水胶体透明敷料在神经外科中心静脉导管固定中的应用

目的 探讨水胶体透明敷料护理锁骨下静脉置管(subclavian vein catheterization,SVC)的效果、费用和工作量。 方法 以160例符合条件的锁骨下静脉置管的患者为研究对象，随机分为对照组和实验组，2组分别应用3M HP TegadermTM敷料、水胶体透明敷料固定导管。观察置管并发症、换药总费用和换药工作量。连续变量之间的比较采用t检验，分类变量之间的比较采用χ2检验。 结果 实验组感染6.8%(5/74) vs.17.7%(14/79)，χ2=4.224，P=0.040]、皮肤过敏1.4%(1/74) vs.8.9%(7/79)，χ2=4.248，P=0.037]、脱管2.7%(2/74) vs.11.4%(9/79)，χ2=4.231，P=0.040]和非计划性拔管5.4%(4/74) vs.15.2%(12/79)，χ2=3.906，P=0.048]发生率均显著低于对照组。与对照组相比，实验组平均换药间隔时间较长(5.9±1.1) d vs.(4.8±1.0) d，t=2.217，P=0.025]，换药工作量较低(41.4±7.0) min vs.(50.6±9.8) min，t=2.078，P=0.039]，单次换药时间(13.8±2.3) min vs.(13.5±2.5) min，t=0.223，P=0.894]、换药总费用(140.4±40.2)元vs.(143.6±37.6)元，t=0.257，P=0.851]差异无统计学意义。 结论 水胶体透明敷料能够更好地维护经锁骨下静脉置管，减少护理工作量，不增加费用，值得在神经外科护理工作中推广应用。 

Transparent hydrocolloid dressing for fixation of subclavian central venous catheters in Department of Neurosurgery

Objective To explore the effect,costs and workload of using transparent hydrocolloid dressing for fixation of subclavian central venous(SVC) catheters. Methods Total 160patients undergoing SVC were included and were randomly divided into control group and test group.3M HP TegadermTM dressing in the control group and transparent hydrocolloid dressing in the test group were used for the fixation of catheters.The catheter-related complications,total medical cost and workload of dressing were observed.The Student t-test was used to compare continuous variables,χ2 test was used to compare categorical variables. Results There were significant difference between the teat group and control group in the incidence of infections6.8%(5/74) vs. 17.7%(14/79),χ2=4.224,P=0.040],skin allergies1.4%(1/74) vs. 8.9%(7/79),χ2=4.248,P=0.037],accidental extubation2.7%(2/74) vs. 11.4%(9/79),χ2=4.231] and unplanned extubation5.4%(4/74) vs. 15.2%(12/79),χ2=3.906,P=0.048].When compared with the control group,the test group had a longer average dressing time interval(5.9±1.1)d vs. (4.8±1.0) d,t=2.217,P=0.025],a lower dressing workload(41.4±7.0)min vs.(50.6±9.8)min,t=2.078,P=0.039];The single dressing time(13.8±2.3)min vs.(13.5±2.5)min,t=0.223,P=0.894] and the total cost of dressing(140.4±40.2)Yuan vs.(143.6±37.6)Yuan,t=0.257,P=0.851] were no significant difference between the two groups. Conclusion Transparent hydrocolloid dressings can better maintain SCV and reduce nursing workload without additional cost,which is worth promoting applications in neurosurgical nursing.