无扎止血带联合外周血管指压充盈在极低出生体质量早产儿中的应用效果

Application Effect of Untie Tourniquet Combined with Peripheral Vascular Acupressure in Very Low Birth Weight Premature Infants

目的探讨无扎止血带联合外周血管指压充盈应用于极低出生体质量早产儿经外周静脉穿刺中心静脉置管(PICC)过程中的效果。方法回顾性选取2019年7月至2020年12月通许县中医院收治的78例极低出生体质量早产儿,按建档时间分为两组,2019年7月至2020年3月35例为对照组,给予扎止血带充盈外周血管法;2020年4—12月43例为观察组,给予指压充盈外周血管法、无扎止血带。比较两组上臂肿胀发生率、血管充盈所需时间、皮肤开始变青紫时间、不同血管(贵要、肘正中、头静脉)一次置管成功率、置管总成功率、置管时间和穿刺时、穿刺后5 min疼痛刺激程度及护理服务质量。结果观察组上臂肿胀发生率(9.30%)低于对照组(28.57%),血管充盈所需时间、皮肤开始变青紫时间长于对照组(P<0.05);观察组不同血管一次置管成功率(76.74%)高于对照组(54.29%),反复穿刺成功率(23.26%)低于对照组(45.71%)(P<0.05),两组置管总成功率均为100.00%;观察组穿刺时、穿刺后5 min疼痛刺激程度轻于对照组(P<0.05);观察组有形性、保证性、可靠性、移情性、反应性评分高于对照组(P<0.05)。结论无扎止血带联合外周血管指压充盈应用于极低出生体质量早产儿PICC过程中,可降低上臂肿胀发生率,减轻皮肤青紫及对早产儿的疼痛刺激,提高一次置管成功率,改进护理服务质量,但会延长血管充盈所需时间。

Objective To investigate the effect of untie tourniquet combined with peripheral vascular acupressure in the process of peripherally inserted central catheter(PICC)in very low birth weight premature infants.Methods Seventy-eight cases of very low birth weight premature infants in Tongxu County Hospital of Traditional Chinese Medicine from July 2019 to December 2020 were retrospectively selected and divided into two groups according to the time of file establishment.Thirty-five cases from July 2019 to March 2020 were the control group,and the method of filling peripheral blood vessels by tying tourniquet was given.Forty-three cases were in the observation group from April to December 2020,and they were given the method of filling peripheral blood vessels with finger pressure without tourniquet.The incidence of upper arm swelling,the time required for vascular filling,the time when the skin began to turn blue,the success rate of one-time catheterization of different blood vessels(Guiyao,median elbow,and cephalic vein),the total success rate of catheterization,pain stimulation of the time of puncture and 5 minutes after puncture,nursing service quality were compared between the two groups.Results The incidence of upper arm swelling in the observation group(9.30%)was lower than that in the control group(28.57%),the time required for blood vessel filling and the time for the skin to turn blue and purple were longer than those in the control group(P<0.05).The success rate of single puncture of different vessels in the observation group(76.74%)was higher than that in the control group(54.29%),and the success rate of repeated puncture(23.26%)was lower than that in the control group(45.71%)(P<0.05).The total success rate of catheterization in both groups was 100.00%.The scores of tangibility,assurance,reliability,empathy and responsiveness in the observation group were higher than those in the control group(P<0.05).Conclusion The application of non-tie tourniquet combined with peripheral vascular acupressure filling in the PICC process of very low birth weight premature infants can reduce the incidence of upper arm swelling,reduce skin bruising and pain stimulation to premature infants,improve the success rate of one-time catheter placement,and improve quality of nursing service,but prolongs the time required for vascular refill.