无缝隙护理在极低出生体重儿脐静脉与PICC联合置管中的应用

Application of Seamless Nursing in the Combined Placement of Umbilical Vein and Plcc in Very Low Birth Weight Infants

目的研究极低出生体重儿脐静脉与经外周静脉穿刺中心静脉联合置管实施无缝隙护理的应用效果。方法选择60例该院所收治的极低出生体重儿,2017年6月—2018年6月作为该研究的时间范围,采用随机数字表法将其分为实验组与参照组,各30例。参照组患儿给予常规的护理方法进行护理,参照组患儿给予无缝隙护理方法进行护理。观察比较两组患儿的出生体重以及出生后第1、第2、第4周的体重质量变化,比较两组患儿的不良反应症状发生情况,比较两组患儿的持续带管时间、住院时间以及两组患儿的家长对护理的满意程度以及负面情绪评分。结果①护理前两组患儿的体重差异无统计学意义(P>0.05),护理后,两组患儿的体重质量均有所上升。实验组患儿的体重质量在第1周、第2周、第4周均远高于参照组,分别为(1 298.56±145.13)g vs (1221.24±145.27)g、(1 318.67±103.96)g vs (1 245.67±104.54)g、(1 459.84±152.14)g vs (1 358.68±125.24)g。差异有统计学意义(t=2.062、2.712、2.812,P=0.044、0.009、0.007)。②实验组患儿的不良反应发生率以及置管不良事件的发生率远低于参照组,不良反应发生例数分别为1例,8例。差异有统计学意义(χ^2=6.540,P=0.030)。③两组患儿的住院时间以及持续带管时间存在一定的差异,实验组患儿的住院时间以及持续带管时间远低于参照组患儿,分别为(10.34±2.14)d vs(7.69±1.22)d、(14.95±3.14)d vs(19.67±5.02)d,差异有统计学意义(t=7.494、4.347,P=0.000、0.000)。④两组患儿家属在护理工作之前的负面情绪评分差异无统计学意义(P>0.05)。两组患儿家属的负面情绪评分相比于护理工作之前均有所下降,差异有统计学意义(P<0.05)。实验组患儿家属的负面情绪评分低于参照组,分别为(59.64±1.24)分vs(36.58±1.02)分、(56.22±1.28)分vs(34.59±1.22)分;实验组患儿家属对护理工作的满意度高于参照组患儿。两组之间差异有统计学意义(t=78.664、66.999、35.861,P=0.000、0.000、0.000)。结论无缝隙护理模式在极低出生体重儿经脐静脉与经外周静脉穿刺中心静脉联合置管中护理效果良好,可以有效的缓解患儿家属的情绪,提高患儿家属的护理满意度。减少患儿静脉输液外漏发生率,提高护理人员工作效率,缩短住院时间。具有一定的临床应用价值。

Objective To study the effect of seamless care in the combination of umbilical vein and peripheral venipuncture of central venous catheter in very low birth weight infants. Methods Sixty cases of very low birth weight infants treated in the hospital were selected. From June 2017 to June 2018 as the time range of this study, they were divided into experimental group and reference grou p by random number table method, each of which were 30 cases.The children in the reference group were given conventional nursing methods for nursing, and the children in the reference group were given seamless nursing methods for nursing. Observe and compare the birth weight of children in the two groups and the changes in body weight in the first, second, and fourth weeks after birth, compare the incidence of adverse reactions in the two groups of children, and compare the duration of continuous tube administration, length of hospital stay and parents’ satisfaction with the care and negative emotion scores of the two groups of children.Results 1.The difference of weights in the two groups of children before nursing were no statistically significant(P >0.05). After the nursing, the weights of the two groups of children increased. The weight of children in the experimental group was much higher than that of the reference group in the first week, the second week, and the fourth week, which were(1 298.56±145.13)g vs(1 221.24±145.27)g、(1 318.67±103.96)g vs(1 245.67±104.54)g、(1 459.84±152.14)g vs(1 358.68±125.24)g;. There were statistically significant differences between the two groups(t= 2.062,2.712,2.812,P=0.044,0.009,0.007). 2. The incidence of adverse reactions and adverse events of catheterization in the experimentalgroup were much lower than those in the reference group. The number of adverse reactions was 1 case and 8 cases respectively. There were statistically significant differences between the two groups(χ^2=6.540,P=0.030). 3.There was a statistically significant differences in the length of hospitalization and the duration of the tube in the two groups of children. The length of hospitalization and the duration of the tube in the experimental group were significantly lower than those in the reference group, which were(10.34±2.14)d vs(7.69±1.22)d、(14.95±3.14)d vs(19.67±5.02)d, there were obvious differences between the two groups(t=7.494,4.347,P=0.000,0.000). 4. There was no statistically significant difference in the negative emotional scores of family members of the two groups of children before nursing work(P >0.05). The negative emotion scores of family members of the two groups of patients were decreased compared with before nursing work, and the difference was statistically significant(P <0.05). The negative emotion scores of family members of the experimental group were lower than those of the reference group, which were(59.64 ±1.24)points vs(36.58±1.02)points、(56.22±1.28)points vs(34.59±1.22)points, respectively. The family members of the experimental group were more satisfied with the nursing work than those of the reference group. There were statistically significant differences between the two groups(t =78.664,66.999,35.861,P =0.000,0.000,0.000). Conclusion The seamless nursing model has good nursing effect in the combination of central venous puncture and central venous puncture of very low birth weight infants, which can effectively alleviate the emotions of children’s family members and improve the nursing satisfaction of children’s family members. Reduce the incidence of leakage of intravenous fluids in children, improve the efficiency of nursing staff and shorten the length of hospital stay. It has certain clinical application value.