风险管理的护理干预在神经外科昏迷患者CVC相关并发症中的应用

Application of nursing intervention based on risk management in neurosurgical coma patients with CVC related complications

目的探讨风险管理的护理干预在神经外科昏迷患者中心静脉导管(CVC)相关并发症防治中的应用效果。方法选择2015年3月至2019年3月收治的神经外科昏迷且进行CVC置管的患者200例,随机分为对照组和试验组,每组100例。对照组实施常规护理,试验组在对照组基础上实施基于风险管理的护理干预。比较2组患者置管后30 d内导管相关性感染、机械性静脉炎、导管堵塞、穿刺部位渗血、导管移位或滑脱的发生情况,患者家属满意度、家属认可度、护理质量评分及2组患者血氨、内毒素以及免疫球蛋白水平。结果试验组患者导管相关性感染、机械性静脉炎、导管堵塞、穿刺部位渗血、导管移位或滑脱发生率低于对照组(P<0.05),试验组家属满意度、家属认可度及护理质量评分高于对照组(P<0.01);试验组血氨、内毒素低于对照组(P<0.01),试验组免疫球蛋白水平高于对照组(P<0.01)。结论基于风险管理的护理干预能够有效降低神经外科昏迷患者CVC导管相关并发症发生率,提高护理质量,改善患者预后,值得临床推广。

Objective To investigate the application effects of nursing intervention based on risk management in neurosurgical coma patients with central venous catheter(CVC)related complications.Methods Two hundred patients with neurosurgical coma who underwent CVC in our hospital from March 2015 to March 2019 were enrolled in the study,who were randomly divided into control group and experimental group.The patients in control group were treated by routine nursing,however,those in experimental group,on the basis of control group,were treated by nursing intervention based on risk management.At 30 days after CVC,the incidence rates of catheter-related infection,mechanical phlebitis,catheter blockage,bleeding at the puncture site,catheter displacement or slippage,satisfaction of family members,recognition degree of family members,nursing quality score,and the levels of blood ammonia,endotoxin and immunoglobulin were observed and compared between the two groups.Results After nursing intervention,the incidence rates of catheter-related infection,mechanical phlebitis,catheter blockage,bleeding at the puncture site,catheter displacement or slippage in experimental group were significantly lower than those in control group(P<0.05),however,the scores of family satisfaction degree,family recognition degree and nursing quality in experimental group were significantly higher than those in control group(P<0.01).Moreover the serum levels of ammonia and endotoxin were significantly lower than those in control group(P<0.05),however,the levels of immunoglobulin were significantly higher than those in control group(P<0.01).Conclusion The nursing intervention based on risk management can effectively reduce the risk of incidence of CVC catheter-related complications in patients with neurosurgical coma,improve the nursing quality and the prognosis of patients,therefore,it is worthy of application and promotion in clinical practice.