上肢锻炼联合FMEA护理对PICC置管患者医院获得性静脉血栓栓塞症发生率及内皮功能的影响

林晓非; 田圆; 林圆圆; 王建群; 许圣美; 王红霞

doi:10.16766/j.cnki.issn.1674-4152.003483

上肢锻炼联合FMEA护理对PICC置管患者医院获得性静脉血栓栓塞症发生率及内皮功能的影响

doi: 10.16766/j.cnki.issn.1674-4152.003483

温州医科大学附属第一医院血液内科，浙江温州 325000

基金项目:

浙江省医药卫生科技计划项目 2023KY887

详细信息

通讯作者:
王红霞，E-mail：284004108@qq.com

中图分类号: R473.55 R543.6
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出版历程
- 收稿日期: 2023-11-25
- 网络出版日期: 2024-05-29

Effect of upper limb exercise combined with FMEA nursing on the incidence and endothelial function of hospital-acquired venous thromboembolism in patients with PICC catheterization

Department of Hematology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China

摘要

摘要: 目的探讨上肢锻炼联合失效模式与效应分析(FMEA)护理应用于经外周静脉置入中心静脉导管(PICC)置管患者的效果，以及对患者内皮功能、医院获得性静脉血栓栓塞症发生率的影响。方法选取2022年6—12月温州医科大学附属第一医院PICC置管患者102例，按随机数表法分为对照组(51例，常规护理)与观察组(51例，上肢锻炼联合FMEA护理)。比较2组护理前后内皮功能(EMCs、FMD)、失效模式RPN值、锻炼依从性、静脉血栓栓塞症情况以及并发症发生情况。结果相较于对照组，观察组患者及其评估、导管因素、置管、冲管和封管、健康教育、日常照护等失效模式RPN值均明显更低(P < 0.05)。相较于护理前，2组护理后EMCs值升高，FMD值降低。但是，观察组护理后EMCs低于对照组[(1 094.59±101.10)% vs. (1 205.73±109.55)%，P < 0.05]，观察组FMD值高于对照组[(4.66±0.48)% vs. (3.73±0.48)%，P < 0.05]。护理后，相较于对照组，观察组锻炼依从性整体更高(P < 0.05)，以及获得性静脉血栓栓塞症整体更轻(P < 0.05)。并且，观察组并发症发生率更低(P < 0.05)。结论上肢锻炼联合FMEA护理应用于PICC置管患者，可提高其锻炼依从性，改善患者内皮功能，降低医院获得性静脉血栓栓塞症发生率，有助于预防血栓的形成。
- PICC置管 /
- 失效模式与效应分析护理 /
- 上肢锻炼 /
- 医院获得性静脉血栓栓塞症 /
- 内皮功能 /
- 血液流变学
Abstract: Objective To explore the effect of upper limb exercise combined with failure modes and effects analysis (FMEA) nursing on patients with peripherally inserted central catheter (PICC), as well as its influence on endothelial function and the incidence of hospital-acquired venous thromboembolism. Methods A total of 102 patients with PICC catheterization in the First Affiliated Hospital of Wenzhou Medical University from June to December 2022 were selected and randomly divided into control group (51 cases, routine nursing) and observation group (51 cases, upper limb exercise combined with FMEA Nursing). The endothelial function (EMCS, FMD), failure mode RPN value, exercise compliance, venous thromboembolism and complications were compared between the two groups before and after nursing. Results Compared with the control group, the RPN values of patients in the observation group and their failure modes such as evaluation, catheter factors, catheterization, flushing, sealing, health education and daily care were significantly lower (P < 0.05). The EMCs value increased and the FMD value decreased following care in both groups, as compared to pre-care levels. However, the EMCs of the observation group [(1 094.59±101.10)%] was significantly lower than that of the control group [(1 205.73±109.55)%], while the FMD value of the observation group [(4.66±0.48)%] was significantly higher than that of the control group [(3.73±0.48)%], with significance levels of P < 0.05. After care, the observation group had higher overall exercise compliance compared with the control group (P < 0.05), and overall acquired venous thromboembolism lighter (P < 0.05). The incidence of complications was lower in the observation group (P < 0.05). Conclusion The application of upper limb exercise combined with FMEA nursing in patients with PICC catheter can improve their exercise compliance, improve endothelial function, reduce the incidence of hospital acquired venous thromboembolism, and help to prevent thrombosis.
- PICC tube placement /
- Failure modes and effects analysis care /
- Upper limb exercise /
- Hospital-acquired venous thromboembolism /
- Endothelial function /
- Hemorheology

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表 1 2组PICC置管患者一般资料比较

Table 1. Comparison of general data between the two groups of patients with PICC

组别	例数	性别[例(%)]		年龄(x±s，岁)	疾病类型[例(%)]					合并症[例(%)]
组别	例数	男性	女性	年龄(x±s，岁)	肺癌	食管癌	胃癌	肠癌	其他	高血压	糖尿病	冠心病
观察组	51	31(60.78)	20(39.22)	53.49±4.23	23(45.10)	6(11.76)	6(11.76)	7(13.73)	9(17.65)	6(11.76)	5(9.80)	4(7.84)
对照组	51	24(47.06)	27(52.94)	53.61±4.30	20(39.22)	7(13.73)	10(19.61)	9(17.65)	5(9.80)	7(13.73)	6(11.76)	5(9.80)
统计量		1.933^a		-0.139^b	2.679^a					0.088^a	0.102^a	0.122^a
P值		0.164		0.889	0.613					0.767	0.750	0.727
注：^a为χ²值，^b为t值。

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表 2 2组PICC置管患者护理前后内皮功能比较(x±s，%)

Table 2. Comparison of endothelial function before and after nursing in between the two groups of patients with PICC(x±s, %)

组别	例数	EMCs		FMD
组别	例数	护理前	护理后	护理前	护理后
观察组	51	809.55±96.52	1 094.59±101.10^b	5.41±0.72	4.66±0.48^b
对照组	51	810.29±97.46	1 205.73±109.55^b	5.19±0.74	3.73±0.48^b
统计量		-0.039^a	0.426^c	1.549^a	3.008^c
P值		0.969	0.515	0.125	0.086
注：^a为t值，^c为F值；与同组护理前比较，^bP < 0.05。

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表 3 2组PICC置管患者失效模式RPN值比较(x±s)

Table 3. Comparison of RPN value of failure mode between the two groups of patients with PICC(x±s)

组别	例数	患者及其评估	导管因素	置管	冲管和封管	健康教育	日常照护
观察组	51	69.67±8.25	77.12±10.36	68.02±9.06	62.04±8.15	88.43±10.28	64.20±7.53
对照组	51	119.37±15.68	139.12±18.91	108.84±13.00	98.90±9.83	136.22±18.47	108.43±12.53
t值		20.040	20.532	18.396	20.616	16.145	21.618
P值		< 0.001	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001

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表 4 2组PICC置管患者锻炼依从性比较[例(%)]

Table 4. Comparison of exercise compliance between the two groups of patients with PICC[cases(%)]

组别	例数	护理前				护理后
组别	例数	不依从	不够依从	基本依从	依从	不依从	不够依从	基本依从	依从
观察组	51	22(43.14)	15(29.41)	6(11.76)	8(15.69)	6(11.76)	11(21.57)	15(29.41)	19(37.25)
对照组	51	24(47.06)	9(17.65)	8(15.69)	10(19.61)	15(29.41)	12(23.53)	11(21.57)	13(25.49)
Z值		0.135				2.138
P值		0.893				0.033

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表 5 2组PICC置管患者获得性静脉血栓栓塞症发生情况比较(例)

Table 5. Comparison of the incidence of acquired venous thromboembolism in patients with PICC between the two groups(cases)

组别	例数	0级	Ⅰ级	Ⅱ级	Ⅲ级
观察组	51	50	1	0	0
对照组	51	45	3	2	1
注：2组比较，Z=1.970，P=0.049。

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表 6 2组PICC置管患者并发症发生率比较[例(%)]

Table 6. Comparison of the incidence of complications between the two groups of patients with PICC[cases(%)]

组别	例数	导管脱出	导管阻塞	穿刺点感染	继发感染	总发生
观察组	51	1(1.96)	1(1.96)	0	0	2(3.92)
对照组	51	3(5.88)	3(5.88)	1(1.96)	2(3.92)	9(17.65)
注：2组患者总体并发症发生率比较，χ²=4.993，P=0.025。

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