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乳腺癌患者经外周静脉置入中心静脉导管维护依从性影响因素及精准护理效果分析

Influencing factors of maintenance compliance of peripherally inserted central catheter and effect of precise nursing

    摘要
  • 摘要:
    目的 探讨乳腺癌患者经外周静脉置入中心静脉导管(PICC)维护依从性的影响因素及精准护理效果。
    方法 选取301例乳腺癌PICC携带者作为研究对象, 采用单因素和多因素Logistic回归分析法分析乳腺癌PICC携带者导管维护依从性的影响因素，并绘制受试者工作特征(ROC)曲线评估多变量联合诊断模型的预测效能。采用双色球法将患者随机分为对照组150例(实施常规护理)和研究组151例(在常规护理基础上实施精准护理)，比较2组患者护理干预前后导管维护依从性水平、自我管理能力和护理满意度、并发症发生情况。
    结果 多因素Logistic回归分析显示，年龄≥50岁(OR=4.148, P=0.021)、文化程度小学及以下(OR=6.632, P=0.003)、文化程度中学或中专(OR=5.900, P=0.004)、月收入 < 2 000元人民币(OR=6.991, P=0.004)、月收入2 000~5 000元人民币(OR=4.679, P=0.034)、常规护理方式(OR=2.910, P=0.002)是乳腺癌PICC携带者导管维护依从性低的危险因素(P < 0.05); ROC曲线显示，多变量联合诊断模型的曲线下面积为0.870(95%CI: 0.829~0.910), 最佳临界值为0.269, 敏感度为83.7%, 特异度为74.0%, Youden指数为0.577。干预后，研究组导管维护依从性高于对照组，差异有统计学意义(P < 0.05); 干预后, 2组的肿瘤患者PICC自我管理能力量表(CPPSM)各维度评分及总分均高于干预前，且研究组高于对照组，差异有统计学意义(P < 0.05)。研究组护理满意度为95.36%, 高于对照组的83.33%, 差异有统计学意义(P < 0.05); 研究组静脉炎、导管堵塞、穿刺点感染、穿刺点出血、非计划性拔管发生率均低于对照组，差异有统计学意义(P < 0.05)。
    结论 精准护理可提升乳腺癌PICC携带者导管维护依从性、自我管理能力和护理满意度，并减少并发症发生。

     

    Abstract:
    Objective To explore influencing factors of catheter maintenance compliance in breast cancer patients with peripherally inserted central catheter (PICC) and the effect of precise nursing.
    Methods A total of 301 breast cancer patients with PICC were selected as study objects, univariate and multivariate analyses were used to analyze the influencing factors of catheter maintenance compliance in breast cancer patients with PICC, and receiver operating characteristic (ROC) curves were drawn to evaluate the predictive efficacy of combined diagnosis models of multivariate. Two-color ball method was used to randomly divide the subjects into control group (n=150, implementing routine nursing) and study group (n=151, implementing precision nursing based on routine nursing). Catheter maintenance compliance, self-management ability, nursing satisfaction and occurrence of complications were compared before and after the two groups.
    Results Logistic regression analysis showed that age≥ 50 years old (OR=4.148, P=0.021), education level of primary school or below (OR=6.632, P=0.003), senior high school or technical secondary school (OR=5.900, P=0.004), monthly income < 2 000 yuan RMB (OR=6.991, P=0.004), monthly income of 2 000 to 5 000 yuan RMB (OR=4.679, P=0.034), and basic nursing (OR=2.910, P=0.002) were risk factors for low level of catheter maintenance compliance of breast cancer PICC carriers (P < 0.05). The area under the ROC curve (AUC) was 0.870 (95%CI, 0.829 to 0.910), the optimal critical value was 0.269, the sensitivity was 83.7%, the specificity was 74.0%, and the Youden index was 0.577. After intervention, the catheter maintenance compliance of the study group was higher than that of the control group (P < 0.05). After intervention, the score of items of PICC Self-management Scale (CPPSM) and total score in two groups were higher than before intervention, and the study group was higher than the control group (P < 0.05). The nursing satisfaction of the study group was 95.36%, which was higher than 83.33% of the control group (P < 0.05). The incidence rates of phlebitis, catheter blockage, puncture point infection, puncture point bleeding and unplanned extubation in the study group were lower than those in the control group (P < 0.05).
    Conclusion Precision nursing can improve catheter maintenance compliance, self-management ability, nursing satisfaction, and reduce the occurrence of complications in breast cancer PICC carriers.

     

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