不同握球运动方式对PICC置管患者静脉血流及相关性血栓的影响  

Effects of different exercise modes of ball-holding on venous flow and related thrombus in patients withperipherally inserted central catheter

作　　者：惠慧 马燕兰[2] 郭艳艳[3] 叶明[4] Hui Hui;Ma Yanlan;Guo Yanyan;Ye Ming(Chinese PLA General Hospital, Medical School of Chinese PLA, Beijing 100853, China;Nursing（Department, First Affiliated Hospital of PLA General Hospital, Beijing 100048, Chin;the First Ward,the First Department of Medical Oncology, First Affiliated Hospital of PLA General Hospital, Beijing 100048,Chin;the Second Ward, the First Department of Medical Oncology, First Affiliated Hospital of PLA General Hospital, Beijing 100048, China)

机构地区：[1]解放军总医院解放军医学院,北京100853 [2]解放军总医院第一附属医院护理部,北京100048 [3]解放军总医院第一附属医院肿瘤内一科一病区,北京100048 [4]解放军总医院第一附属医院肿瘤内一科二病区,北京100048

出　　处：《中华现代护理杂志》2018年第12期1391-1398,共8页Chinese Journal of Modern Nursing

摘　　要：目的 探讨不同握球运动方式对预防PICC 相关性血栓的效果，为护理人员制定科学的护理措施提供依据。方法 采用目的抽样法，选取解放军总医院第一附属医院肿瘤科2017 年6 — 11月置入PICC 导管行化疗的肿瘤住院患者86 例，通过抛硬币法将肿瘤科2 个不同病区的患者分为试验组和对照组。置管后试验组每日三餐后 握球25～30 次，每次握紧10 s，松开10 s，握力大小以将握力球压缩至1/2 为准，对照组按常规护理每天分3 次握球500 次左右。使用多普勒彩色超声仪动态观察两组患者腋静脉血液流速、血栓发生情况、血栓形成部位、形成时间、血栓分级，同时监测置管后其他并发症的发生情况，并采用SAS 9.4 软件进行统计分析。结果 本研究排除失访后纳入试验组42 例、对照组 41 例患者。试验组患者置管前腋静脉最大流速为（16.12±3.62） cm/s，置管后1、3、7、14、21、28 d腋静脉最大流速分别为（15.83±3.07）、（15.69±3.01）、（15.05±2.49）、（14.46±3.85）、（15.47±2.95）、（14.75±2.91） cm/s，两组患者置管前血流差异无统计学意义（t=-0.54，P=0.594 5），置管后每个时间点组间比较发现21、 28 d 差异有统计学意义（t 值分别为-5.00、-4.69；P＜ 0.000 1），两组患者腋静脉最大流速组间与不同时间点交互作用有统计学意义（F=22.23，P＜ 0.000 1）。试验组患者置管前腋静脉单位时间内平均流速为（9.97±3.01） cm/s，置管后1、3、7、14、21、28 d 腋静脉单位时间内平均流速分别为（9.69±2.61）、（9.72±2.49）、（8.88±1.47）、（8.55±2.20）、（9.48±2.71）、（9.26±2.73） cm/s，两组患者置管前血流差异无统计学意义（t=0.07，P=0.945 9），置管后每个时间点组间比较发现21、28 d差异有统计学意义（t值分别为 -4.60、-4.48；P＜ 0.000 1），两组患者腋静脉单位时间内平均流速组间与不同时�Objective To explore the effects of different exercise modes of ball-holding on preventing peripherally inserted central catheter（ PICC） related thrombus, so as to provide a basis for formulating scientific nursing intervention. Methods From June to November 2017, this study selected 86 cancer patients with chemotherapy through PICC of Oncology Department in First Affiliated Hospital of PLA General Hospital by purposive sampling. All of the patients from two wards of Oncology Department were divided into the experimental group and the control group by tossing a coin. Patients of the experimental group carried out ball-holding 25 times to 30 times after 3 meals each day with clenching for 10 seconds, loosening 10 seconds and grip strength according to that the ball was compressed to one half. Patients of the control group accepted conventional nursing that ball-holding was implemented 3 times, a total of 500 times. Color Doppler ultrasound was used to dynamically observe the blood flow velocity, incidence, formation position, formation time and classification of thrombus as well as other complications after indwelling catheter. The SAS 9.4 was used to statistical analysis. Results This study involved 42 patients in the experimental group and 41 patients in the control group after removing missing patients. The maximum velocity of axillary vein of patients in experimental group before and 1, 3, 7, 14, 21, 28 days after indwelling catheter was（ 16.12±3.62）,（ 15.83±3.07）,（ 15.69±3.01）, （15.05±2.49）,（ 14.46±3.85）,（ 15.47±2.95） and（ 14.75±2.91） cm/s respectively. There was no significant difference in blood flow velocity before indwelling catheter between two groups（ t=-0.54, P=0.594 5）. But, there were significant differences in blood flow velocity 21 and 28 days after indwelling catheter between two groups（ t=-5.00,-4.69; P 〈 0.000 1）. The difference of the maximum velocity in interaction between groups and different time points was significant（ F=2

关 键 词：护理 静脉血栓形成 握球运动 PICC 导管相关性血栓 静脉流速 

分 类 号：R473.73[医药卫生—护理学]