摘要
目的探讨QC小组干预活动降低烧伤创面股静脉置管期间导管相关性感染(CRI)发生率的效果,探索经烧伤创面深静脉置管的维护标准。方法回顾性分析2017年1月至2021年12月汕头市第二人民医院烧伤整形科经烧伤创面置股静脉导管患者,其中实施常规处理的65例(95例次)患者为非干预组,运用QC小组干预活动对其置管期间护理质量与安全进行干预的115例(185例次)患者为干预组。两组患者按置管持续时间分段(0~22 d、23~30 d、31~45 d)统计各例次置管后CRI发生情况。计量资料行正态性检验,用x±s表示,组间比较采用t检验,否则用中位数(四分位间距)表示,采用Mann-Whitney U检验;计数资料用例(%)表示,根据数据情况采用χ^(2)检验或Fisher确切概率法,两组间多重比较采用Bonferroni法。结果干预组在导管留置为0~22 d的病例数为99例次、23~30 d为51例次、31~45 d为35例次;非干预组在导管留置0~22 d的病例数为30例次、23~30 d为27例次、31~45 d为38例次。非干预组在导管留置0~22 d、23~30 d、31~45 d CRI发生率为30.00%、40.47%、47.37%,分别高于干预组的14.14%、17.65%、22.86%,差异具有统计学意义(χ^(2)=3.952、4.938、4.773,P<0.05)。两组CRI发生率比较,干预组(16.76%)明显低于非干预组(40.00%),差异有统计学意义(χ^(2)=18.261,P<0.001)。烧伤深度Ⅱ°与Ⅲ°(OR=9.924,95%CI:5.376~16.921)、烧伤总面积(OR=1.048,95%CI:1.019~1.078)、置管时长(OR=1.074,95%CI:1.032~1.117)和QC干预护理(OR=0.181,95%CI:0.103~0.256)是影响CRI的关键因素。结论QC小组干预活动能提高经烧伤创面股静脉置管期间患者护理质量与安全,按计划拔管的同时,有效降低经烧伤创面置管期间并发症发生率。
Objective To explore the application effect of QC circle intervention activities in reducing the incidence of catheter-related infection(CRI)during femoral vein catheterization through burn wounds,and explore the establishment of maintenance standards for deep vein catheterization through burn wounds.Methods Patients who underwent femoral vein catheterization through burn wounds from January 2017 to December 2021 in Department of Burns and Plastic Surgery,the Second People′s Hospital of Shantou were selected and retrospectively investigated.Among them,65 patients(95 times)who underwent routine treatment were set as non-intervention group,and 115 patients(185 times)who used QC group intervention activities to intervene in the QC nursing during catheterization were set as intervention group.The two groups of patients were divided into the duration of catheterization(0-22 d,23-30 d,31-45d).The occurrence of CRI after catheterization was counted.The measurement data were first tested for normality,expressed as±s deviation,and t test was used for comparison between groups.Otherwise,the median(interquartile range)was expressed as Mann-Whitney U test;the enumeration data were expressed as the number of cases.Chi-square test or Fisher exact probability method was used according to the data.Bonferroni was used for multiple comparisons between the two groups.Results In the intervention group,there were 99 cases of catheter indwelling for 0-22 days,51 cases for 23-30 days and 35 cases for 31-45 days.In the non-intervention group,there were 30 cases of catheter indwelling for 0-22 days,27 cases for 23-30 days and 38 cases for 31-45 days.The incidence of CRI in the non-intervention group was 30.00%,40.47%and 47.37%at 0-22 d,23-30 d and 31-45 d after catheter indwelling,which was higher than 14.14%,17.65%and 22.86%in the intervention group,respectively.The incidence of CRI was statistically significant(χ^(2)=3.952,4.938,4.773,P<0.05).The incidence of CRI in the intervention group(16.76%)was significantly lower than that in the non-intervention group(40.00%)(χ^(2)=18.261,P<0.001).In addition,by Logistic multivariate analysis,burn depthⅡ°andⅢ°(OR=9.924,95%CI:5.376-16.921),total burn area(OR=1.048,95%CI:1.019-1.078),catheterization time(OR=1.074,95%CI:1.032-1.117)and QC intervention nursing method(OR=0.181,95%CI:0.103-0.256)were the key factors affecting CRI.Conclusion The intervention of QC circle can improve the quality and safety of patient care during femoral vein catheterization through the burn wound.While the catheter was removed as planned,the incidence of complications during catheterization through the burn wound is effectively reduced,as well as the medical and nursing costs,benefiting the patients.
作者
蔡柔妹
曾洁梅
黄伟丽
谢文敏
刘燕丹
吴漫君
蔡楚燕
Cai Roumei;Zeng Jiemei;Huang Weili;Xie Wenmin;Liu Yandan;Wu Manjun;Cai Chuyan(Department of Burns and Plastic Surgery,the Second People's Hospital of Shantou,Shantou 515011,China)
出处
《中华损伤与修复杂志（电子版）》
CAS
2023年第5期399-404,共6页
Chinese Journal of Injury Repair and Wound Healing(Electronic Edition)
基金
2019年汕头市第一、二批卫生科技计划项目(汕府科[2019]77号)。
关键词
感染
护理管理研究
QC小组
烧伤创面
股静脉导管
Infections
Nursing management research
QC circle
Burn wounds
Femoral vein catheter
