Application of child life program intervened in children' s intravenous indwelling needle puncture
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摘要:
目的 探讨儿童生活计划干预在住院患儿静脉留置针穿刺中的应用效果。 方法 收集安徽医科大学第一附属医院2019年2月25日—2021年6月12日年龄3~10岁需行静脉留置针穿刺的新入院患儿120例，采用随机数字表法分为2组，干预组61例，对照组59例。对照组留置针穿刺前采用常规护理和健康教育，干预组在此基础上采用儿童生活计划干预。采用疼痛行为评估量表(FLACC)和面部表情疼痛量表(Wong-Baker)对患儿留置针穿刺时疼痛程度进行评分，比较2组患儿的疼痛评分、留置针穿刺依从性和一次穿刺成功率。 结果 在静脉条件良好的患儿中, 干预组FLACC量表得分[2(1, 3)分]和面部表情疼痛得分[2(2, 3)分]均显著低于对照组[5(2, 8)分和6(4, 8)分, Z=-4.335、-5.802, 均P < 0.001]。在穿刺护士年资为N3(6~10年)、N4(>10年)的患儿中, 干预组FLACC量表得分低于对照组[2(1, 3)分vs. 4(2, 8)分, Z=-3.022, P=0.003; 2(1, 3)分vs. 5(2, 7)分, Z=-2.975, P=0.003), 面部表情疼痛得分也显著低于对照组[2(2, 4)分vs. 6(3.5, 10)分，Z=-4.760, P < 0.001; 2(2, 2)分vs. 6(4, 10)分，Z=-4.431，P < 0.001]。干预组患儿留置针穿刺依从性及一次穿刺成功率明显高于对照组(均P＜0.05)。 结论 儿童生活计划干预可减轻儿童对静脉留置针穿刺的疼痛反应，提高留置针穿刺的依从性和一次穿刺成功率。 Abstract:Objective Child Life Program intervened the use of various measures to reduce children' s stress during medical processes. This study aimed to investigate the application effect of child life program intervened in children' s intravenous indwelling needle puncture. Methods From February 25, 2019 to June 12, 2021, 120 newly admitted children aged 3 to 10 years who underwent intravenous indwelling needle puncture from the First Affiliated Hospital of Anhui Medical University were collected and randomly divided into two groups by the radom number table method, with 61 cases in the intervention group and 59 cases in the control group. The control group used conventional children' s indwelling needle pre-puncture care and health education methods, whereas the intervention group used child life program intervention with routine education. Using the FLACC (face, legs, activity, cry, and consolability) pain behaviour assessment scale and the Wong-Baker faces pain rating scale, the degree of children' s pain during indwelling needle puncture was scored. The pain scores, compliance and one-time puncture success rate was compared. Results In children with good venous conditions at the puncture site, the FLACC scale scores [2(1, 3)] points and the Wong-Baker FACES scale scores [2(2, 3)] points of the intervention group were significantly lower than those of the control group [5(2, 8) points, 6(4, 8) points, Z=-4.335, -5.802, all P < 0.001]; Among the children who were operated by nurses with 6 to 10 years or more of experience, the FLACC scale scores and were significantly lower than those of the control group [2(1, 3) points vs. 4(2, 8) points, Z=-3.022, P=0.003; 2(1, 3) points vs. 5(2, 7) points, Z=-2.975, P=0.003]; And Wong-Baker faces scale scores and of the intervention group were significantly lower than those of the control group [2(2, 4) points vs. 6(3.5, 10) points, Z=-4.760, P < 0. 001; 2(2, 2) points vs. 6(4, 10) points, Z=-4.431, P < 0.001]. Moreover, the compliance of intravenous indwelling needle puncture and the one-time puncture success rate in the intervention group were significantly higher than those in the control group. Conclusion The application of child life program can reduce the pain response of children' s intravenous indwelling needle puncture, improve compliance and increase the primary puncture success rate. -
表 1 2组患儿病种情况及陪护者基本特征比较
Table 1. Comparison of basic characteristics of child chaperones and their disease types in the two groups
组别 例数 陪护者 陪护者文化程度a 病种情况 父亲 母亲 祖父母 初中及以下 高中或大专 本科及以上 肺及支气管受累 其他 干预组 61 11(18.0) 44(72.1) 6(9.8) 19(31.7) 18(30.0) 23(38.3) 54(88.5) 7(11.5) 对照组 59 8(13.6) 48(81.4) 3(5.1) 15(25.4) 21(35.6) 23(39.0) 47(79.7) 12(20.3) χ2值 1.585 0.693 1.768 P值 0.447 0.707 0.184 注：a干预组陪护者文化程度缺失1个样本。 
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表 2 FLACC量表
Table 2. FLACC scale
项目 0分 1分 2分 面部表情 无特定表情或笑容 偶尔面部表情或皱眉 持续颤抖下颏，紧缩下颏，紧皱眉头 肢体活动 正常体位或放松状态 不适，无法休息，肌肉或神经紧张，肢体间断弯曲/伸展 踢腿或拉直腿，高张力，扩大肢体弯曲度/伸展，发抖 体位 安静平躺，正常体位，可顺利移动 急促不安，来回移动，紧张，移动忧虑 卷曲或痉挛，来回摆动，头部左右摇动，揉搓身体各部位 哭闹 不哭不闹 呻吟或啜泣，偶尔哭泣，叹息 不断哭泣，尖叫或抽泣，呻吟 可安慰度 平静的，满足的，放松，不要求安慰 可通过偶尔身体接触消除疑虑，分散注意力 安慰有困难 注：评估总分0分为放松、舒服；1~3分为轻微不适；4~6分为中度疼痛；7~10分为严重疼痛、不适或二者都有。
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表 3 不同静脉条件下2组患儿穿刺时疼痛得分比较[M(P25, P75)，分]
Table 3. Comparison of pain scores between the Child Life Plan intervention and control groups under different puncture vein conditions [M(P25, P75), scores]
组别 例数 FLACC量表得分 面部表情疼痛得分 条件良好 条件一般 条件差 条件良好 条件一般 条件差 干预组 61 2.00(1.00, 3.00) 2.00(0.00, 3.00) 2.50(1.75, 4.25) 2(2, 3) 2(0, 3) 3(2, 4) 对照组 59 5.00(2.00, 8.00) 2.00(1.00, 4.00) 7.50(2.50, 8.75) 6(4, 8) 4(2, 6) 10(4, 10) Z值 -4.335 0.304 0.163 -5.802 0.050 0.090 P值 < 0.001 0.321 0.171 < 0.001 0.055 0.114
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表 4 由不同年资护士进行穿刺的2组患儿疼痛得分比较[M(P25, P75)，分]
Table 4. Comparison of pain scores between the intervention and control groups of the children whose punctures were performed by nurses of different seniority [M(P25, P75), scores]
组别 例数 FLACC量表得分 面部表情疼痛得分 N3(6~10年) N4(＞10年) N3(6~10年) N4(＞10年) 干预组 61 2(1, 3) 2(1, 3) 2.0(2.0, 4.0) 2.0(2.0, 2.0) 对照组 59 4(2, 8) 5(2, 7) 6.0(3.5, 10.0) 6.0(4.0, 10.0) Z值 -3.022 -2.975 -4.760 -4.431 P值 0.003 0.003 < 0.001 < 0.001
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表 5 2组患儿留置针穿刺依从性及一次穿刺成功率比较[例(%)]
Table 5. Comparison of compliance with indwelling needle puncture and success rate of one puncture between two groups of children[cases (%)]
组别 例数 穿刺依从性 一次性成功 好 良 差 干预组 61 26(42.62) 27(44.26) 8(13.11) 55(90.16) 对照组 59 21(35.59) 19(32.20) 19(32.20) 45(76.27) 统计量 -2.136a 4.168b P值 0.033 0.041 注：a为Z值，b为χ2值。
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