目的 探讨壳聚糖抗菌成膜喷剂在鼻咽癌患者经外周静脉置入中心静脉导管(PICC)置管部位接触性皮炎治疗中的应用效果。方法 选取2020-05至2022-04联勤保障部队第909医院因置入PICC所致接触性皮炎的94例鼻咽癌患者为研究对象,其中2020-05至2021-04的46例患者为对照组,2021-05至2022-04的48例患者为观察组。对照组采用地塞米松注射液外涂联合3M透明敷料行PICC换药,观察组采用喷涂壳聚糖抗菌成膜喷剂联合3M透明敷料行PICC换药。对比观察两组患者临床疗效、并发症的发生率、愈合时间、换药次数、患者的自付费用及满意度情况。结果 观察组治疗第1周、第2周总有效率(95.83%,100%)均显著高于对照组治疗总有效率(73.91%,89.13%)(P＜0.05),观察组愈合时间[(10.43±0.52)d]、换药次数[(3.30±0.69)次]显著短于或少于对照组愈合时间[(18.15±0.33)d]、换药次数[(5.67±0.96)次](P＜0.05),观察组患者满意度得分(8.71±0.82)显著高于对照组患者满意度得分(5.67±0.96)(P＜0.05),两组患者在导管移位率、脱管率及患者自付费用三方面无明显区别,差异无统计学意义(P＞0.05)。结论 壳聚糖抗菌成膜喷剂治疗鼻咽癌同步放化疗患者PICC置管部位接触性皮炎效果明显,可减少换药次数,减轻护理工作量,降低局部感染率,提高患者满意度。
Abstract
Objective To investigate the application effect of chitosan antibacterial film-forming spray in the treatment of PICC contact dermatitis in patients with nasopharyngeal carcinoma.Methods A total of 94 patients with nasopharyngeal carcinoma and PICC-induced contact dermatitis in the 909th Hospital of PLA Joint Logistics Support Force from May 2020 to April 2022 were selected as intervention subjects. According to time nodes, 46 patients from May 2020 to April 2021 were selected as control group, and 48 patients from May 2021 to April 2022 were selected as observation group. The control group was given dexamethasone injection external coating combined with 3M transparent dressing for PICC dressing change, while the observation group was given chitosan antibacterial film forming spray combined with 3M transparent dressing for PICC dressing change. The clinical efficacy, incidence of complications, healing time, times of dressing change, out-of-pocket costs and satisfaction of patients in the two groups were compared.Results The total effective rate (95.83%, 100%) in the first and second weeks of treatment in the observation group was significantly higher than that in the control group (73.91%, 89.13%) (P<0.05). Healing time [(10.43±0.52) d] and dressing change times (3.30±0.69) in observation group were significantly lower than those in control group [(18.15±0.33) d; (5.67±0.96)] (P<0.05). The satisfaction score of observation group (8.71±0.82) was significantly higher than that of control group (5.67±0.96) (P<0.05), and there was no significant difference in catheter displacement rate, catheter removal rate or out-of-pocket costs between the two groups (P>0.05).Conclusions Chitosan antibacterial film spray is effective in the treatment of PICC catheterization contact dermatitis in patients with nasopharyngeal carcinoma with concurrent radiotherapy and chemotherapy, which can reduce the number of dressing changes, reduce nursing workload, reduce local infection rate and improve patient satisfaction.
关键词
壳聚糖抗菌成膜喷剂 /
经外周静脉置入中心静脉导管 /
接触性皮炎 /
治疗效果
Key words
chitosan antibacterial film forming spray /
PICC /
contact dermatitis /
therapeutic effect
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参考文献
[1] Thayer D. Skindamage associated with intravenous therapy: common problems and stra- tegies for prevention[J].J Infus Nurs,2012,35(6):390-401.
[2] 柳 静,刘春芳, 李秀川,等. PICC导管相关皮肤损伤预防的最佳证据总结[J].中华护理杂志, 2022, 57(16):1987-1994.
[3] 曹 洁, 顾 婕, 吕 春,等. 2021年第8版《输液治疗实践标准》的解读及启示[J].护理学报, 2022, 29(22):74-78.
[4] Broadhurst D, Moureau N, Ullman A J, et al. Manage-ment of central venous accessdevice-associated skin impairment: anevidence-basedalgorithm[J].J Wound Ostomy Continence Nurs, 2017, 44(3):211-220.
[5] 张微竹,何 凤,付 莉,等.思乐扣在乳腺癌患者深静脉置管化疗护理中的应用[J].国际护理学杂志, 2013,32(4):892-894.
[6] 李娟娟. 医用功能性敷料A型预防ICU患者一次性心电电极片相关性皮肤损伤的效果观察[D].太原:山西医科大学,2019.
[7] 孟婧雅,沈旭慧,谢新芳,等.深静脉置管相关接触性皮炎护理的研究进展[J].护士进修杂志, 2018,33(2):125-128.
[8] 刘 丹,苏 青,樊 皎,等.壳聚糖喷雾剂促大鼠创伤及烫伤愈合作用的研究[J].中国药师, 2016,19(11):2049-2051.
[9] 石 聪,王东凯,耿志辉.龙血竭联合重组牛碱性成纤维细胞生长因子凝胶治疗烧烫伤临床研究[J].河北医科大学学报,2018,39(10):1217-1220.
[10] 李娟娟,魏绍辉,赵文芳,等.壳聚糖抗菌成膜喷剂预防一次性心电电极片相关性皮肤损伤的效果观察[J].护理研究,2019,33(11):1966-1968.
[11] 魏绍辉,李娟娟,王银燕,等.壳聚糖抗菌成膜喷剂治疗一次性电极片致皮肤损伤效果砚察[J].护理研究,2020,34(16):2951-2953.
[12] 康 敏.中国鼻咽癌放射治疗指南(2020版)[J].中华肿瘤防治杂志,2021,28(03):167-177.
[13] 谢 贞,黄恒吉.《INS输液治疗实践标准》中文版在《中华护理杂志》特刊发布[J].中华护理杂志,2017,52(1):110.
[14] 李春燕.美国 INS2016版《输液治疗实践标准》要点解读[J].中国护理管理,2017, 17(2): 150- 153.
[15] 蔡文智,李亚洁.控制中心静脉导管感染的进展[J].国外医学(护理学分册),2005,24(12): 731- 733.
[16] Yamamoto A J, Solomon J A, Soulen M C,et al.Sutureless secure-mentdevice reduces complication of peripherally inserted centralvenous catheters[J].J Vasc Interv Radiol,2002,13(1): 77-81.
[17] 马洪丽,杨 青,罗 稀,等.思乐扣在经颈内静脉置入的中心静脉导管固定中的应用[J].肿瘤预防与治疗,2014,27(4):190-193.
[18] 林金香,吴冬冰,李欢云.聚维酮碘湿敷治疗留置中心静脉导管穿刺点感染的护理[J]. 中华现代护理杂志,2008,14(28):3026-3027.
[19] 张雅琴,王晓杰,马玉芬,等.基于分时段入院提高患者入院体验满意度的效果评价[J]. 中国医院管理,2018,38(6):64-65.
[20] 孙 昊,帅 棋.壳聚糖与葡聚糖在基因递送应用中的研究进展[J].中国现代应用药学, 2022, 39(15): 2034-2038.
[21] 董秀慧,张树元,杨占华,等.润燥玉肤方冷敷联合红蓝光疗法对面部急性期激素依赖性皮炎的临床观察[J].中国中医急症,2021,30(10):1815-1817.
[22] 马 芸,栗琼洋,廖 娟,等.中药热奄包对PICC术后机械性静脉炎的影响[J].西部中医药, 2021, 34(12): 144-147.
[23] 张彩琳,李 婷,陶彦凤,等.肺癌化疗后中医适宜技术的应用效果观察[J].甘肃医药, 2021, 40(6): 565-566.
[24] 韩雪玲,李婷婷,张秋阳.芦荟硫酸镁凝胶贴剂治疗输液性静脉炎的疗效观察[J].哈尔滨医药, 2019, 39(2):166-167.
[25] 牟 丹,王彩芳,李芳梅,等.运用循证护理探讨3M液体敷料降低PICC置管患者接触性皮炎的效果观察[J].岭南现代临床外科,2019,19(5):642-645,653.
[26] 蒋琪霞.急性皮肤创伤快速处理方法[J].创伤外科杂志,2022,24(2):159-161.
[27] 刘佳鑫,张喜成,高启航,等.壳聚糖及其复合物在治疗下肢慢性溃疡中的研究进展[J].中国普通外科杂志,2020,29(6):752-758.
[28] 韩 伟,周金池,赵曙光.壳聚糖用于战伤救治的研究进展[J].人民军医, 2019,62(12): 1151- 1154,1161.
[29] Gorski L A,Hadaway L,Hagle M E,et al. Infusion therapy stan-dards of practice,8th edition[J].J Infus Nurs,2021,44(Suppl1):S1-224.
基金
福建省自然科学基金(2020J011124)
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