我国三级甲等医院血液透析专科护理不良事件的现况调查及护理人力资源相关影响因素分析  

Current situation investigation of nursing adverse events and analysis of influencing factors related to nursing human resources in hemodialysis centers attached to class-A tertiary hospitals in China

作　　者：刘瑶[1,2] 黄子叶 李静[1,2] 许莹[1,2] 于重燕[1,2] 孟利 李桂 王朕玉 丁炎明[2] 曹立云[1,2] Liu Yao;Huang Ziye;Li Jing;Xu Ying;Yu Chongyan;Meng Li;Li Gui;Wang Zhenyu;Ding Yanming;Cao Liyun(Renal Division,Department of Medicine,Peking University First Hospital/Institute of Nephrology,Peking University/Key Laboratory of Renal Disease,Ministry of Health of China/Key Laboratory of Chronic Kidney Disease Prevention and Treatment,Ministry of Education/Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases,Chinese Academy of Medical Sciences,Beijing 100034,China;Department of Nursing,Peking University First Hospital,Beijing 100034,China)

机构地区：[1]北京大学第一医院肾内科,北京大学肾脏疾病研究所,卫生部肾脏疾病重点实验室,慢性肾脏病防治教育部重点实验室,中国医学科学院免疫介导肾病诊治创新单元,北京100034 [2]北京大学第一医院护理部,北京100034

出　　处：《中国实用护理杂志》2025年第4期275-283,共9页Chinese Journal of Practical Nursing

基　　金：中国卫生人才培养项目护理研究子项目(2021-HLYJ-011)。

摘　　要：目的调查我国三级甲等医院血液透析中心(简称血透中心)专科护理不良事件的现况并分析其护理人力资源相关影响因素,以期为血透中心科学调整护理人力资源以减少专科护理不良事件的发生提供参考依据。方法采用便利抽样法,于2021年8—10月,使用自行设计的调查问卷,对我国2020年860家三级甲等医院血透中心专科护理不良事件发生情况进行横断面调查,采用多因素Logistic回归分析血透中心发生失血、血液透析导管相关性血流感染(CRBSI)和穿刺针脱出(VND)等护理不良事件的影响因素。结果共收到有效问卷826份,有效回收率96.05%(826/860)。826家血透中心覆盖我国31个省、市、自治区,各中心建立年限为24(18,30)年,透析机45(30,62)台,在透患者180(110,260)例,注册护士19(13,27)名。发生失血、血液透析CRBSI和VND的血透中心数量占比分别为70.94%(586/826)、68.04%(562/826)和46.97%(388/826)。多因素Logistic回归分析显示,每日治疗班次(OR=0.730,95%CI 0.536~0.994)、本科及以上学历护士占比(OR=1.635,95%CI 1.142~2.342)和护士是否兼职腹膜透析工作(OR=0.225,95%CI 0.052~0.965)是血透中心发生失血的影响因素(均P<0.05);每日治疗班次(OR=0.566,95%CI 0.413~0.777)、每护士每班次负责患者例数(OR=0.549,95%CI 0.400~0.753)、血液净化专科护士占比(OR=1.661,95%CI 1.216~2.269)、护士是否兼职连续性肾脏替代治疗工作(OR=0.700,95%CI 0.511~0.957)、护理管理者学历为专科及以下(OR=3.789,95%CI 1.576~9.113)和本科(OR=2.585,95%CI 1.328~5.033)是血透中心发生血液透析CRBSI的影响因素(均P<0.05);每护士每班次负责患者例数(OR=0.580,95%CI 0.433~0.777)是血透中心发生VND的影响因素(P<0.05)。结论失血、血液透析CRBSI和VND在血透中心护理不良事件中较为常见,医院管理者可针对上述影响因素采取相应措施,预防并降低血液透析护理不良事件的发生,提高护理质量安全。ObjectiveTo investigate the current situation of adverse events in hemodialysis nursing in class-A tertiary hospitals in China and analyze their nursing human resources related influencing factors,aiming at provide references for hemodialysis centers to adjust nursing human resources scientifically to reduce the occurrence of nursing adverse events.MethodsA convenient sampling method was used.From August to October 2021,a self-designed questionnaire was used to investigate nursing adverse events in hemodialysis centers of 860 class-A tertiary hospitals during 2020 in China.Multivariate Logistic regression was used to analyze the influencing factors of blood loss,hemodialysis catheter-related blood stream infection(CRBSI)and venous needle dislodgement(VND)in hemodialysis centers.ResultsA total of 826 valid questionnaires were received,with an effective response rate of 96.05%(826/860).There were 826 hemodialysis centers covering 31 provinces,municipalities and autonomous regions in China.The establishment period of each center was 24(18,30)years.There were 45(30,62)dialysis machines,180(110,260)patients and 19(13,27)registered nurses.Blood loss,hemodialysis CRBSI and VND occurred in 70.94%(586/826),68.04%(562/826)and 46.97%(388/826)of hemodialysis centers,respectively.Multivariate Logistic regression results showed that the daily treatment shift(OR=0.730,95%CI 0.536-0.994),the proportion of nurses with bachelor's degree or above(OR=1.635,95%CI 1.142-2.342),and whether nurses worked part-time on peritoneal dialysis treatment(OR=0.225,95%CI 0.052-0.965)were the influencing factors for blood loss in hemodialysis centers(all P<0.05).The daily treatment shift(OR=0.566,95%CI 0.413-0.777),the number of patients which each nurse was responsible for per shift simultaneously(OR=0.549,95%CI 0.400-0.753),proportion of blood purification specialized nurses(OR=1.661,95%CI 1.216-2.269),whether nurses worked part-time on CRRT(OR=0.700,95%CI 0.511-0.957),the education level of the nursing manager was junior college and below(OR=3.

关 键 词：感染 血液透析中心 护理不良事件 护理人力资源 影响因素 失血 穿刺针脱出 

分 类 号：R473.5[医药卫生—护理学]