积木拼插游戏在学龄期PICC置管患儿上肢功能锻炼中的应用研究

doi:10.3761/j.issn.0254-1769.2024.08.008

摘要/Abstract

摘要：

目的探讨积木拼插游戏在学龄期PICC置管患儿上肢功能锻炼中的应用效果。方法采用便利抽样法，选取2022年11月—2023年4月在河南省某三级甲等医院儿科病房进行PICC置管的90例住院患儿作为研究对象，采用随机数字表法将其分为试验组和对照组各45例。试验组在常规握球运动的基础上进行积木拼插游戏，对照组采用常规握球运动进行上肢功能锻炼。比较两组上肢功能锻炼依从率、置管侧腋静脉时间平均峰值流速以及导管相关并发症发生率。结果研究过程中，试验组脱落2例、对照组脱落3例，最终试验组纳入43例、对照组纳入42例。住院期间，试验组上肢功能锻炼依从率为93.03%，对照组为64.29%，两组比较，差异具有统计学意义（P<0.001）；试验组置管后第3天置管侧腋静脉时间平均峰值流速为（5.58±1.24） cm/s，置管后第7天为（5.37±1.24） cm/s，对照组分别为（3.87±1.06） cm/s和（3.56±0.81） cm/s，两组比较，差异均具有统计学意义（P<0.001）；试验组导管相关性血栓发生率为4.65%，对照组为21.43%，两组比较，差异具有统计学意义（P=0.021）；试验组穿刺点渗血、导管移位发生率均为4.65%，对照组分别为7.14%、4.76%，两组比较，差异无统计学意义（均P>0.05）。结论在常规握球运动的基础上进行积木拼插游戏能提高PICC置管患儿上肢功能锻炼依从性，提升置管侧腋静脉血液流速，降低导管相关性血栓发生率，且不会增加穿刺点渗血、导管移位的发生风险。

关键词: 经外周置入中心静脉导管, 学龄期, 功能锻炼, 积木拼插, 握球, 血液流速, 儿科护理学

Abstract:

Objective To explore the effectiveness of building block assembly games in the upper limb functional exercise of school-aged children with peripherally inserted central catheter catheterization. Methods Using convenience sampling，90 catheterized children who met the inclusion criteria in the pediatric ward of a tertiary hospital in Henan Province from November 2022 to April 2023 were selected as research subjects. They were randomly divided into an experimental group and a control group，with 45 cases in each group. The experimental group participated in building block assembly games in addition to conventional ball-gripping exercises，while the control group engaged solely in conventional ball-gripping exercises. The compliance rates of upper limb exercises，time average peak flow rate of axillary vein of the catheterization side，and the incidence of catheter-related complications were compared between the 2 groups. Results During the study，2 cases in the experimental group and 3 in the control group dropped out，resulting in 43 cases in the experimental group and 42 in the control group. The compliance rate of upper limb exercises in the experimental group during hospitalization was 93.03%，significantly higher than 64.29% in the control group（P<0.001）. On the third day after catheterization，the time average peak flow rate of axillary vein of the catheterization side was（5.58±1.24） cm/s and （5.37±1.24） cm/s on the seventh day in the experimental group，compared to（3.87±1.06） cm/s and（3.56±0.81） cm/s，respectively，in the control group. These differences were statistically significant（P<0.001）. The incidence of catheter-related thrombosis in the experimental group was 4.65%，significantly lower than 21.43% in the control group（P=0.021）. The rates of bleeding at the puncture site and catheter displacement in the experimental group were both 4.65%，compared to 7.14% and 4.76%，respectively，in the control group. These differences were not statistically significant（both P>0.05）. Conclusion Incorporating building block assembly games into routine ball-gripping exercises can improve the compliance of upper limb exercises in children with PICC placement，improve the blood flow velocity in the axillary vein of the catheterization upper limb，and reduce the incidence of catheter-related thrombosis，without increasing the risk of bleeding at the puncture site or catheter displacement.

Key words: Peripherally Inserted Central Catheter, School Stage, Functional Exercise, Building Block Assembly, Ball Gripping, Blood Flow Velocity, Pediatric Nursing

王龙君, 王丹, 徐海莉, 金歌, 方艳艳, 曾庆虎. 积木拼插游戏在学龄期PICC置管患儿上肢功能锻炼中的应用研究[J]. 中华护理杂志, 2024, 59(8): 947-952.

WANG Longjun, WANG Dan, XU Haili, JIN Ge, FANG Yanyan, ZENG Qinghu. Research on the application of building block assembly games in upper limb functional exercise for school-aged children with PICC catheterization[J]. Chinese Journal of Nursing, 2024, 59(8): 947-952.

图/表 3

表1 调查对象的一般资料(n=232)

Table 1 Participants characteristics(n=232)

表2 两组置管侧腋静脉时间平均峰值流速比较结果[cm/s，（$\bar{x}±s$）]

Table 2 Comparison of time average peak flow rate of axillary vein of the catheterization side between 2 groups[cm/s，（$\bar{x}±s$）]

表3 两组导管相关并发症发生情况比较[例（百分率,%）]

Table 3 Comparison of incidence of catheter-related complications between 2 groups[cases（percentage, %）]

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