危重症患儿中心静脉导管相关性血栓预防方案的构建及应用

Construction and application of a prevention programme for central venous catheter-related thrombosis critically ill children

目的 构建危重症患儿中心静脉导管相关性血栓(central venous catheter-related thrombosis,CRT)预防方案并评价其应用效果。方法 以Donabedian的“结构-过程-结果 ”质量管理理论为基础,在文献回顾、证据总结后,于2021年8月-9月进行2轮专家咨询,构建危重症患儿CRT预防方案。采用便利抽样法,选取2022年1月-3月在吉林省某三级甲等医院儿科重症监护病房(pediatric intensive care unit,PICU)中接受中心静脉置管的危重症患儿作为试验组,2021年10月-12月接受中心静脉置管的作为对照组。试验组应用危重症患儿CRT预防方案,对照组接受常规预防措施。比较两组医护人员对CRT常规预防措施的执行率以及患儿CRT发生率、导管相关不良事件发生率、PICU住院时间。结果 共进行2轮专家咨询,有效问卷回收率均为100%,专家的权威系数分别为0.85、0.90。在第2轮专家咨询中,各条目重要性评分的变异系数为0~0.144,肯德尔和谐系数为0.359(P<0.001);可行性评分的变异系数为0~0.141,肯德尔和谐系数为0.513 (P<0.001)。最终构建的危重症患儿CRT预防方案包括3个一级条目、10个二级条目和24个三级条目。应用结果显示,试验组深静脉血栓形成风险评估工具使用率、风险评估时机正确率、颈静脉置管率、药物预防依从率均高于对照组,CRT发生率低于对照组,PICU住院时间少于对照组,差异均具有统计学意义(P<0.05)。结论该研究构建的危重症患儿CRT预防方案具有科学性、实用性。实施该方案可提高医护人员对常规预防措施的执行率,降低危重症患儿CRT发生率,缩短其住院时间。

Objective To construct a prevention programme of central venous catheter-related thrombosis(CRT)in critically ill children,and to evaluate its clinical effects.Methods Based on the theory of“structure-processresult”quality evaluation model,literature research and evidence summary,2 rounds of expert consultations were conducted to construct a CRT prevention programme for critically ill children from August to September 2021.The critically ill children who received central venous catheterization in the pediatric intensive care unit(PICU)of a tertiary hospital in Jilin Province from January to March 2022 were selected as an experimental group by convenience sampling,those who received central venous catheterization from October to December 2021 as a control group.The experimental group was given the CRT prevention programme,while the control group was given routine precautions.The implementation rate of precautions,incidence of CRT,incidence of adverse events and hospitalization time in PICU were compared between 2 groups.Results The effective recovery rates of 2 rounds of expert consultations were 100%,and the authority coefficient were 0.85,0.90.In the second round,the coefficient of variation of importance score of each item was 0-0.144,and the Kendall's harmony coefficient was 0.359(P<0.001);the coefficient of variation of the feasibility score was 0-0.141,and the Kendall's harmony coefficient was 0.513(P<0.001).Finally,the CRT prevention programme for critically ill children included 3 first-level items,10 second-level items and 24 third-level items.The application results showed that the utilization rate of deep venous thrombosis risk assessment tool,timing of risk assessment,rate of jugular vein catheterization and the compliance rate of drug prevention in the experimental group were higher than those in the control group,and the incidence of CRT and hospitalization time in PICU were lower than those in the control group(P<0.05).Conclusion The CRT prevention programme constructed in this study is scientific and practical.The implemented the programmecan improve the implementation rate of precautions,decrease the incidence of CRT in critically ill children and shorten the hospitalization time.