经外周置入中心静脉导管后首次换药时间对乳腺癌术后患者的影响

AThe Impact of the timing of initial dressing change following PICC catheterization on postoperative breast cancer patients

目的探讨乳腺癌术后患者经外周置入中心静脉导管(PICC)后首次换药时间对其临床、心理、经济的影响。方法本研究选取2023年4—10月期间乳腺癌术后并接受PICC置管的120例患者,根据纳排标准分为观察组和对照组,每组60例。观察组在置管后48 h进行首次换药,对照组24 h内进行首次换药,比较两组患者在首次换药时穿刺点疼痛程度,1周内穿刺点渗血情况,3周内心理状态(PHQ-9抑郁量表和GAD-7焦虑量表)和维护频率、费用的差异。结果两组患者的基线资料无差异。观察组在置管后首次换药时的疼痛程度、1周内穿刺点渗血程度及渗血持续时间均显著低于对照组,差异有统计学意义(P<0.001)。此外,观察组在置管后的抑郁、焦虑评分和3周内的维护频率、费用均低于对照组,差异有统计学意义(P<0.001)。结论乳腺癌术后患者在PICC置管后48 h进行首次换药,可减少穿刺点出血、减轻疼痛,从而缓解患者抑郁、焦虑程度。同时也可降低换药频率,减轻患者的经济负担。

Objective To investigate the clinical,psychological,and economic impacts of the initial dressing change timing following peripherally inserted central catheter(PICC)placement in postoperative breast cancer patients.Methods We enrolled a total of 120 patients who underwent PICC placement following breast cancer surgery at a tertiary hospital in Guangzhou between April and October 2023 for this study.Based on predefined inclusion and exclusion criteria,the patients were divided into an observation group and a control group,with each group comprising 60 patients.In the observation group,the first dressing change was performed 48 hours after PICC placement,whereas in the control group it was done within 24 hours post-placement.The primary outcomes assessed included pain intensity at the puncture site during the initial dressing change,occurrence of bleeding at the puncture site within one week,psychological state evaluated using validated scales such as PHQ-9 depression scale and GAD-7 anxiety scale,as well as maintenance frequency and associated costs over a three-week period.Results There were no significant differences in baseline characteristics between the two groups.The obser-vation group exhibited significantly lower pain levels at the puncture site during the initial dressing change,reduced bleeding at the puncture site within one week,and a shorter duration of bleeding compared to the control group(P<0.001).Moreover,the observation group demonstrated statistically significant decreases in depression and anxiety scores,as well as maintenance frequency and costs within three weeks post-placement when compared to the control group(P<0.001).Conclusions The implementation of an early dressing change within 48 hours after PICC cath-eterization in breast cancer patients undergoing surgery has been demonstrated to effectively ameliorate hemorrhage and discomfort at the puncture site,consequently mitigating patient distress and anxiety.Moreover,this intervention facilitates a decrease in dressing change frequency while reducing financial burdens on patients.