【摘要】目的探讨血液净化血管通路中心设置专职通路护士岗位的效果。方法将郑州大学第一附属医院2018 年7 月～12 月行透析通路手术的1529 名患者作为对照组，由病房责任护士实施围手术期常规护理；2019 年1 月～6 月行手术的1824 名患者作为试验组，设置血管通路专职护理岗位，实施标准化通路管理模式，2 组各跟踪随访6 个月，比较干预效果。结果2 组当前通路构成比(c2= 12.546，P=0.002)、新建血管通路类型构成比(c2=17.526，P=0.002)均有统计学差异，其中，当前通路自体动静脉内瘘使用率增加(c2=11.743，P=0.001)，导管使用率下降(c2=12.544，P＜0.001)，新建通路自体动静脉内瘘使用率增加(c2=11.849，P= 0.001)，导管使用率下降(c2=4.097, P=0.043)；患者内瘘术后6 个月通畅率、规律复诊率增加(c2值分别为8.928, 98.558, P 值分别为0.003，＜0.001)。结论血管通路专职护士全程参与患者通路管理工作，有效提高患者内瘘使用率、通畅率及复查依从性。
【Abstract】Objective To explore the effect of setting up a full-time nursing post for blood purification vascular access center in our hospital. Methods A total of 1,529 patients undergoing vascular access surgery for hemodialysis from July to December 2018 in First Affiliated Hospital of Zhengzhou University were selected as the control group, and the perioperative routine nursing mode was implemented by the ward nurses. A total of 1,824 patients undergoing vascular access surgery from January to June 2019 were recruited as the intervention group; a vascular access full-time nursing post was established, and standardized vascular access management process was implemented in the intervention group. The intervention effects of the two groups were compared after follow-up for six months. Results There were significant differences both in ratios of current vascular access type (c2=12.546, P=0.002) and access type for new patients (c2=17.526, P=0.002) between the two groups; in current vascular access type, AVF rate increased from 67.5% to 72.9% (c2=11.743, P=0.001) and central venous catheterization (CVC) rate reduced from 31.1% to 25.5% (c2=12.544, P<0.001); in access type for new patients, AVF rate increased from 49.3% to 56.8% (c2=11.849, P=0.001) and CVC rate reduced from 40.5% to 36.2% (c2=4.097, P=0.043). Fistula patency rate within 6 months after operation increased from 85.1% to 89.2% (c2=8.928, P=0.003). Follow-up rate increased from 30.1% to 50.1% (c2=98.558, P<0.001). Conclusion The vascular access full-time nurses involved in blood access management of the patients. Their work effectively increased the AVF rate, fistula patency rate and follow- up compliance.
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