新生儿PICC置管手术中透明敷料置换方法和时间的探讨

Correlation analysis between neonatal PICC catheter-related infections and transparent dressings nursing

目的在透明敷料不同置换方法和不同置换时间条件下，分析对比新生儿PICC置管出现相关性感染的差异，探索提高透明敷料护理效果的最佳置换方法和置换时间。方法回顾性分析2014年1月至2016年1月间在本院进行PICC穿刺的178例新生儿作为实验的研究对象，其中2014年1月至2015年1月间86例新生儿分为实验组（44例）和对照组（42例），实验组透明敷料的护理方法为“三步去除敷料法”，对照组采取常规“一步去除敷料法”。2015年2月至2016年1月92例新生儿根据透明敷料的更换频率分为A组3d／次（28例），B组5d／次（33例）和C组7d／次（31例），比较两个阶段各组的感染情况。结果实验组44例新生儿中2例（4．54％）出现感染，对照组42例新生儿中8例（19．05％）出现感染，两组感染情况比较差异有统计学意义（P〈0．05）。A组2例（7．14％）出现感染，B组2例（6．06％）出现感染，C组9例（29．03％）出现感染，3组感染情况比较差异有统计学意义（P〈0．05）。感染种类各组之间比较差异无统计学意义（P〉0．05）。结论采用“三步去除敷料”护理方式更有助于减少相关性感染的发生，同时敷料更换频率保证在5d／次是较为经济和有效的。

Objective To analyze and compare the difference of neonatal PICC catheter-related infections under the condition that different replacement method and frequency of transparent dressing, explore the best care dressings replacement method and the replacement frequency to improve the effect of nursing. Methods Retrospectively analyzed 178 cases of neonatal PICC puncture treated in our hospital from January 2014 to January 2016, as the research object of the experiment, among whom 86 cases from January 2014 to January 2015 were divided into experimental group （44 cases） and control group （42 cases）. The dressing transparent nursing method of experimental group was ＂three-step method to remove the dressing＂, while control group took normal method of ＂one-step method to remove the dressing＂. According to transparent dressing change frequency, 92 cases of neonates from January 2015 to January 2016 were divided into three groups： group A （3 d/time, 28 cases）, group B （5 d/time, 33 cases）, and group C （7 d/time, 31 cases）. Compared infection of each group in the two phases. Results There were 2 neonates infected among 44 cases in experimental group, accounting for 4.54%, and there were 8 neonates infected among 42 cases in control group, accounting for 19.05%, with statistically significant difference in infection between two groups （P〈0.05）. Group A and group B both experienced 2 cases of infection, accounting for 7.14% and 6.06% respectively, and group C experienced 9 cases of infection, accounting for 29.03%, with statistically significant difference in infection among three groups （P〈0.05）. There were no statistically significant differences in infection species between the groups （P〉0.05）. Conclusion ＂Threestep to remove the dressing＂ nursing method can help to reduce the incidence of infection-related, and it is more economical and efficient that the frequency of dressing changing is 5 d/time.