维持性血液透析患者出血报警绷带的设计与应用

doi:10.3761/j.issn.0254-1769.2024.24.007

摘要/Abstract

摘要：

目的设计、制作维持性血液透析患者出血报警绷带，并探讨其应用效果。方法出血报警绷带由弹力绷带、监测元件和监测盒组成。采用便利抽样法，选取2021年1月—6月在安徽省某三级甲等综合医院血液净化中心接受规律血液透析治疗的患者，采用随机数字表法分为试验组和对照组，每组各40例。试验组每次上机后在每30 min巡视1次的基础上使用出血报警绷带实时监测；对照组每次上机后每30 min巡视1次，比较两组的穿刺点渗血发生率、发现率及渗血量的差异。结果试验组穿刺点渗血发生率为17.00%，对照组穿刺点渗血发生率为25.25%，两组比较差异具有统计学意义（χ²=8.170，P=0.004）；其中试验组穿刺点重度渗血发生率为1.50%，对照组穿刺点重度渗血发生率为11.50%，两组比较差异具有统计学意义（χ²=32.910，P<0.001）。试验组穿刺点渗血发现率为94.12%，对照组穿刺点渗血发现率为89.11%，两组比较差异无统计学差异（χ²=1.261，P=0.262）；其中试验组中度渗血发现率为100%，对照组穿刺点中度渗血发现率为85.37%，两组比较差异具有统计学意义（χ²=6.170，P=0.013）。试验组穿刺点渗血量为1.29（0.88， 1.74） g，对照组穿刺点渗血量为2.77（1.60，4.77） g，两组比较差异具有统计学意义（Z=-5.825，P<0.001）；其中试验组穿刺点中度渗血量为1.49（1.27，1.81） g，对照组穿刺点中度渗血量为1.92（1.52，2.44） g，两组比较差异具有统计学意义（Z=-2.835，P=0.005）。结论使用出血报警绷带可有效对维持性血液透析患者穿刺点渗血情况进行实时监测及报警，有助于降低渗血发生率，提高渗血发现率，减少渗血量，提高透析治疗的安全性，保障透析护理质量。

关键词: 维持性血液透析, 动静脉瘘, 出血, 护理

Abstract:

Objective To design and produce a bleeding alert bandage and investigate its effectiveness in patients undergoing hemodialysis. Methods The bleeding alert bandage consists of elastic bandage，monitoring element and monitoring box. A convenience sampling method was used to select patients who received regular hemodialysis treatment in the blood purification center of a tertiary A comprehensive hospital in Anhui Province from January 2021 to June 2021. These patients were randomly assigned into an experimental group and a control group，with 40 cases in each group. Patients in the control group were inspected every 30 min by traditional method. Patients in the experimental group were monitored in real-time with a bleeding alert bandage in addition to the 30 min rounds. The detection rate，incidence，and volume of bleeding at the puncture site were compared in 2 groups of patients. Results The incidence of bleeding from the puncture sites was 17.00% in the experimental group and 25.25% in the control group，with statistical significance（χ²=8.170，P=0.004）. The incidence of bleeding for severe bleeding from puncture sites was 1.50% in the experimental group and 11.50% in the control group，with statistical significance（χ²=32.910，P<0.001）. The bleeding detection rate from puncture sites was 94.12% in the experimental group and 89.11% in the control group，with no statistical difference（χ²=1.261，P=0.262）. The detection rate for moderate bleeding from puncture sites was 100% in the experimental group and 85.37% in the control group，with statistical significance（χ²=6.170，P=0.013）. Additionally，the bleeding volume from the puncture site was 1.29（0.88，1.74） g in the experimental group and 2.77（1.60，4.77） g in the control group，with statistical significance（Z=-5.825，P<0.001）. The moderate bleeding volume from the puncture site was 1.49（1.27，1.81） g in the experimental group and 1.92（1.52，2.44） g in the control group，with statistical significance（Z=-2.835，P=0.005）. Conclusion The bleeding alert bandage is effective in real-time monitoring and alerting of bleeding at the puncture sites during hemodialysis，which can help reduce the incidence of blood seepage，improve the detection rate of blood seepage，reduce the amount of bleeding and improve the safety of dialysis treatment.

Key words: Maintenance Hemodialysis, Arteriovenous Fistula, Hemorrhage, Nursing Care

陶明芬, 周健美, 王翠珍, 周加军, 陶秀彬. 维持性血液透析患者出血报警绷带的设计与应用[J]. 中华护理杂志, 2024, 59(24): 2990-2994.

TAO Mingfen, ZHOU Jianmei, WANG Cuizhen, ZHOU Jiajun, TAO Xiubin. The design and application of a bleeding alarm bandage for maintenance hemodialysis patients[J]. Chinese Journal of Nursing, 2024, 59(24): 2990-2994.

图/表 4

图1 出血报警绷带示意图注：1.监测盒；2.监测元件；3.弹力绷带；4.穿刺点；5.粘扣。

Figure 1 A schematic diagram of bleeding alarm bandage

表1 两组穿刺点渗血发生率比较[例（百分比，%）]

Table 1 Comparison of incidence of bleeding at puncture sites between 2 groups[case，（percentage，%）]

表2 两组穿刺点渗血发现率比较[例（百分比，%）]

Table 2 Comparison of detection rate of bleeding at puncture sites between 2 groups[case，（percentage，%）]

表3 两组穿刺点渗血量比较[g，M（P25，P75）]

Table 3 Comparison of volume of bleeding at puncture sites between 2 groups

参考文献 16

[1]	郑旭彤, 林晓忆, 秦朱珠, 等. 慢性肾病患者及其照护者家庭血液透析体验质性研究的Meta整合[J]. 中华护理杂志, 2023, 58(11):1365-1372. DOI URL
	Zheng XT, Lin XY, Qin ZZ, et al. The experience of chronic kidney disease and their caregivers in home hemodialysis:a meta-synthesis of qualitative research[J]. Chin J Nurs, 2023, 58(11):1365-1372.
[2]	李明妍, 路遥, 张美斌, 等. 1例动静脉内瘘扣眼穿刺处内膜增生患者的护理[J]. 中华护理杂志, 2024, 59(2):170-174. DOI URL
	Li MY, Lu Y, Zhang MB, et al. Nursing care of a case of intimal hyperplasia at buttonhole puncture site of arteriovenous fis-tula[J]. Chin J Nurs, 2024, 59(2):170-174.
[3]	张华. 维持性血液透析患者52例内瘘穿刺点减少渗血的穿刺技巧及渗血护理方法[J]. 临床医药文献电子杂志, 2020, 7(4):124-126.
	Zhang H. Puncture techniques and nursing methods of reducing blee-ding through puncture points in 52 patients with maintenance hemodialysis[J]. J Clin Med Lit Electron J, 2020, 7(4):124-126.
[4]	袁静, 李恒, 应金萍, 等. 102例血液透析患者动静脉内瘘血栓形成的原因及护理[J]. 中华护理杂志, 2020, 55(4):607-610. DOI URL
	Yuan J, Li H, Ying JP, et al. Causes and nursing of arteriove-nous fistula thrombosis in 102 hemodialysis patients[J]. Chin J Nurs, 2020, 55(4):607-610.
[5]	李朋朋, 李亚娟. 一种多功能血液透析患者用止血绷带的设计[J]. 医疗卫生装备, 2017, 38(4):117-119.
	Li PP, Li YJ. Design of multifunction hemostatic bandage for hemo-dialysis patient[J]. Chin Med Equip J, 2017, 38(4):117-119.
[6]	李海杰, 许春. 渗血探针报警器的设计与实现[J]. 医疗装备, 2023, 36(8):16-20.
	Li HJ, Xu C. Design and imple-mentation of blood oozing probe alarm[J]. Med Equip, 2023, 36(8):16-20.
[7]	宗晓玉. 防穿刺针脱落与渗血监测仪在血液透析护理中的应用[J]. 临床医药实践, 2019, 28(12):949-951.
	Zong XY. Application of anti-puncture needle shedding and blood leakage monitor in hemodialysis nursing[J]. Proceeding Clin Med, 2019, 28(12):949-951.
[8]	吴香菊, 吴琳琳, 闫璐捷. 渗液报警器在血液透析治疗中的运用分析[J]. 中国医疗器械信息, 2022, 28(7):40-42.
	Wu XJ, Wu LL, Yan LJ. Application of seepage alarm in hemodialysis treatment[J]. Chin J Med Devices Inform, 2022, 28(7):40-42.
[9]	黄垂文, 陈兴富, 许世林, 等. 一种医用体外出血报警装置的设计[J]. 医疗装备, 2021, 34(3):9-11.
	Huang CW, Chen XF, Xu SL, et al. Design of a medical extracorporeal hemorrhage alarm device[J]. Med Equip, 2021, 34(3):9-11.
[10]	Chan DYF, Dobson S, Barber T. Hemodialysis taping styles and their effect on reducing the chance of venous needle dislodgement[J]. Semin Dial, 2021, 34(3):218-223.
[11]	Frinak S, Kennedy J, Zasuwa G, et al. Detection of hemodialysis venous needle dislodgment using venous access pressure measurements:a simulation study[J]. Kidney360, 2023, 4(4):e476-e485.
[12]	Ribitsch W, Schilcher G, Hafner-Giessauf H, et al. Prevalence of detectable venous pressure drops expected with venous needle dislodgement[J]. Semin Dial, 2014, 27(5):507-511.
[13]	Kennedy C, McGrath-Chong M, Arustei D, et al. A prototype line clamp for venous access bleeding in hemodialysis:a prospective cohort study[J]. Hemodial Int, 2019, 23(2):151-157. DOI PMID
[14]	胡成文, 杨玲. 藻酸盐敷料在预防经外周静脉置入中心静脉导管穿刺点出血的效果观察[J]. 护理实践与研究, 2015, 12(1):120-121.
	Hu CW, Yang L. Observation on the effect of alginate dressing in preventing bleeding at the puncture point of central venous catheter inserted through peripheral vein[J]. Nurs Pract Res, 2015, 12(1):120-121.
[15]	刘蓉, 修穆群, 黄秀兰. 藻酸盐敷料在肿瘤患者PICC置管穿刺出血预防中的应用[J]. 当代医学, 2017, 23(32):153-154.
	Liu R, Xiu MQ, Huang XL. Application of alginate dressing in the prevention of PICC puncture bleeding in tumor patients[J]. Contemp Med, 2017, 23(32):153-154.
[16]	唐成, 李莉, 洪蕾, 等. 专用漏血监测装置评估血液透析患者穿刺效果及满意度研究[J]. 中国医学装备, 2021, 18(2):130-133.
	Tang C, Li L, Hong L, et al. Study on the effect of special blood leakage monitoring device on the puncture effect and satisfaction degree of patients in hemodialysis treatment[J]. China Med Equip, 2021, 18(2):130-133.