胃腸惡性腫瘤病人PICC置管後舒適度現狀和影響因素

Comfort Status and Its Influencing Factors in Patients With Gastrointestinal Cancer After PICC Catheterization

李靈(Ling LI) ； 高竹林(Zhulin GAO) ； 郭亮(Liang GUO)

《護理雜誌》 67卷6期 (2020/12) Pp. 32-39

https://doi.org/10.6224/JN.202012_67(6).06

摘要

背景：胃腸惡性腫瘤是全球發病率較高的惡性腫瘤之一，接受化療的胃腸惡性腫瘤病人多以經外周靜脈置入中心靜脈導管（peripherally inserted central catheter, PICC）為主要的輸液工具，但現關注病人置管後舒適度的研究較少。目的：調查中國地區某三甲醫院胃腸惡性腫瘤病人PICC置管後舒適度現狀並分析其影響因素。方法：自2018年6月－2019年8月期間應用方便抽樣選取長沙市某三甲醫院因胃腸惡性腫瘤住院，初次化療行超聲引導下PICC置管的病人共91例。運用病人一般情況調查表、置管後舒適度評價量表、腫瘤病人自我管理能力調查量表、置管後併發症評估表等表格為測量工具，於病人置管後1個月進行調查。結果：初次化療行PICC置管病人之有效問卷數為91例，問卷回收率為100%。PICC置管期間舒適度總分為34.99 ± 4.07，10例（11.0%）為一般，81例（89.0%）為舒適。病人自我管理能力平均分為151.55 ± 18.33。穿刺點滲血共19例（20.9%）、導管脫出7例（7.7%），無其他併發症。多元逐步線性回歸分析顯示穿刺肢體、自我管理能力、職業是病人自我護理能力的影響因素（p ＜ .05），這3個變項所能解釋的舒適度得分變異占21.9%。結論：胃腸惡性腫瘤初次化療病人PICC置管後舒適度總體處於舒適水準。在臨床工作中，護理人員宜根據病人的意願選擇左側肢體置管，當照顧者重視病人自我管理能力的提高，對需要工作的病人提供適當的護理建議，進而可提高病人置管後的舒適度。

關鍵字

胃腸惡性腫瘤 ； 經外周靜脈置入中心靜脈導管 ； 舒適度 ； 自我管理能力 ； 影響因素

並列摘要

Background: Gastrointestinal cancer is one of the higher-incidence malignant tumors worldwide. A majority of patients with gastrointestinal cancer receive chemotherapy, with peripherally inserted central catheter (PICC) serving as the main infusion instrument. Little research has addressed the issue of post-catheterization comfort in patients. Purpose: The purpose of the study was to investigate the comfort status of patients with gastrointestinal cancer at a tertiary hospital in China after PICC catheterization and to analyze the influencing factors. Methods: Ninety-one patients with gastrointestinal cancer who were currently receiving initial chemotherapy were recruited from a third-class hospital in Changsha City from June 2018 to August 2019. Patients received ultrasound-guided PICC catheterization and were then investigated one-month later using a general demographics questionnaire, comfort evaluation scale, Cancer Patients PICC Self-management Scale, and complications evaluation scale. Results: Ninety-one effective questionnaires were received (recovery rate: 100%). The total comfort score was 34.99 ± 4.07, with 10 patients (11.0%) reporting 'general comfort' and 81 patients (89.0%) reported 'comfort'. The average score for self-management ability was 151.55 ± 18.33. Nineteen patients (20.9%) had blood leakage and 7 (7.7%) had catheter prolapse. Multiple stepwise linear regression analysis showed that the limb used for catheterization, self-management ability, and occupation were the factors that significantly influenced degree of comfort in the participants (p ＜ .05), predicting 21.9% of the total comfort score. Conclusion: The overall comfort level of patients with gastrointestinal cancer after PICC catheterization was comfort. In clinical work, nurses should choose the left limb based on patient wishes, pay attention to improving the self-management ability of patients, and provide appropriate nursing suggestions for patients who are wage earners to improve post-catheterization comfort.

並列關鍵字

gastrointestinal cancer ； peripherally inserted central catheter (PICC) ； comfort ； self-management ability ； influencing factors

參考文獻

李　萱、李秀花、陳清惠（2005）．一位接受週邊置入中心靜脈導管急性淋巴性白血病患者的護理經驗．護理雜誌，52（2），78–86。[Lee, H., Lee, H.-H., & Chen, C.-H. (2005). An experience in nursing an acute lymphocytic leukemia patient with peripherally inserted central catheter. The Journal of Nursing, 52(2), 78–86.] https://doi.org/10.6224/JN.52.2.78

卞伶玲、趙　益（2016）．應用雙腔power經外周中心靜脈置管與深靜脈導管的舒適度及活動度比較．解放軍護理雜誌，33（16），56–58。[Bian, L. L., & Zhao, Y. (2016). Comparison of comfort and activity between double cavity power PICC and central venous catheterization. Nursing Journal of Chinese People's Liberation Army, 33(16), 56–58.] https://doi.org/10.3969/j.issn.1008-9993.2016.16.015

王豐松（2015）．三種PICC穿刺部位對患者舒適度的影響．齊魯護理雜誌，21（1），33–34。[Wang, F.-S. (2015). Effect of three kinds of PlCC methods on degree of patient's comfort. Journal of Qilu Nursing, 21(1), 33-34.] https://doi.org/10. 3969/j.issn.1006-7256.2015.01.013

吳紅娟、陳雪峰、張美英、胡巧雲、林小琴（2008）．腫瘤患者PICC置管主要併發症及其相關因素分析．中華護理雜誌，43（2），134–135。[Wu, H.-J., Chen, X.-F., Zhang, M.-Y., & Lin, X.-Q. (2008). Analysis of main complications and related factors of PICC catheterization in cancer patients. Chinese Journal of Nursing, 43(2), 134–135.] https://doi.org/10.3761/j.issn.0254-1769.2008.02.016

李　芳、李　莉、王珊珊、唐　雙、王傳英、夏園園、李　敏、李月華（2018）．個體化自我管理教育對乳腺癌病人PICC併發症發生情況的影響．護理研究，32（4），111–113。[Li, F., Li, L., Wang, S., Tang, S., Wang, C., Xia, Y., Li, M., & Li, Y. (2018). Influence of individualized self-management education on occurrence of PICC complications in patients with breast cancer. Chinese Nursing Research, 32(4), 111–113.] https://doi.org/10.3969/j.issn.1009-6493.2018.04.031