小儿心脏手术后中心静脉导管渗血相关因素分析与护理对策
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摘要
目的探讨小儿心脏手术后中心静脉导管渗血相关因素及护理干预措施。方法选择2016年5月至2018年5月我院治疗的心脏手术患儿89例作为研究对象,术后发生中心静脉导管渗血的患儿19例作为渗血组,未发生渗血的患儿70例作为无渗血组。比较患儿性别、年龄、导管留置时间、导管移位、穿刺前血小板水平,对上述可能的因素进行单因素分析与多因素logistic回归分析,针对危险因素制定有效护理措施。结果多因素logistic回归分析显示,小儿心脏手术后中心静脉导管渗血发生与年龄、导管留置时间、导管移位有关。结论小儿心脏手术后中心静脉导管渗血发生率较高,受患儿年龄、导管留置时间及导管移位因素影响,且不同因素能相互作用、相互影响,根据危险因素制定有效的护理措施,能降低渗血发生率。
Objective To investigate the factors related to oozing blood of central venous catheter after pediatric cardiac surgery and nursing intervention measures. Methods To select 89 children with cardiac surgery who were treated in our hospital from May 2016 to May 2018 as the study subjects. We set the 19 children with central venous catheter oozing after operation as the oozing group,and the 70 children without oozing blood as the non-bleeding group. The gender,age,catheter indwelling time,catheter displacement,and pre-puncture platelet level were compared between the children. Univariate analysis and multivariate logistic regression analysis were performed on the above possible factors,and effective nursing measures were developed for risk factors. Results Multivariate logistic regression analysis showed that central venous catheter oozing after pediatric cardiac surgery was associated with age,catheter indwelling time,and catheter displacement. Conclusion The incidence of venous bleeding in central venous catheter after pediatric cardiac surgery is high,which is affected by age,catheter indwelling time and catheter displacement factors. And the different factors can interact and influence each other. If we can develop effective nursing measures according to the risk factors,we can reduce the incidence of bleeding.
Objective To investigate the factors related to oozing blood of central venous catheter after pediatric cardiac surgery and nursing intervention measures. Methods To select 89 children with cardiac surgery who were treated in our hospital from May 2016 to May 2018 as the study subjects. We set the 19 children with central venous catheter oozing after operation as the oozing group,and the 70 children without oozing blood as the non-bleeding group. The gender,age,catheter indwelling time,catheter displacement,and pre-puncture platelet level were compared between the children. Univariate analysis and multivariate logistic regression analysis were performed on the above possible factors,and effective nursing measures were developed for risk factors. Results Multivariate logistic regression analysis showed that central venous catheter oozing after pediatric cardiac surgery was associated with age,catheter indwelling time,and catheter displacement. Conclusion The incidence of venous bleeding in central venous catheter after pediatric cardiac surgery is high,which is affected by age,catheter indwelling time and catheter displacement factors. And the different factors can interact and influence each other. If we can develop effective nursing measures according to the risk factors,we can reduce the incidence of bleeding.
引文
[1]高瑞秋.肿瘤晚期患儿静脉营养支持治疗经外周静脉穿刺中心静脉置管相关并发症分析及护理对策[J].山西医药杂志,2017,46(22):2714-2716.
[2]刘朝红,向阳.高龄伴肌张力障碍患儿PICC置管后渗血原因分析及护理对策[J].实用临床医药杂志,2017,21(18):146-147.
[3]Yamaguchi RS,Noritomi DT,Degaspare NV,et al.Peripherally inserted central catheters are associated with lower risk of bloodstream infection compared with central venous catheters in paediatric intensive care patients:a propensity-adjusted analysis[J].Intensive Care Medicine,2017,43(8):1-8.
[4]谭晶,韩玉霞,史小英,等.ICU中心静脉导管相关性血流感染的高危因素分析及护理对策[J].检验医学与临床,2017,14(A01):242-244.
[5]徐丽君,王芬,黄丽红,等.并发症预防护理在长期留置颈内静脉导管围手术期患者中的应用[J].护理实践与研究,2017,14(15):126-127.
[6]周文华,史冬雷,宋晨,等.急诊重症监护病房中心静脉导管相关血行感染目标性监测及危险因素分析[J].中华现代护理杂志,2017,23(22):2894.
[7]马佩芬,王东敏,张秀,等.长效物理抗菌材料应用于中心静脉导管相关性感染的有效性及安全性分析[J].中华医院感染学杂志,2017,27(24):5592-5595.
[8]路云婷.PDCA护理在白血病患者经外周置入中心静脉导管中的应用[J].护理实践与研究,2018,15(16):121-122.
[9]范敏.临床护理路径降低经外周静脉置入中心静脉导管并发症中的积极作用分析[J].山西医药杂志,2017,46(10):1250-1251.
[10]郭宏.早期预见性护理预防恶性肿瘤外周静脉置入中心静脉导管时静脉血栓形成的临床价值[J].血栓与止血学,2017,23(2):355-357.
[11]Steenvoorden TS,Smit JM,Haaksma ME,et al.Necessary additional steps in ultrasound guided central venous catheter placement:getting to the heart of the matter[J].CriticalCare,2017,21(1):307.
[2]刘朝红,向阳.高龄伴肌张力障碍患儿PICC置管后渗血原因分析及护理对策[J].实用临床医药杂志,2017,21(18):146-147.
[3]Yamaguchi RS,Noritomi DT,Degaspare NV,et al.Peripherally inserted central catheters are associated with lower risk of bloodstream infection compared with central venous catheters in paediatric intensive care patients:a propensity-adjusted analysis[J].Intensive Care Medicine,2017,43(8):1-8.
[4]谭晶,韩玉霞,史小英,等.ICU中心静脉导管相关性血流感染的高危因素分析及护理对策[J].检验医学与临床,2017,14(A01):242-244.
[5]徐丽君,王芬,黄丽红,等.并发症预防护理在长期留置颈内静脉导管围手术期患者中的应用[J].护理实践与研究,2017,14(15):126-127.
[6]周文华,史冬雷,宋晨,等.急诊重症监护病房中心静脉导管相关血行感染目标性监测及危险因素分析[J].中华现代护理杂志,2017,23(22):2894.
[7]马佩芬,王东敏,张秀,等.长效物理抗菌材料应用于中心静脉导管相关性感染的有效性及安全性分析[J].中华医院感染学杂志,2017,27(24):5592-5595.
[8]路云婷.PDCA护理在白血病患者经外周置入中心静脉导管中的应用[J].护理实践与研究,2018,15(16):121-122.
[9]范敏.临床护理路径降低经外周静脉置入中心静脉导管并发症中的积极作用分析[J].山西医药杂志,2017,46(10):1250-1251.
[10]郭宏.早期预见性护理预防恶性肿瘤外周静脉置入中心静脉导管时静脉血栓形成的临床价值[J].血栓与止血学,2017,23(2):355-357.
[11]Steenvoorden TS,Smit JM,Haaksma ME,et al.Necessary additional steps in ultrasound guided central venous catheter placement:getting to the heart of the matter[J].CriticalCare,2017,21(1):307.