循证护理在心脏直视术后中心静脉导管相关性感染中的应用观察

Application of evidence-based nursing in patients with central venous catheter-related infections after open heart surgery

目的探讨系统性护理干预对行心脏直视术后中心静脉导管相关性感染的影响,为降低感染率提供护理经验。方法将2014年1月—2015年6月中国人民解放军海军总医院心脏中心心脏直视术后置中心静脉导管患者206例随机分为2组,观察组和对照组各103例,对照组给予常规护理措施,观察组通过检索相关文献找出中心静脉导管相关性感染与护理相关的问题,根据中心静脉导管相关感染的危险因素(高龄、长时间置管、无菌操作不严格、置管维护质量、静脉置管途径等),将以上护理问题结合患者的个体差异制订护理措施,在围手术期予以实施。观察2组中心静脉导管置管后导管穿刺部位感染、中心静脉导管相关性血流感染及发生时间,局部渗血、导管脱出、导管阻塞等不良反应的发生率。结果观察组与对照组患者穿刺点感染发生率分别为5.82%和18.44%(6例和19例),2组差异有统计学意义(P<0.01);中心静脉导管相关性血流感染的发生率分别为2.91%和11.65%(3例和12例),2组差异有统计学意义(P<0.05);观察组与对照组置管后导管堵塞、脱出、局部渗血的发生率分别为3.89%、5.82%、2.91%和13.59%、16.50%、9.70%,2组差异均有统计学意义(P<0.05)。结论心脏直视术后中心静脉导管的循证护理干预可明显降低中心静脉导管相关性感染及减少不良情况的发生,值得在相关护理工作中借鉴。

Objective To observe the effect of systematic nursing intervention on central venous catheter-related infections after open heart surgery,in order to provide nursing experience in reducing infection rate. Methods From January,2014 to June ,2015,206 patients underwent central venous catheters placement after open heart surgery in our department were randomly divided into experimental group and control group（ n = 103 ）. The patients in the control group received the conventional nursing while the patients in the experimental group received the evidence-based nursing. First of all, the problems in nursing associated with central venous catheter-related infections were retrieved from literatures, including advanced age, prolonged catheter placement, improper aseptic technique, quality of catheter nursing, method of catheter placement etc. The nursing plan was taken up according to problems above and individual differences, and implemented in perioperative period. The incidence of adverse effects of central venous catheter placement, including infection of puncture site ,central venous catheter related bloodstream infections and duration, local bleeding, catheter extrusion, catheter obstruction, etc. were observed. Results The rate of puncture site infection in the experimental group and control group was 5.82% and 18.44% ,respectively ,which was significantly different（ P 〈 0.01 ）. The incidence of central venous catheter related bloodstream infection in the two groups was 3.89% and 11.65% , respectively, which was significantly different （ P 〈 0.05 ）. The incidence of catheter obstruction,extrusion and local bleeding in two groups were 3.89% vs. 13.59% , 5.82% vs. 16.50% ,2.91% vs. 9.70% , respectively,which were all significantly different （ P 〈 0.05 ）. Conclusion The evidence-based nursing in central venous catheter nursing after open heart surgery can significantly reduce the incidence of central venous catheter-related infections and adverse effects.