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目的:总结无缝隙护理用于极低出生体质量儿脐静脉插管与经外周静脉穿刺中心静脉置管(PICC)联合的临床体会。方法:将本院2015年3月至2016年3月76例极低出生体质量儿根据无缝隙护理实施前后分为对照组(2015年3月至9月)与观察组(2015年10月至2016年3月),两组均38例。胎儿出生后即刻进行脐静脉插管,7~10 d后改为PICC。对照组采取常规护理;观察组实施无缝隙护理,即无缝隙护理管理培训→建立无缝隙护理团队→联合置管护理评估、对策→出院后管理→无缝隙护理质量控制标准。比较两组患儿出生即刻,出生1、2、4周时体质量变化,分组记录并比较两组置管相关不良事件及并发症发生率。结果:两组患儿随观察时点推移,体质量呈上升趋势,观察组2、4周时体质量均较出生体质量高(P<0.05),对照组4周时体质量与出生体质量才有差异(P<0.05),组间不同时点比较差异均无统计学意义(P>0.05)。观察组联合置管相关不良事件发生率为13.16%,对照组发生率为50%,观察组发生率显著低于对照组(P=0.01);观察组6例患儿出现并发症,对照组11例患儿发生并发症,差异无统计学意义(P>0.05)。结论:无缝隙护理用于极低出生体质量儿脐静脉插管与PICC联合中可加快患儿体质量增加速度,同时可显著降低置管相关不良事件,间接减少患儿置管后并发症发生率,具有良好的临床应用价值。
OBJECTIVE: To summarize the clinical experience of seamless nursing for combination of umbilical vein catheterization with peripheral venipuncture and central venous catheterization (PICC) at very low birth weight. Methods: From March 2015 to March 2016, 76 cases of very low birth weight children were divided into control group (March-September 2015) and observation group (October-October 2015- March 2016), 38 cases in both groups. Fetal umbilical vein catheter immediately after birth, 7 ~ 10 d after the PICC. The control group to take regular care; observation group to implement seamless care, namely, seamless care management training → seamless care team to establish → joint care assessment, management → discharge management → seamless care quality control standards. The changes of body weight were compared between the two groups immediately before birth, at 1, 2, and 4 weeks after birth, and the incidences of catheter-related adverse events and complications were recorded and compared in two groups. Results: The body weight of the two groups increased with the time of observation. The body weight of the observation group was higher than that of the birth weight at the 2nd and 4th week (P <0.05), while the body weight and birth weight of the control group at 4 weeks (P <0.05). There was no significant difference between the two groups at different time points (P> 0.05). The incidence of adverse events associated with catheterization was 13.16% in the observation group and 50% in the control group, and the incidence in the observation group was significantly lower than that in the control group (P = 0.01). Complications were observed in 6 children in the observation group and 11 Cases of complications occurred in children, the difference was not statistically significant (P> 0.05). Conclusion: Seamless nursing can be used to speed up the increase of body mass in children with very low birth weight infants and PICC, significantly reduce the incidence of catheter-related adverse events, and indirectly reduce the incidence of complications after catheterization in children Rate, with good clinical value.