握拳运动在预防老年PICC置管患者上肢深静脉血栓中的应用效果

摘要

目的 探讨握拳运动对预防老年PICC置管患者上肢深静脉血栓(UEDVT)的效果.方法 采用便利抽样法选取2015年1月—2017年1月150例在南京大学医学院附属鼓楼医院老年科住院行PICC治疗的患者,按照随机数字表法分为对照组和干预组,每组75例,对照组按PICC后常规护理,包括心理护理、健康宣教、肢体活动(旋腕、肘关节伸屈)等,干预组在常规护理基础上给予握拳运动,比较两组置管后第1、3、15、30天的腋下静脉平均血流速度、最大血流速度和上肢深静脉血栓发生率及发生程度.结果 干预组第3、15、30天的腋下静脉平均血流速度与腋下最大血流速度均大于对照组,差异有统计学意义(F值分别为4.336、5.127;P<0.05);干预组UEDVT发生率低于对照组,差异有统计学意义(F=6.637,P=0.001);对照组UEDVTⅡ级、Ⅲ级发生率高于干预组,差异有统计学意义(Z=237.300,P<0.001).结论 对老年PICC置管患者实施握拳运动简单有效,患者易于接受,对促进患者康复,提高生活质量具有积极的意义.%Objective To explore the effects of fisting activity in preventing upper extremity deep vein thrombosis (UEDVT) associated with peripheral inserted central catheter (PICC) in elderly patients. Methods A total of 150 patients with PICC in the Geriatric Department of Nanjing Drum Tower Hospital from January 2015 to January 2017 were selected by convenience sampling method and randomly divided into intervention group and control group according the random number table, with 75 cases in each group. The patients in the control group were given routine PICC nursing, including psychological care, health education, physical exercise (wrist swing, elbow flexion and extension) and so on. While on the basis of the routine PICC nursing, fisting activity was applied in the intervention group. The average blood flow velocity of the armpit vein, the peak of blood flow velocity and the incidence of deep vein thrombosis were compared between the two groups on the 1st, 3rd, 15th and 30th day after the catheterization. Results The mean velocity of the armpit vein and the peak velocity of the armpit on 3rd, 15th and 30th day in the intervention group were significantly higher than those in the control group, and the differences were statistically significant (F=4.336,5.127;P< 0.05). The incidence of UEDVT in the intervention group was lower than that in the control group, and the difference was statistically significant (F=6.637,P=0.001). The incidences of grade Ⅱ and Ⅲ UEDVT in the control group were higher than those in the intervention group, and the differences were statistically significant (Z=237.3,P<0.001). Conclusions The fisting activity is a simple and effective exercise for elderly patients with PICC catheter, which can be easily accepted by the patients, so as to promote the rehabilitation of patients and improve the quality of life.