改良尿管外固定法在住院患者尿管固定中的应用研究

Application of the modified external fixation methods in urinary catheter fixation for inpatients

目的:探讨改良尿管外固定方法与常规固定方法的差异,探索改良尿管外固定方法的优良性,以期增加尿管固定稳固性,提高护理工作效率,进行临床推广应用。方法:将2018年1月1日至2018年6月30日于西南医科大学附属医院泌尿外科、骨科、神经内科住院且符合条件的180名患者进行分组,常规组60例,螺旋固定组60例,大Ⅰ型固定组60例。比较3组患者在尿管有效固定天数、非计划性拔管(UEX)例数、医用粘胶剂相关皮肤损伤(MARSI)例数是否具有差异。结果:①尿管有效固定天数:3组患者尿管有效固定天数差异有统计学意义(P≤0.05);Ⅰ型固定组尿管固定天数最多,其次是螺旋固定组,常规组最少,差异有统计学意义(P≤0.05);②UEX发生例数:常规组尿管UEX发生例数为2(3.3%)例,螺旋固定组、大Ⅰ型固定组均为0(0.0%)例。经Fisher确切概率法比较得出,3组患者在尿管UEX发生例数的差异不具有统计学意义(P> 0.05);③MARSI发生例数:常规组患者MARSI发生人数为1(1.7%)人,螺旋固定法和大Ⅰ型固定组患者MARSI发生人数均为0(0.0%)人。经Fisher确切概率法比较得出,3组患者在MARSI发生例数的差异不具有统计学意义(P> 0.05)。结论:大Ⅰ型固定法在尿管有效固定天数方面更优于螺旋固定法和常规法,可增加尿管固定牢固性,减少护理人员工作量,值得临床推广。

Objective:To investigate the advantages of the modified external fixation of urinary catheters over routine fixation,and to find a better method that can enhance catheter stability and improve nursing efficiency for clinical promotion. Methods:We enrolled 180 eligible patients who were hospitalized from January 1 to June 30,2018 in the Department of Urology,Department of Orthopedics,and Department of Neurology in the Affiliated Hospital of Southwest Medical University. They were randomly divided into routine group(n = 60),spiral fixation group(n = 60),and Ⅰ-type fixation group(n = 60). The days of effective catheter fixation,the number of cases with unplanned extubation(UEX),and the number of cases with medical adhesive-related skin injuries(MARSI)were compared between the three groups. Results:Compared with the routine group,the spiral fixation group and the Ⅰ-type fixation group had significantly fewer cases with UEX(P < 0.05). The Ⅰ-type fixation group showed significantly more days of effective catheter fixation than the spiral fixation group and the routine group(P < 0.05). Conclusion:Both the spiral fixation and Ⅰ-type fixation methods are superior to the routine method in terms of reducing the incidence of UEX in patients with urinary catheterization. The Ⅰ-type fixation method shows an advantage in the days of effective catheter securement over the other two methods. The Ⅰ-type fixation method enhances catheter stability,decreases the incidence of UEX,and reduces nurse providers’ workload,worthy of clinical promotion.