钝性分离送鞘技术在凝血功能障碍老年患者中长导管置管中的应用研究

doi:10.3761/j.issn.0254-1769.2024.04.002

摘要/Abstract

摘要：

目的探讨钝性分离与扩皮刀送鞘技术在凝血功能障碍老年患者中长导管置管中的应用效果。方法采用便利抽样法，选取2022年10月—2023年4月在某综合三级甲等医院行中长导管植入的80例凝血功能障碍的老年患者作为研究对象，以随机数字表法将其分为试验组和对照组，每组各40例。两组均在超声引导下结合改良塞丁格技术置管，试验组采用钝性分离送鞘，对照组采用扩皮刀送鞘。比较两组穿刺点渗血渗液程度、置管后疼痛程度及并发症（渗血渗液、静脉炎、有症状导管相关性血栓、导管堵塞、导管脱出等）的发生率等。结果试验组扩皮后即刻与置管后24 h穿刺点渗血渗液程度、置管后1 d与3 d穿刺点疼痛评分、渗血渗液发生率、总并发症发生率和维护总次数均低于对照组，差异具有统计学意义（P<0.05）。两组间扩皮后即刻与置管后5 d穿刺点疼痛评分、静脉炎发生率、有症状导管相关性血栓发生率、导管堵塞发生率、导管脱出发生率、导管相关性皮肤损伤发生率、非计划性拔管率、一次性送鞘成功率和导管留置时长比较，差异无统计学意义（P>0.05）。结论采用钝性分离送鞘置入中长导管可降低凝血功能障碍老年患者穿刺点渗血发生率与程度，减轻患者疼痛，减少维护次数。

关键词: 中长导管, 钝性分离, 出血, 血液凝固障碍, 老年人, 护理

Abstract:

Objective To explore the efficacy of blunt separation method in midline catheter intubation in elderly patients with coagulation dysfunction. Methods A total of 80 elderly patients with coagulation dysfunction were selected in the convenience sampling method from October 2022 to April 2023 in our hospital，and they were randomly divided into an experimental（blunt） group and a control（routine） group，with 40 patients in each group. The differences in the degree of bleeding and exudation at the puncture site，the pain score and the incidence of complications（including bleeding and exudation，phlebitis，symptomatic catheter-related thrombus，catheter blockage，catheter pulling-off） were compared between 2 groups. Results In the experimental group，the degree of bleeding and exudation at the puncture point immediately after the operation，degree of bleeding and exudation at the puncture point 24 hours after the operation，pain score 1 day after the catheterization，pain score 3 days after the catheterization，incidence of bleeding and exudation，total incidence of complications and maintenance times were significantly lower than these in the control group（P<0.05）. In terms of the pain score immediately after the operation，pain score 5 days after the operation，incidence of phlebitis，incidence of symptomatic catheter-related thrombosis，incidence of catheter blockage，incidence of catheter pulling-off，incidence of catheter related skin injury，incidence of unplanned extubation，success rate of one-time sheath delivery and the indwelling time，the differences between the experimental group and control group were not significant（P<0.05）. Conclusion The application of blunt separation method in midline catheter indwelling can significantly reduce the incidence and degree of bleeding at the puncture point，decrease the maintenance times and relieve the pain in elderly patients with coagulation dysfunction.

Key words: Midline Catheter, Blunt Separation Method, Bleeding, Coagulation Dysfunction, Aged, Nursing Care

贾秀芬, 刘玉平, 龙淑红, 王锦, 孟冉, 姜晓丽. 钝性分离送鞘技术在凝血功能障碍老年患者中长导管置管中的应用研究[J]. 中华护理杂志, 2024, 59(4): 395-400.

JIA Xiufen, LIU Yuping, LONG Shuhong, WANG Jin, MENG Ran, JIANG Xiaoli. A study on the application of blunt separation method in midline catheter intubation in elderly patients with coagulation dysfunction[J]. Chinese Journal of Nursing, 2024, 59(4): 395-400.

图/表 4

表1 两组一般资料的比较

Table 1 Comparison of characteristics of 2 groups

表2 两组扩皮后即刻与置管后24 h穿刺点渗血渗液程度的比较[例（百分比，%）]

Table 2 Comparison of degree of bleeding and exudation in 2 groups[cases（percentage，%）]

表3 两组扩皮后即刻与置管后1、3、5 d疼痛程度的比较（分，$\bar{x} \pm s$）

Table 3 Comparison of pain levels in 2 groups（score，$\bar{x} \pm s$）

表4 两组并发症发生率的比较[例（百分率，%）]

Table 4 Comparison of incidence of complications in 2 groups [cases（percentage，%）]

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