RCA指导下护理干预在深静脉导管非计划性拔管中的应用

doi:10.3760/cma.j.cn441417-20250317-20035

摘要/Abstract

摘要： 目的　在分析根本原因分析法（RCA）指导下护理干预预防手术室深静脉非计划性拔管中应用价值。方法　本研究为前瞻性研究，采用随机数表法将2020年5月至2022年7月期间于商洛市中医医院手术室中需置入深静脉置管的186例患者分为对照组和研究组各93例，其中，对照组男67例，女26例，年龄（51.83±6.52）岁，均采用常规护理干预，而研究组男58例，女35例，年龄（49.67±6.91）岁，在常规护理的基础上进行根本原因分析法干预，比较两组患者经干预后的自我效能［自我效能量表（GSES）］、患者舒适度［舒适状况量表（GCQ）］、非计划性拔管率以及并发症发生率。采用t检验和x2检验。结果　干预后，的GSES、GCQ评分相较于干预前有所改善，其中，研究组GSES评分中的信心水平、应对能力、目标实现性和持久性维度评分均显著高于对照组［（29.73±5.86）分比（21.76±4.11）分、（28.92±6.94）分比（21.57±5.35）分、（29.37±7.08）分比（22.11±7.27）分、（30.15±6.77）分比（22.43±4.06）分］，两组比较差异均有统计学意义（均P<0.05）；研究组GCQ评分中的身体、心理、环境和社交维度评分均显著高于对照组［（92.47±7.89）分比（70.56±7.87）分、（93.72±7.96）分比（71.64±8.02）分、（94.23±8.04）分比（71.49±7.98）分、（93.89±7.92）分比（70.78±7.86）分］，两组比较差异均有统计学意义（均P<0.05）；经干预后，研究组患者由深静脉置管堵塞、移位以及脱出等现象导致的非计划性拔管率4.30%（4/93）显著低于对照组患者出现的12.90%（12/93），两组比较差异有统计学意义（P<0.05）；另外，研究组患者干预后出现的感染、血栓、气胸等并发症情况6.45%（6/93）显著低于对照组患者出现的16.13%（15/93），两组比较差异有统计学意义（P<0.05）。结论　采用RCA指导下的护理干预可有效降低患者的非计划性拔管率，提高患者舒适度和治疗安全性。

关键词: 根本原因分析法, 深静脉置管, 非计划性拔管, 自我效能, 舒适度

Abstract: Objective　To investigate the value for applying root cause analysis (RCA)-guided nursing intervention in preventing unplanned extubation of deep venous catheters. Methods　One hundred and eighty-six patients requiring deep venous catheterization in Operation Room, Shangluo Hospital of Traditional Chinese Medicine from May 2020 to July 2022 were selected for the prospective study, and were divided into a control group and a study group by the random number table method, with 93 cases in each group. There were 67 males and 26 females in the control group; they were (51.83±6.52) years old. There were 58 males and 35 females in the study group; they were (49.67±6.91) years old. The control group received conventional nursing; in addition, the study group received RCA-guided intervention. The self-efficacy [General Self-Efficacy Scale (GSES)], comfort [General Comfort Questionnaire (GCQ)], unplanned extubation rates, and incidence rates of complications were compared between the two groups by t and χ2 tests. Results　After the intervention, the scores of GSES and GCQ were better than those before the intervention in both groups; the scores of confidence level, coping ability, goal achievement, and persistence of GSES in the study group were higher than those in the control group (29.73±5.86 vs. 21.76±4.11, 28.92±6.94 vs. 21.57±5.35, 29.37±7.08 vs. 22.11±7.27, and 30.15±6.77 vs. 22.43±4.06), with statistical differences between the two groups (all P<0.05); the scores of physical, psychological, environmental and social dimensions of GCQ in the study group were higher than those in the control group (92.47±7.89 vs. 70.56±7.87, 93.72±7.96 vs. 71.64±8.02, 94.23±8.04 vs. 71.49±7.98, and 93.89±7.92 vs. 70.78±7.86), with statistical differences between the two groups (all P<0.05). The unplanned extubation rate due to catheter obstruction, displacement, or detachment in the study group was lower than that in the control group [4.30%(4/93). vs. 12.90%(12/93)], with a statistical difference between the two groups (P<0.05). The incidence rate of complications (infection, thrombosis, and pneumothorax) in the study group was lower than that than in the control group [6.45%(6/93) vs. 16.13%(15/93)], with a statistical difference between the two groups (P<0.05). Conclusion　RCA-guided nursing intervention can effectively decrease the unplanned extubation rate and improve patient comfort and treatment safety.

Key words: Root cause analysis, Deep venous catheterization, Unplanned extubation, Self-efficacy, Comfort

杨艳莉裴雪蕾李宗芳.

RCA指导下护理干预在深静脉导管非计划性拔管中的应用 [J]. 国际医药卫生导报, 2025, 31(20): 3507-3511.

Yang Yanli, Pei Xuelei, Li Zongfang.

Application of RCA-guided nursing intervention in unplanned extubation of deep venous catheters [J]. International Medicine and Health Guidance News, 2025, 31(20): 3507-3511.

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