANZHEFEIJIHUAXINGBACHUDAOGUANSHENZHISIWANGDEZHONGYAOYINSU[1,2,3]。YINQIDAOGUANNEIGANRANDEZHIBINGWEISHENGWUZHUYAOLAIZIPIFU[4]。YUFANGDAOGUANXIANGGUANGANRANSHIXUETOUSHIHULIGONGZUODEZHONGDIANHENANDIAN。DAICuffDAOGUANSHIZHIDAIYOUDILUNTAODEDAOGUAN,SHIXUEYETOUXIYONGXUEGUANTONGLUDEYIZHONG,LIUZHISHIXUJIANLIYIDUANPIXIASUIDAO,CuffTONGCHANGFANGZHIYUJULIDAOGUANPIFUCHUKOU2 cmCHUDEPIXIASUIDAONEI,SHURIHOUPIXIAZUZHIHUIZHANGRUDILUNTAO。GAISHEJIYIFANGMIANKEGUDINGDAOGUANBIMIANDAOGUANHUATUO;LINGYIFANGMIANYINFENGBILEWAIJIEYUZHONGXINJINGMAIZHIJIANDEFENGXI,KEMINGXIANJIANGDIDAOGUANXIANGGUANXINGGANRANDEFENGXIAN。YINCI,DAICuffDAOGUANYECHENGWEIZHANGQIDAOGUAN、BANYONGJIUDAOGUAN,QISHIYONGSHOUMINGJIAOBUDAICuffDAOGUANDADAYANZHANG。DAICuffDAOGUANXIANGDUIYULINSHIXUETOUDAOGUANJUYOUGUANQIANGDA、BINGFAZHENGSHAO、HUANZHESHUSHIXINGHAODENGYOUDIAN,ZAILINCHUANGXUEYETOUXIZHONGDEYINGYONGYEZHUJIANZENGDUO[5]。WOKECONG2017NIAN1YUE—2018NIAN5YUEDUIDAICuffXUETOUDAOGUANTOUXIHUANZHEZHIGUANKOUZHOUWEIPIFUGUANLIJINXINGCHIXUGAIJIN,QUDELEYIDINGXIAOGUO。XIANBAODAORUXIA。

                          1、 对象与方法

                          1.1、 对象

                          XUANQU2017NIAN1YUE—2018NIAN5YUEZAIGUILINSHIRENMINYIYUANXUEYETOUXIZHONGXINJINXINGGUILVMENZHENTOUXIDE122LIDAICuffXUETOUDAOGUANHUANZHEWEIYANJIUDUIXIANG。NARUBIAOZHUN:(1)GENJU《MEIGUOGUOJIASHENZANGBINGJIJINHUIZHINAN》ZHENDUANWEIMANXINGSHENGONGNENGSHUAIJIE;(2)NIANLING≥18SUI;(3)YISHIQINGCHU,WUYANZHONGSHENZANGJIBINGBINGFAZHENG,WUXIANGGUANGANRAN;(4)TOUXIQIJIANDAOGUANXUELIULIANG>200 m L/min;(5)MEIZHOUTOUXI2~3CI,MEICI4 h,TOUXISHIJIAN6~36GEYUE,JUNWEISHOUCIZHIGUAN。PAICHUBIAOZHUN:(1)JIN1GEYUEFASHENGGUOGANRAN、WAISHANG、SHOUSHU;(2)DUITOUXIBUNAISHOUHUOTOUXIYAOWUGUOMIN;(3)YOUNAOCHUXUESHI、XIAOHUADAOCHUXUEBINGSHI、HUODONGXINGCHUXUEHUOYOUCHUXUEQINGXIANG;(4)CHUYUJIBINGJIXINGHUODONGQI。BENYANJIUJINGWOYUANLUNLIWEIYUANHUIPIZHUNTONGYI,BINGZAIQIJIANDUXIAWANCHENG。ANRUYUANSHIJIANDEXIANHOUJIANGHUANZHEFENWEILIANGZU。YI2017NIAN1—8YUEZHIGUANDE60LIHUANZHEZUOWEIDUIZHAOZU,NANXING42LI,NVXING18LI,PINGJUNNIANLING(50±2)SUI;YUANFAJIBINGWEITANGNIAOBINGSHENBING32LI、MANXINGSHENXIAOQIUSHENYAN18LI,QITA(GENGZUXINGSHENBING、GAOXUEYASHENBING、LANGCHUANGXINGSHENBING、DUONANGSHENDENG)10LI。YI2017NIAN9YUE—2018NIAN5YUEZHIGUANDE62LIHUANZHEZUOWEIGUANCHAZU,NANXING45LI,NVXING17LI,PINGJUNNIANLING(53±3)SUI。YUANFAJIBINGWEITANGNIAOBINGSHENBING30LI、MANXINGSHENXIAOQIUSHENYAN20LI,QITA(GENGZUXINGSHENBING、GAOXUEYASHENBING、LANGCHUANGXINGSHENBING、DUONANGSHENDENG)12LI。LIANGZUHUANZHEJUNCAIYONGSHUANGQIANGDAICuffXUETOUDAOGUAN(BADEGONGSISHENGCHAN,SHIYONGZHANGDUWEI19~23 cm),ZHIGUANBUWEIJUNWEIYOUCEJINGNEIJINGMAI。LIANGZUHUANZHENIANLING、XINGBIE、JIBINGZHENDUANDENGYIBANZILIAOBIJIAO,CHAYIWUTONGJIXUEYIYI(P>0.05)。

                          1.2 、方法

                          1.2.1 、干预方法

                          1.2.1. 1、 对照组

                          按照《实用血液净化护理培训教程》实施常规护理,包括:(1)置管处的换药使用安尔碘由内向外消毒两遍,消毒范围直径大于5 cm并清除局部的血垢[6];(2)换药时注意观察置管处有无红、肿、热等感染情况;(3)严格执行无菌技术,保证透析操作环境的整洁干净,定期对护理人员手卫生及导管护理操作进行培训考核,保持导管护理操作同质化。
                         

                        带Cuff血透患者置管口周围皮肤管理改进分析
                         

                          1.2.1. 2 、观察组

                          ZAICHANGGUIHULIDEJICHUSHANG,CAIYONGGAILIANGPIFUGUANLIDEFANGFA,JUTICUOSHIRUXIA:(1)KESHICHENGLIDAOGUANHULIXIAOZU,SHELIZUZHANG1MING,ZUYUAN6MING,MEIWEIZUYUANFENBIEFUZE8~10LIHUANZHE,DUIHUANZHEJIJIASHUJINXINGRICHANGDAOGUANWEIHUDEJIANKANGZHISHIJIAOYU,DUIHUANZHEDEDAOGUANJINXINGRICHANGWEIHU,DUIGAOWEIGANRANHUANZHEZAIKESHIGANRANKONGZHIQUNTIQIANJINXINGYUJING。ZUZHANGMEIZHOUJIANCHAXIAOZUCHENGYUANGONGZUOLUOSHIQINGKUANG,MEIYUETONGJIDAOGUANHULICUNZAIDEWENTI、DAOGUANGANRANRENSHUJIGANRANDEYUANYIN,TICHUGAIJINCUOSHI,BINGZAIMEIYUEHULIZHILIANGFENXIFANKUIHUIYISHANGJINXINGHUIBAO。(2)ANCHANGGUIHULIFANGFAJIYUHUANZHEDAOGUANHUANYAO。SHIYONG2%PUTAOTANGLVJIDINGCHUNZUOWEIDAOGUANZHOUWEIPIFUXIAODUJI。LVYIDINGPIFUXIAODUJIKEYIMINGXIANJIANGDIDAOGUANXIANGGUANXINGXUELIUGANRAN、DAOGUANXIJUNDINGZHIDEFASHENGLV[7]。(3)DAOGUANKOUYOUHONGZHONGSHI,SHIYONG2%PUTAOTANGLVJIDINGCHUNSHIFUZHIGUANKOU30 min,ZAIYONGBAIDUOBANGRUANGAO(MOPILUOXING)TUMOZHIGUANKOU[8],ZHUHUANZHEMEIRIHUANYAO,BIMIANYINQISUIDAOGANRANJIDAOGUANXIANGGUANXUELIUGANRAN。(4)HUANZHESHANGJIJIESHUHOU,ZERENHUSHITONGYIDUIHUANZHEJINXINGPIFUQINGXI。FANGFARUXIA:SHIYONGPENYOUSUGANSHOUXIAODUJI(JIEFUROUTAIXINPAIXIAODUYE[9])DEWUJUNSHABUDUIHUANZHEPIFUJINXINGCASHI,CASHIFANWEIYOUZHIGUANKOUZHIJING5 cmCHUKAISHIZHIZHIGUANKOUZHIJING15 cmCHU[10],ZHUYAOCASHIHUANZHEPIFU,ZHUYIYEWO、ERHOUJIHEXIAPIFUZHOUZHECHU。(5)DUIHUANZHEJINXINGJIANKANGXUANJIAO。ZHIDAOHUANZHEBAOCHIPIFUQINGJIE,MEITIANYONGQINGSHUIQINGXIBIQIANG,JIANSHAOBIQIANGZHIBINGJUNFANZHI;ZHIDAOZHIGUANHUANZHEZUIHAOLIUDUANFABINGDINGQIQINGXI。CAOZUOSHIHUANZHEYINGDAIKOUZHAOJIFAMAO,TOUPIANXIANGYICE。BINGTONGGUOWENJUANDIAOCHA,LEJIEHUANZHEDAOGUANZHISHIZHANGWOQINGKUANG,PINGGUHUANZHEYICONGXING。

                          1.2.2 、观察指标

                          1.2.2. 1、 血液透析导管感染情况

                        棋牌大全下载安装   CANZHAOYECHAOYANGZHUBIANDE《XUEYETOUXIXUEGUANTONGLUJISHUYULINCHUANGYINGYONG》[8]ZHONGDAOGUANXIANGGUANXINGGANRANDEZHENDUANBIAOZHUNJIBAGUANZHIZHENG。(1)DAOGUANCHUKOUGANRAN:DAOGUANCHUKOUBUWEIJUBUHONGZHONG、SHENCHU,WUQUANSHENZHENGZHUANG,XUEPEIYANGYINXING,YIBANWUXUBACHUDAOGUAN。(2)SUIDAOGANRAN:DAOGUANSUIDAOBIAOMIANPIFUHONG、ZHONG、RE、TONG,DAOGUANPIFUXIAYOUJINONGHUOZHESHENYE,BUFENKEYOUFAREDENGQUANSHENZHENGZHUANG。RUGANRANNANYIKONGZHI,XUYAOBACHUDAOGUAN。(3)XUELIUXINGGANRAN:TOUXIZHONGCHUXIANHANZHAN、FARE,HUOTOUXIJIANQICHIXUFARE,XUEPEIYANGWEIYANGXING。XUELIUXINGGANRANZHENGZHUANGZHONGSHI,XUYAOBACHUDAOGUAN。HUANZHESUIFANGSHIJIANZIZHIGUANDANGTIANKAISHIJISUAN,30 dWEI1GEDAOGUANYUE。RUGAIDAOGUANYUEWEIFASHENGGANRAN,ZEJIWEIYINXING;RUGAIDAOGUANYUEFASHENGGANRAN,ZEJIWEIYANGXING,MINGQUEGANRANZHIRIBULUNSHIFOUYIMAN30 d,JUNSHIWEI1GEDAOGUANYUE,BENCIGANRANZHILIAOJIESHUHOUJIJINRUXIAGEDAOGUANYUE。CICIYANJIUDUIRUZUHUANZHEJUNJINXINGLEWEIQI8GEYUEDESUIFANG,YOUDAOGUANXIAOZUCHENGYUANJINXINGSUIFANGDENGJI,ZUZHANGMEIYUEJINXINGGANRANLVJIYIWAIBAGUANLVDEXIANGGUANTONGJI。

                          1.2.2. 2、 非计划性拔管率

                        棋牌大全下载安装   BAGUANBIAOZHUNCANZHAOZHONGGUOXUEYETOUXIYONGXUEGUANTONGLUZHUANJIAGONGSHI(DI2BAN)[11],YIXIAQINGKUANGXUBACHUDAOGUAN:(1)NIANZHUJUNSHUGANRAN;(2)FASHENGNONGDUXUEZHENG、XINNEIMOYAN,XUESHUANXINGCHENG;(3)SUIDAOGANRAN,YOUNONGZHONGXINGCHENG;(4)JINHUANGSEPUTAOQIUJUN、GELANSHIYINXINGGANJUNDENGDAOZHIDEGANRAN,ZAIKANGGANRANZHILIAO72 hHOURENGWUFAKONGZHIDEGANRAN。GEZUFEIJIHUABAGUANDELISHUYUGAIZUHUANZHELISHUBIZHIDEBAIFENBIJIWEIFEIJIHUABAGUANLV。

                          1.2.2. 3、 患者满意度

                          CAIYONGKESHIZIZHIMANYIDUDIAOCHAWENJUANDUIHUANZHEJINXINGDIAOCHA。NEIRONGBAOKUO:HUANZHETOUXITIYANMANYIDU、DAOGUANHULI(PIFUQINGJIEDU)MANYIDU、HULIRENYUANJISHUCAOZUOSHULIANDU、HUANZHEYUHULIRENYUANGOUTONGJIAOLIUMANYIDU、HUANZHEDUIYURICHANGDAOGUANHULIZHISHIJIESHOUMANYIDU5GEFANGMIAN,GONG5GETIAOMU。MEIGETIAOMUJUNAN“FEICHANGMANYI、MANYI、BUMANYI”3GEDENGJIJINXINGTONGJI。MEIYUEDIAOCHA1CI,JIFENFANGFA:ZONGMANYIDU=(FEICHANGMANYIXIANGSHU+MANYIXIANGSHU)/ZONGXIANGSHU×100%。

                          1.2.3 、统计学方法

                        棋牌大全下载安装   CAIYONGSPSS 21.0RUANJIANJINXINGTONGJIFENXI。JISHUZILIAOCAIYONGLISHUJIBAIFENBIBIAOSHI,LIANGZUHUANZHEDAOGUANGANRANQINGKUANGBIJIAOCAIYONGχ2JIANYAN,YIP<0.05WEICHAYIYOUTONGJIXUEYIYI。

                          2、 结果

                          2.1 、两组患者导管感染及非计划拔管情况比较见表1。

                          2.2 、两组患者满意度情况比较见表2。

                          3、 讨论

                          3.1、 带Cuff导管透析患者皮肤护理的重要性

                        棋牌大全下载安装   SHOUXIAN,DAICuffDAOGUANTOUXIHUANZHERICHANGMUYUSHOUDAOHENDAXIANZHI,HENDUOHUANZHEBUGANMUYUYEBUGANCAXIZHIGUANCESHENTIPIFU。ZHEIZAILAONIAN、XINGDONGBUBIANDEDAIGUANHUANZHEZHONGTIXIANGENGJIAMINGXIAN。QICI,YOUYUGUDINGDAOGUANSHIXUJIANGJIAOBUTIEZAIPIFUSHANG,DAOZHIPIFUBIAOMIANCANLIUYIXIEJIAOBUHENJI,SHIJUBUPIFUXINGCHENGWUGOU,CHENGWEIWEISHENGWUDEFANZHICHANGSUO。ERDAOGUANGANRANZHUYAOWEISHENGWULAIZIPIFU[2],SUOYILIUZHIZHANGQIDAOGUANDETOUXIHUANZHEQIPIFUXIAODU、QINGJIEZHIGUANZHONGYAO。JIANYUXUETOUSHIHULIGONGZUOLIANGDA、SHANGJICAOZUOMIJI、HUANZHEDAISHANGJIXINQIEDENGYUANYIN,ZAISHIJIGONGZUOZHONG,ANXUEYEJINGHUACAOZUOGUICHENG,ZERENHUSHIZAISHANGJIQIANDUIHUANZHEDEDAOGUANJINXINGGUIFANHUANYAO、CHUZHI,SHANGJIHOU,ZAITONGYIDUIHUANZHEPIFUJINXINGQINGJIE,ZHEIYANGJIBUWEIFANCAOZUOGUICHENG,BAOZHENGLEHUANZHEDEPIFUHULI,YOUMANZULEHUANZHEXIANGJINZAOSHANGJIJINXINGTOUXIDEYIYUAN。

                          表1 两组患者导管感染及非计划拔管情况比较
                        表1 两组患者导管感染及非计划拔管情况比较

                          表2 两组患者满意度情况比较
                        表2 两组患者满意度情况比较

                        棋牌大全下载安装   ZHU:χ2=10.91,P=0.0042

                          3.2、 带Cuff导管置管透析患者导管感染及非计划拔管情况分析

                        棋牌大全下载安装   YANJIUJIEGUOXIANSHI,GUANCHAZUHUANZHEDAOGUANGANRANLVDIYUDUIZHAOZU(P<0.05)。DUIZHAOZUZHONGYOU4LIFEIJIHUAXINGBAGUANHUANZHE;GUANCHAZUZHONGJINYOU1LIFASHENGLESUIDAOGANRAN,QIEJINGKANGSHENGSUZHILIAO,GANRANDEDAOKONGZHI,WEIXINGBAGUAN。FENXIYUANYIN:GUANCHAZUHUSHIZAISHISHIHULICUOSHIGUOCHENGZHONGBUDUANJIESHOUPEIXUN、KAOHEYUDUCHA,TONGGUOCHENGLIDAOGUANHULIXIAOZU,ZUZHANGMEIYUEDUIDAOGUANHULIQINGKUANGJINXINGZONGJIE,FENXICUNZAIWENTIBINGCHIXUGAIJINLUOSHI;TONGSHI,KESHIYUNYONGGANRANHUANZHEDESHILIJINXINGJINGSHIJIAOYU,RANGHUSHIZHIGUANYISHIDAODAOGUANGANRANJIHUANZHEDAILAIDEYANZHONGHOUGUO,JINYIBUZENGQIANGLEHUSHIDEGONGZUOZERENXINJISHENDUJINGSHEN;GUANLISHANGSHULIGANRANWUXIAOSHIDELINIAN,YONGYUYUFANGGANRANDECHENGBENJUEBUSUOJIAN。YANJIUJIEGUOXIANSHI,GUANCHAZUHUANZHEDUIHUSHIGONGZUOMANYIDUYOUYUDUIZHAOZU(P<0.05)。ZHEIKENENGYUHUSHIZAIWEIGUANCHAZUHUANZHEQINGJIEZHIGUANCEPIFUSHIGENGJIAZHUYIJIAQIANGJIAOLIUYUGOUTONG,ZHIDAOHUANZHERUHEZUOHAORICHANGPIFUHULI,BINGNENGQINGTINGHUANZHEFANKUIYUSUQIUDENGYOUGUAN。

                          3.3、 血透导管护理消毒剂的选择

                          CHANGGUISHIYONGDEANERDIANXIAODUYEDUIPIFUYOUYIDINGCIJI[12],ERQIEDUIYUDIANGUOMINHUANZHECUNZAIYIDINGGUOMINFENGXIAN[13]。2%PUTAOTANGLVJIDINGCHUNHESUGANSHOUXIAODUYESUICHENGBENXIANGDUIJIAOGAO,DAN2%PUTAOTANGLVJIDINGCHUNSHIZHANGXIAOKANGJUNXIAODUJI,DUIPIFUWUCIJIXING,QIXIAOKUAI,PIFUDAIGANSHIJIANDUAN[14],KEYIMINGXIANJIANGDIDAOGUANXIANGGUANXINGXUELIUGANRAN、DAOGUANXIJUNDINGZHIDEFASHENGLV[7]。GUANCHAZUSHIYONGDESUGANSHOUXIAODUJI,QIZHUYAOCHENGFENWEICUSUANLVYIJIDING(0.44%~0.54%)JIYICHUN(63%~77%),DUIPIFUWUCIJIXINGQIEYOUBAOHUZUOYONG,ZAISHIYONGGUOCHENGZHONGSHANGWEIFAXIANHUANZHEPIFUGUOMINJIQITABUSHIZHENGZHUANG。QIANRUIZHUDENG[15,16]DEYANJIUDOUCENGBAODAO,SUGANSHOUXIAODUJIDUIJINHUANGSEPUTAOQIUJUN、DACHANGGANJUN、BAISENIANZHUJUN、TONGLVJIADANBAOJUNJUNYOUSHAMIEZUOYONG[17],ERZHEIXIEXIJUNYESHIDAOZHIDAOGUANGANRANDEZHUYAOJUNZHONG。DAOGUANKOUYOUHONGZHONGSHI,GUANCHAZUXUANYONGBAIDUOBANGRUANGAO(MOPILUOXING[8])TUMOZHIGUANKOU。BAIDUOBANGJUYOUJUBUXIAOYANZUOYONG,YOULIYUCUJINMAOXIXUEGUANDEXINGCHENGJIHUAISIZUZHIHEXIANWEIDANBAIDERONGJIE,QIEWUJIEJIAXINGCHENG[18]。

                          4、 小结

                          LIANGHAODEPIFUGUANLICUOSHINENGYOUXIAOJIANGDIDAICuffXUETOUDAOGUANGANRANLVJIFEIJIHUAXINGBAGUANLV,TIGAOHUANZHEDUIHULIGONGZUODEMANYIDU,ZENGJINHUHUANGUANXI,TISHENGHUANZHEDEZIWOGUANLIYISHI。YOUYUYANJIUSHIJIANYOUXIAN,CICIYANJIUWEIJIANGSUOYOUXUETOUDAOGUANDEPIFUGUANLINARUYANJIU,RUGUJINGMAIDELINSHIDAOGUANPIFUGUANLIDENG,YIHOUGONGZUOZHONGYOUDAIJINYIBUYANJIUYANZHENG。

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