自我管理模式在PICC置管肿瘤患者中应用

目的探讨自我管理模式在经外周中心静脉导管（PICC）置管肿瘤患者中的应用效果。方法将100例PICC置管肿瘤化疗患者采用随机数字表法分为干预组和对照组（各50例），对照组实施常规护理，干预组在常规护理的基础上采用自我管理模式。采用焦虑自评量表（SAS）、自我护理能力测定量表（ESCA）在置管后第1，10，30天对患者进行调查，并比较两组患者导管相关并发症的发生率。结果干预组患者干预前后SAS评分（46．32±7．71）分比（40．34±4．49）分]比较，差异有统计学意义（t=4．17，P〈0．01），干预组自我护理能力总分（103．06±16．22）、自我护理技能（46．45±9．74）分、健康知识水平（47．43±8．66）分、自护责任感（16．61±3．20）分和自我概念（19．06±4．06）分4个维度上得分明显高于对照组的（90．61±17．09），（21．78±4．31），（39．73±9．88），（12．35±3．09），（15．77±3．79）分]，两组比较，差异均有统计学意义（t分别为2．8302，3．3860，2．8605，1．9834，1．6776；P〈0．05）。两组患者在PICC导管置管后10d共发生并发症12例，其中干预组5例，对照组7例，两组比较差异无统计学意义（χ2=0．379，P〉0．05）。置管后1个月内，共发生并发症15例，其中干预组2例，对照组13例，两组导管相关感染的发生率、总的并发症发生率比较，差异有统计学意义（χ2=9．490，P〈0．01）。结论自我管理模式可以提高PICC置管肿瘤患者的自我护理能力，减轻患者焦虑症状，可以有效地预防肿瘤患者PICC置管并发症的发生。

Application of self-management model in tumor patients with PICC

Objective To observe the application and effects of self-management model in tumor patients with peripherally inserted central catheter （PICC）. Methods Totals of 100 tumor patients with PICC were randomly divided into control group （ n = 50 ） which received routine care, and intervention group （ n = 50 ） which received the self-management model on the basis of routine care. The self-rating anxiety scale （SAS） and exercise of self-care ability scale （ ESCA ） score and the incidence of catheter-related complications were observed before intervention, 10th days and 30th days after intervention, respectively. Results The SAS score after intervention （40. 34 ± 4.49） was significantly lower than that before intervention （46.32 ± 7.71 ） in intervention group （ t = 4.17,P 〈 0.01 ）. Totals score of ESCA （ 103.06 ± 16.22） and its four aspects including self - management skill （ 46.45 ± 9.74 ）, health knowledge level （ 47.43 ± 8.66）, self-care responsibility （16.61 ±3.20） and self-concept （19.06 ± 4.06 ） in intervention group were all significantly higher that in control group （90.61 ± 17.09, 21.78 ± 4.31, 39.73 ± 9.88, 12.35 ± 3.09,15.77 ± 3.79, respectively ） （ t = 2. 830 2, 3. 386 0, 2. 860 5, 1. 983 4, 1. 677 6 ; P 〈 0.05）. At 10th day, the incidence of catheter-related complications in intervention group （5 cases ） and control group （7 cases ）, no significant difference was detected （ t = 0. 334 2, P 〉 0. 05 ）. While at 30th day, the incidence of catheter-related complications in intervention group was 4.0%, which was significantly lower than 19.6% in control group （ t = 7. 1324, P 〈 0.01）. Conclusions Self-management model can effectively improve the self-nursing ability, relieve the anxiety and prevent the catheter-related complications for tumor patients with PICC.