尿激酶疏通深静脉导管血凝性堵管循证护理效果观察

Effect of evidence-based nursing of urokinase in dredging blood coagulation blockage of deep venous catheter

目的观察在尿激酶疏导深静脉导管血凝性堵管中实施循证护理的方法及效果。方法选取2019年1月至2021年5月间在广州市胸科医院接受各种深静脉导管治疗患者720例为研究对象,其中62例为外周静脉穿刺中心静脉置管(PICC)和中心静脉导管(CVC)血凝性堵管,男37例,女25例,年龄22~73(41.53±4.10)岁。根据研究方案,其中31例采用三通开关负压技术通管,31例采用2 ml注射器负压技术通管,均采取尿激酶疏通方案并实施循证护理干预,所有数据采用XLS统计并采用SPSS 18.0软件总结分析62例患者的导管再通率及凝血功能及血小板变化情况。结果经实施循证护理干预,三通开关负压疏通法复通率达到83.87%(26/31),2 ml注射器负压疏通法复通率达到100.00%(31/31),两种疏通方法比较,差异有统计学意义(χ^(2)=33.055,P<0.05)。凝血功能指标中D2聚体指标正常者9例,偏高者53例;纤维蛋白原指标正常者12例,偏高者50例;血小板检测结果显示正常者50例,偏高者9例,偏低者3例。未对临床治疗产生影响,未对导管功能造成影响,未造成导管损伤。结论经长期临床实践研究证实,实施循证护理可显著提升PICC、CVC等深静脉导管的再通率,保障临床治疗顺利实施,具有较高的临床推广应用价值。

Objective To observe the methods and effect of evidence-based nursing in urokinase to relieve hemagglutinative occlusion of deep venous catheter.Methods A total of 720 patients who received various deep venous catheter treatments in Guangzhou Chest Hospital between January 2019 and May 2021 were selected as the research objects.Among them,62 patients had peripherally inserted central catheterization(PICC)and central vein catheter(CVC)hemagglutinative occlusions,including 37 males and 25 females,and they were 22-73(41.53±4.10)years old;according to the research plan,31 cases used three-way switch negative pressure technology to open the tubes,and 31 cases used 2 ml syringe negative pressure technology to open the tubes;urokinase was used to dredge the catheters and evidence-based nursing intervention was implemented in both groups.All the data were calculated using XLS,and SPSS 18.0 software was used to summarize and analyze the catheter recanalization rate,coagulation function,and platelet changes of the 62 patients.Results After the implementation of evidence-based nursing intervention,the recanalization rate of the three-way switch negative pressure dredging method reached 83.87%(26/31),and the recanalization rate of the negative pressure dredging method of 2 ml syringe reached 100.00%(31/31),with a statistical difference(χ^(2)=33.055,P<0.05).Among the coagulation function indicators,the D2 aggregate was normal in 9 cases and high in 53 cases;the fibrinogen was normal in 12 cases and high in 50 cases;the platelet test was normal in 50 cases,high in 9 cases,and low in 3 cases.It did not affect the clinical treatment and catheter function,and did not cause catheter damage.Conclusion Long-term clinical practice studies have confirmed that the implementation of evidence-based nursing can significantly increase the recanalization rate of PICC,CVC,and other deep venous catheters and ensure the smooth implementation of clinical treatments,so it is worth being clinically generalized.