Objective: To explore the influence of cluster nursing intervention on inadequate drainage in vacuum sealing drainage (VSD) for inpatients in burn unit. Methods: From October to December 2016, 60 patients, aged (43.6±2.8) years admitted to our department, receiving VSD treatment and conforming to the inclusion criteria, were included in the routine nursing group, and among the patients, 37 cases were male and 23 cases were female. From May to July 2017, 58 patients, aged (44.2±3.2) years admitted to our department, receiving VSD treatment and conforming to the inclusion criteria, were included in the cluster nursing group, and among the patients, 36 cases were male and 22 cases were female. The patients' medical records were retrospectively analyzed. After VSD treatment, patients in routine nursing group received routine nursing, and patients in cluster nursing group received cluster nursing. A cluster intervention group was formed and headed by a chief surgeon. The cluster nursing plan was formulated and implemented strictly from the following six aspects of material preparation, negative pressure value control and negative pressure mode setting, drainage tube nursing, semi-permeable membrane reinforcement, standardizing changing process and timing of drainage capsule, and health education. During VSD treatment, the incidence of inadequate drainage, reasons of inadequate drainage and the occurrences, occurrences of inadequate drainage of wounds in different types and sites, and satisfaction of patients in two groups were observed and calculated. The patient satisfaction items included procedure of drainage capsule replacement, the method of tube fixation, the content and form of health education. Data were processed with independent sample t test and chi-square test. Results: (1) During VSD treatment, the incidence of inadequate drainage of patients in routine nursing group was 43.33% (130/300), which was significantly higher than 17.24% (50/290) in cluster nursing group (χ(2)=43.350, P<0.01). (2) During VSD treatment, the incidences of inadequate drainage caused by blockage of drainage tube due to scabbing of drainage, low negative pressure, air leakage of semi-permeable membrane, improper changing process of drainage capsule, shedding, compression, reversal of drainage tube of patients in cluster nursing group were 7.93% (23/290), 4.48% (13/290), 1.72% (5/290), 1.03% (3/290), and 2.07% (6/290), respectively, significantly lower than 16.67% (50/300), 11.67% (35/300), 4.33% (13/300), 4.00% (12/300), and 6.67% (20/300) in routine nursing group (χ(2)=10.379, 22.951, 4.832, 7.840, 7.399, P<0.05 or P<0.01). (3) During VSD treatment, the incidences of inadequate drainage of burn wounds, trauma wounds, pressure ulcer, venous ulcer in lower limbs, and diabetic foot of patients in cluster nursing group were significantly lower than those in routine nursing group (χ(2)=17.835, 6.809, 9.478, 4.939, 8.631, P<0.05 or P<0.01). During VSD treatment, the incidences of inadequate drainage of wounds in different types of patients in the same group were close (χ(2)=0.434, 0.057, P>0.05). (4) During VSD treatment, the incidences of inadequate drainage of wounds in limbs, trunk, buttocks, and sacrococcyx of patients in cluster nursing group were significantly lower than those in routine nursing group (χ(2)=31.892, 9.588, 4.939, 4.549, P<0.05 or P<0.01). During VSD treatment, the incidences of inadequate drainage of wounds in different wound sites of patients in the same group were close (χ(2)=0.071, 0.069, P>0.05). (5) The satisfaction scores in changing process of drainage capsule, method of tube fixation, content and form of health education of patients in cluster nursing group after VSD treatment were significantly higher than those in routine nursing group (t=5.166, 4.471, 7.958, 8.975, P<0.01). Conclusions: Cluster nursing intervention on patients receiving VSD treatment could reduce the incidences of inadequate drainage of wounds in different types and sites caused by various reasons. It also can improve patient satisfaction.
目的： 探讨集束化护理干预对烧伤科住院患者行负压封闭引流(VSD)治疗中引流不畅的影响。 方法： 将笔者科室2016年10—12月收治的符合入选标准的60例(43.6±2.8)岁行VSD治疗的患者(男37例、女23例)设为常规护理组，2017年5—7月收治的符合入选标准的58例(44.2±3.2)岁行VSD治疗的患者(男36例、女22例)设为集束化护理组，回顾性分析其病历资料。行VSD治疗后，常规护理组患者采用常规护理方法；集束化护理组患者采用集束化护理方法，成立由1名主任医师任组长的集束化干预小组，制订集束化护理干预方案，并从用物准备、负压值控制及负压模式设置、引流管护理、半透膜加固、规范负压内囊更换时机和流程及健康教育等6个方面严格执行。观察并计算2组患者VSD治疗期间引流不畅的发生率、引流不畅的原因及发生情况、不同类型创面引流不畅的发生情况、不同部位创面引流不畅的发生情况及VSD治疗后患者满意度(内囊更换流程、管道固定方法、健康宣教内容及宣教形式)。对数据行独立样本t检验、χ(2)检验。 结果： (1)常规护理组患者行VSD治疗期间引流不畅发生率为43.33%(130/300)，明显高于集束化护理组的17.24%(50/290)，χ(2)＝43.350，P<0.01。(2)集束化护理组患者行VSD治疗期间引流物结痂致引流管堵塞，负压值过小，半透膜密闭不严，负压内囊更换流程欠规范，负压管道脱落、受压、反折导致引流不畅的发生率分别为7.93%(23/290)、4.48%(13/290)、1.72%(5/290)、1.03%(3/290)、2.07%(6/290)，明显低于常规护理组的16.67%(50/300)、11.67%(35/300)、4.33%(13/300)、4.00%(12/300)、6.67%(20/300)，χ(2)＝10.379、22.951、4.832、7.840、7.399，P<0.05或P<0.01。(3)集束化护理组患者烧伤创面、外伤创面、压疮、下肢静脉性溃疡、糖尿病足行VSD治疗期间引流不畅的发生率均明显低于常规护理组(χ(2)＝17.835、6.809、9.478、4.939、8.631，P<0.05或P<0.01)。2组患者组内不同类型创面行VSD治疗期间引流不畅的发生率相近(χ(2)＝0.434、0.057，P>0.05)。(4)集束化护理组患者四肢、躯干、臀部、骶尾部创面行VSD治疗期间引流不畅的发生率均明显低于常规护理组(χ(2)＝31.892、9.588、4.939、4.549，P<0.05或P<0.01)。2组患者组内不同部位创面行VSD治疗期间引流不畅的发生率相近(χ(2)＝0.071、0.069，P>0.05)。(5)集束化护理组患者行VSD治疗后对满意度中内囊更换流程、管道固定方法、健康宣教内容及宣教形式维度评分均明显高于常规护理组(t＝5.166、4.471、7.958、8.975, P<0.01)。 结论： 对行VSD治疗的患者实施集束化护理干预，可降低各种原因导致的不同类型、不同部位创面引流不畅的发生率，提高患者满意度。.
Keywords: Bundles of care; Drainage effect; Negative-pressure wound therapy; Nursing process.