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目的探讨系统性护理干预对行心脏直视术后中心静脉导管相关性感染的影响,为降低感染率提供护理经验。方法将2014年1月—2015年6月中国人民解放军海军总医院心脏中心心脏直视术后置中心静脉导管患者206例随机分为2组,观察组和对照组各103例,对照组给予常规护理措施,观察组通过检索相关文献找出中心静脉导管相关性感染与护理相关的问题,根据中心静脉导管相关感染的危险因素(高龄、长时间置管、无菌操作不严格、置管维护质量、静脉置管途径等),将以上护理问题结合患者的个体差异制订护理措施,在围手术期予以实施。观察2组中心静脉导管置管后导管穿刺部位感染、中心静脉导管相关性血流感染及发生时间,局部渗血、导管脱出、导管阻塞等不良反应的发生率。结果观察组与对照组患者穿刺点感染发生率分别为5.82%和18.44%(6例和19例),2组差异有统计学意义(P<0.01);中心静脉导管相关性血流感染的发生率分别为2.91%和11.65%(3例和12例),2组差异有统计学意义(P<0.05);观察组与对照组置管后导管堵塞、脱出、局部渗血的发生率分别为3.89%、5.82%、2.91%和13.59%、16.50%、9.70%,2组差异均有统计学意义(P<0.05)。结论心脏直视术后中心静脉导管的循证护理干预可明显降低中心静脉导管相关性感染及减少不良情况的发生,值得在相关护理工作中借鉴。
Objective To investigate the effect of systemic nursing intervention on central venous catheter-related infection after open heart surgery and to provide nursing experience for reducing the infection rate. Methods From January 2014 to June 2015, 206 patients with posterior central venous catheters undergoing open heart surgery in the Naval General Hospital of Chinese People’s Liberation Army were randomly divided into 2 groups: 103 cases in observation group and control group, while those in control group were given conventional Nursing measures, the observation group to retrieve the relevant literature through the search for central venous catheter-related infection and nursing-related issues, according to the risk factors of central venous catheter-related infection (elderly, prolonged catheterization, aseptic operation is not strict, quality control , Venous catheter approach, etc.), the above nursing issues combined with the individual differences in patients to develop nursing interventions, be carried out during the perioperative period. The incidences of catheterization, central venous catheter-related bloodstream infections and their occurrence, local bleeding, catheter prolapse and catheter obstruction were observed in 2 groups of central venous catheters. Results The incidence of puncture point infection in observation group and control group were 5.82% and 18.44% respectively (6 cases and 19 cases), the difference between the two groups was statistically significant (P <0.01); central venous catheter-related bloodstream infections (2.91% and 11.65% respectively) (3 cases and 12 cases). The difference between the two groups was statistically significant (P <0.05). The incidences of catheter blockage, prolapse and local bleeding in the observation group and the control group were 3.89%, 5.82%, 2.91% and 13.59%, 16.50% and 9.70%, respectively. There were significant differences between the two groups (P <0.05). Conclusion Evidence-based nursing intervention after central venous catheterization can significantly reduce the incidence of central venous catheter-related infections and reduce the incidence of adverse events, which is worth learning from the related nursing work.