【摘要】目的探讨集束化护理在血液透析患者动静脉内瘘绳梯式穿刺中的应用效果。方法选择南京市高淳人民医院自2017 年1 月～2019 年1 月收入的60 例使用动静脉内瘘行血液透析患者作为研究对象，按照随机数字表法将患者均分成对照组和试验组，对照组采用常规护理，试验组在对照组基础上应用集束化护理，比较2 组患者一次性穿刺成功率、绳梯式穿刺执行率、内瘘自我护理能力、内瘘渗血率、血管瘤发生率、穿刺部位感染率、内瘘血栓发生率。结果试验组绳梯式穿刺执行率95.37%，显著高于对照组的绳梯式穿刺执行率88.53%(χ2=128.139，P＜0.001)，试验组动静脉内瘘自我护理能力分值(131.97±5.09)显著高于对照组(111.97±6.41)的分值(χ2=13.880, P＜0.001)，而试验组一次性穿刺成功率和对照组无明显差异性(P＞0.05)。试验组患者内瘘渗血(χ2=34.734, P＜0.001)、血管瘤发生(χ2=27.778,P＜0.001)、穿刺部位感染(χ2=5.192,P=0.023)、内瘘血栓(χ2=6.405,P=0.011)。结论使用集束化护理可以显著提高护士动静脉内瘘绳梯式穿刺执行率以及患者内瘘自我护理能力，减少患者动静脉内瘘并发症的发生，值得临床推广应用。
【Abstract】Objective To explore the application effect of cluster nursing mode on rope ladder puncture of arteriovenous internal fistula (AVF) in hemodialysis patients. Methods A total of 60 patients with AVF for hemodialysis and admitted to our hospital from January 2017 to January 2020 were recruited as the research subjects. They were divided into control group and experimental group according to the random number table method. All patients were treated with the conventional nursing care, while patients in the experimental group were also treated with the cluster nursing mode. The success rate of first puncture, performance rate of rope ladder puncture, self-care ability of AVF, bleeding rate of AVF, incidence of hemangioma, infection rate at the puncture site, and incidence of thrombosis in AVF were compared between the two groups. Results Rope ladder puncture was used in 95.37% patients in experimental group, higher than 88.53% patients in control group (χ2=128.139, P＜0.001). The score of self- care ability of AVF was (131.97 ± 5.09) in experimental group, higher than (111.97±6.41) in control group (t=13.880, P＜0.001). The success rate of first puncture had no significant difference between the two groups (P>0.05). Complications of rope ladder puncture were lower in experimental group than in control group (P<0.05): blood exudation from AVF not found in experimental
group and 8 cases in control group, hemangioma 2 cases in experimental group and 8 cases in control group, infection at puncture site one case in experimental group and 7 cases in control group, and thrombosis in AVF one case in experimental group and 8 cases in control group. Conclusion The application of cluster nursing mode significantly increased the performance rate of rope ladder puncture of AVF and the self-care ability of AVF and decreased the incidence of AVF complications in hemodialysis patients with AVF. Therefore, the cluster nursing mode is worthwhile to be used in clinical practice.
[1]Lok CE，Huber TS，Lee T，et al.KDOQI Clinical Practice Guideline for Vascular Access：2019 Update[J].Am J Kidney Dis, 2020, 75(4):s-l
[2]高菊林, 梁珊珊, 杜晶晶, 刘小敏, 蒋红利.B超下画图计划绳梯穿刺在动静脉内瘘患者中的应用与分析[J]. [J].中国血液净化,, 2018, 17(5):356-359
[3]Kukita K, Ohira S, Amano I, et al.update Japanese Society for Dialysis Therapy Guidelines of Vascular Access Construction and Repair for Chronic Hemodialysis[J].TherApher Dial, 2015, 19(Suppl 1):1-39
[4]徐元恺, 张丽红, 张文云, 等.自体动静脉内瘘建立后的血管重构及其影响因素[J].中华肾脏病杂志, 2014, 30(6):424-428
[5]陈文涛, 邱红, 杨勤, 等.用动、静脉内瘘穿刺图谱对血透患者动静脉内瘘使用效果的探讨[J].兵团医学, 2016, 49(3):23-24
[6]韩丽君, 彭幼清, 吴倩等.血液透析病人动静脉内瘘自我护理能力量表的编制及信效度检验[J].[J].全科护理, 2019, 17(34):4331-4334
[7]ELIZABETHR, JARMAN B, SUNTHARALINGUM G.Using care bundles to reduce in hospital mortality：quantitative survey[J].Br Med J, 2010, 340(15):861-863
[8]BUKHARI S Z, HUSSAIN W M.BANJAR A A.et al. Application of ventilator care bundle and its impact on ventilator associated pneumonia incidence rate in the adult intemve care unit [J].[J].Saudi Medical JournaI., 2012, 33(3):278-283
[9]熊敏，吴丹叶，彭庆雄.预防机械通气患者鼻饲液反流及误吸的集束化护理实践[J]．[J].护理实践与研究, 2018, 8(14):54-56
[10]熊敏，吴丹叶，彭庆雄.预防机械通气患者鼻饲液反流及误吸的集束化护理实践[J].护理实践与研究, 2011, 8(14):54-56
[11]宋尚川.集束化护理理念的应用研究进展[J].[J].全科护理, 2019, 17(2):178-180
[12]陈景霞, 陈景伟, 孟凡婷.集束化护理对无肝素血液透析患者凝血的影响[J]. [J].中国卫生标准管理, 2020, 11(9):148-150
[13]徐骅, 耿梦雅.集束化护理在维持性血液透析患者中的应用[J]. [J].护理实践与研究,, 2019, 16(11):32-34
[14]劳永娟.集束化护理在预防血液透析导管相关血流感染中的效果分析[J]. [J].基层医学论坛，, 2020, 24(17):148-150
