繆健麗　楊麗平　張秋萍

【摘要】 目的：通過對血透患者制定針對性集束化護理措施，觀察集束化護理對導(dǎo)管相關(guān)并發(fā)癥的影響。方法：通過對各種常見的留置透析導(dǎo)管相關(guān)并發(fā)癥原因進行分析，針對存在的問題制定集束化護理措施。將246例留置透析導(dǎo)管患者采用隨機數(shù)字表法分為兩組，每組123例，其中試驗組采用集束化護理，對照組采用常規(guī)護理，比較兩組患者留置透析導(dǎo)管相關(guān)并發(fā)癥的發(fā)生情況。結(jié)果：通過對8個相關(guān)因素分析，結(jié)果顯示年齡、文化程度、收入水平、血糖水平等與并發(fā)癥發(fā)生有一定的關(guān)系。試驗組患者留置導(dǎo)管感染發(fā)生率為3.25%、脫管率為14.63%、導(dǎo)管阻塞發(fā)生率為4.07%；對照組分別為14.63%、30.89%、16.26%，差異均有統(tǒng)計學(xué)意義（P<0.05）。試驗組和對照組患者的依從性分別為92.68%、87.80%，差異無統(tǒng)計學(xué)意義（P>0.05）。試驗組和對照組留置導(dǎo)管平均時間分別為（35.40±5.20）、（28.40±5.30） d，試驗組優(yōu)于對照組，差異有統(tǒng)計學(xué)意義（P<0.05）。結(jié)論：對留置透析導(dǎo)管患者進行集束化護理，可有效降低導(dǎo)管相關(guān)并發(fā)癥的發(fā)生率。

【關(guān)鍵詞】 集束化護理； 留置透析導(dǎo)管； 并發(fā)癥

The Effect of Cluster Nursing to Prevent the Dialysis Catheter Complication of Patient with Hemodialysis/MIAO Jian-li，YANG Li-ping，ZHANG Qiu-ping.//Medical Innovation of China，2017，14（19）：094-098

【Abstract】 Objective：To investigate the influence of cluster nursing on catheter related complications in hemodialysis patients.Method：The causes of complications related to the indwelling catheter were analyzed，and the cluster nursing measures were put forward in view of the existing problems.246 patients with indwelling dialysis catheter were divided into experimental group and control group，123 cases in each group，the experimental group was treated by cluster nursing，and the control group by routine nursing.The complications of indwelling catheter were compared between the two groups.Result：8 related factors were analysed，the results showed that age，education level，income level and blood sugar level were related to the complications.The catheter infection rate was 3.25%，the catheter removal rate was 14.63% and the catheter obstruction occurred rate was 4.07% of the experimental group；which were 14.63%，30.89%，16.26% of the control group，the differences were statistically significant（P<0.05）.The compliance of the experimental group and the control group were 92.68% and 87.80% respectively，there was no significant difference（P>0.05）.The time of indwelling dialysis catheter time of the experimental group was （35.40±5.20） days，which was better than control groups（28.40±5.30）days，the difference was statistic significant（P<0.05）.Conclusion：Cluster nursing can effectively reduce the incidence of catheter related complications in patients with indwelling dialysis catheter.

【Key words】 Cluster nursing； Indwelling dialysis catheter； Complications

First-authors address：The Peoples Hospital of Yuancheng District in Heyuan City，Heyuan 517000，China

doi：10.3969/j.issn.1674-4985.2017.19.027

血液透析是指將患者的體內(nèi)的血液引流至體外，體內(nèi)血液經(jīng)過透析器，血液和透析液在一根根空心纖維內(nèi)外，通過對流達到物質(zhì)的交換，以清除體內(nèi)的代謝廢物，同時也可將體內(nèi)多余的水分排出，維持機體電解質(zhì)和酸堿的平衡狀態(tài)，是治療急慢性腎功能衰竭的主要方式。血管通路是保證患者的充分透析的首要條件和患者的“生命線”，理想的血管通路在患者進行血透時應(yīng)有足夠的血流量、穿刺方便、持久耐用及并發(fā)癥少等特點[1-2]。有關(guān)研究表明，采用適當(dāng)?shù)淖o理模式可以有效地減少留置導(dǎo)管所引發(fā)的并發(fā)癥的發(fā)生，其中又以集中化護理模式最為顯著[3]。endprint