目的 探讨超声引导下静脉血液标本采集流程在急诊创伤性休克患者中的应用效果。方法 选取2020年9月—2021年12月杭州市某三级甲等医院急诊抢救室的创伤性休克患者为研究对象,将流程应用后（2021年5月—12月）的患者纳入试验组,流程应用前（2020年9月—2021年4月）的患者纳入对照组。试验组共56例以超声引导下静脉血液标本采集流程进行静脉采血,对照组共52例以超声引导下静脉血液标本无采集流程进行静脉采血,比较两组静脉血液标本采集首次穿刺成功率、穿刺用时、血常规及ABO血型标本送出时间、急诊室滞留时间、并发症发生率、标本溶血率及患者舒适度的差异。结果 试验组较对照组穿刺用时、血常规及ABO血型标本送出时间均明显降低,急诊室滞留时间明显缩短,且首次穿刺成功率明显提高,差异均具有统计学意义（P<0.05）;试验组皮下血肿发生率及标本溶血率明显低于对照组,差异具有统计学意义（P<0.05）;试验组患者舒适状况量表总分高于对照组,差异具有统计学意义（P<0.05）。结论 应用超声引导下静脉血液标本采集流程,可有效指导急诊创伤性休克患者的临床采血,降低并发症及溶血率的发生率,增加患者的舒适度。
Objective To explore the application effect of ultrasound-guided venous blood sample collection process in emergency patients with traumatic shock. Methods From September 2020 to December 2021,patients with emergency traumatic shock in the emergency room of a tertiary Grade A hospital in Hangzhou were selected as the research objects. Patients after the application of the process（from May to December 2021） were included in the experimental group,and patients before the application of the process（from September 2020 to April 2021） were included in the control group. A total of 56 cases in the experimental group received venous blood collection process guided by ultrasound,while 52 cases in the control group received venous blood collection guided by ultrasound without collection process. The success rate of first puncture,puncture time,blood routine and ABO blood group delivery time,emergency room retention time,complication rate,sample hemolysis rate and patient comfort were compared between the two groups. Results Compared with the control group,the puncture time,blood routine and ABO blood group delivery time of the experimental group were significantly reduced,the retention time of emergency room was significantly shortened,and the success rate of the first puncture was significantly increased（P< 0.05）. The complication rate and hemolysis rate of subcutaneous hematoma in the experimental group were significantly lower than those in the control group（P< 0.05）. The total score of the comfort scale in the experimental group was higher than that in the control group,and the difference was statistically significant（P< 0.05）. Conclusion s The application of ultrasound-guided venous blood sample collection process can effectively guide the clinical blood collection of emergency traumatic shock patients,reduce the incidence of complications and hemolysis rate,and increase the comfort of patients.
[1] 袁素娥,陈煜,蔡小芳,等. 安全采集成人静脉血标本共识[J]. 中国感染控制杂志,2021,20(9):775-781.
Yuan SE,Chen Y,Cai XF,et al.Consensus on safe sampling of adult venous blood[J]. Chin J Infect Control,2021,20(9):775-781.
[2] 张菀楠. 一种新型采血样本收集板的设计[J]. 护士进修杂志,2018,33(20):1918-1919.
Zhang YN.Design of a new blood sample collection plate[J]. J Nurses Train,2018,33(20):1918-1919.
[3] 郑洋,陈聪,朱秀霞. 基于休克指数指导的风险分级护理在创伤性休克患者中的应用效果[J]. 护理实践与研究,2022,19(17):2577-2581.
Zheng Y,Chen C,Zhu XX.Application effect of risk grading nursing based on shock index guidance in patients with traumatic shock[J]. Nurs Prac Res,2022,19(17):2577-2581.
[4] 张小纯,张秋红,陈洁,等. 颈外静脉穿刺在急性创伤性休克患者急诊建立静脉通道与采血中的优势[J]. 中华损伤与修复杂志(电子版),2017,12(6):473-476.
Zhang XC,Zhang QH,Chen J,et al.Advantages of puncture of external jugular vein in establishing venous access and blood extraction of patients with acute traumatic shock[J]. Chin J Injury Repair and Wound Healing(Electronic Edition),2017,12(6):473-476.
[5] 朱丽,陈宇,张秀杰. 探讨骨髓腔穿刺输液在危重症患者抢救中的应用[J]. 西藏医药,2017,38(1):64-66.
Zhu L,Chen Y,Zhang XJ.To explore the application of bone marrow cavity puncture infusion in the rescue of critically ill patients[J]. Xizang Med,2017,38(1):64-66.
[6] 唐菲,杨漂羽,王萍,等. 骨髓腔内输液技术在急危重症患者中的应用进展[J]. 中华急危重症护理杂志,2020,1(6):540-544.
Tang F,Yang PY,Wang P,et al.Application progress of intramedullary infusion technique in critically ill patients[J]. Chin J Emerg Crit Care Nurs,2020,1(6):540-544.
[7] 钱海兴,闫亚敏. 困难静脉通路评估工具的研究进展[J]. 中国实用护理杂志,2017,33(31):2477-2480.
Qian HX,Yan YM.Research progress of difficult venous access assessment tool[J]. Chin J Pract Nurs,2017,33(31):2477-2480.
[8] 蒋玉勤,吴佳敏,蒋芝萍. B超引导下采集动脉血气标本在困难型危重患者中的应用[J]. 中国乡村医药,2018,25(9):10-11.
Jiang YQ,Wu JM,Jiang ZP.Application of ultrasound-guided arterial blood gas collection in difficult critical patients[J]. Chin J Rural Med,2018,25(9):10-11.
[9] 袁海军. 床旁超声在急诊患者体液容量状态评估中的应用研究进展[J]. 现代医药卫生,2022,38(2):239-243.
Yuan HJ.Research progress of bedside ultrasound in assessing fluid volume status of emergency patients[J]. Mod Med Heal,2022,38(2):239-243.
[10] 王飒,陈水红,金静芬. 急诊创伤团队的护理时效分析[J]. 中华护理杂志,2016,51(7):811-814.
Wang S,Chen SH,Jin JF.Analysis of nursing effectiveness in emergency trauma team[J]. Chin J Nurs,2016,51(7):811-814.
[11] 朱婷,刘红霞,胡文君,等. 改良舒适度量表在加速康复外科护理中的应用[J]. 护士进修杂志,2018,33(12):1138-1140.
Zhu T,Liu HX,Hu WJ,et al. Application of modified comfort scale in enhanced recovery after surgery nursing[J]. J Nurs Train,2018,33(12):1138-1140.
[12] 孙建华,刘大为,王小亭,等. 超声技术在重症护理领域中的应用进展[J]. 中华护理杂志,2016,51(6):729-732.
Sun JH,Liu DW,Wang XT,et al.Application of ultrasonic technology in the field of intensive care[J]. Chin J Nurs,2016,51(6):729-732.
[13] 宋立婷,李娜,凌丹,等. 超声引导困难外周静脉穿刺临床应用效果的Meta分析[J]. 实用心脑肺血管病杂志,2018,26(12):22-25.
Song LT,Li N,Ling D,et al.Meta-analysis of the clinical effect of ultrasound-guided peripheral venipentesis[J]. J Pract Heart Brain Lung Vasc Dis,2018,26(12):22-25.
[14] 周云,陈松旺,黄岩,等. 超声导引下瘤体旁注射0.9%氯化钠溶液治疗股动脉假性动脉瘤18例[J]. 介入放射学杂志,2018,27(2):163-166.
Zhou Y,Chen SW, Huang Y,et al.Ultrasound-guided peritumoral injection of 0.9% sodium chloride solution in the treatment of 18 cases of femoral artery pseudoaneurysm[J]. J Inter Radiol,2018,27(2):163-166.
[15] 尤娟娟,王薇,迟群,等. 超声引导在外周静脉采血困难患儿中的应用研究[J]. 内蒙古医学杂志,2019,51(4):485-487.
You JJ,Wang W,Chi Q,et al.Application of ultrasound-guided blood collection in children with peripheral venous difficulty[J]. Inner Mongolia Medical J,2019,51(4):485-487.
[16] 邹蜜,张敏,王欢,等. 超声引导下经外周静脉穿刺的中心静脉导管置管术在晚期肺癌化疗患者中的应用[J]. 医疗装备,2022,35(2):173-175.
Zou M,Zhang M,Wang H,et al.Ultrasound-guided central venous catheterization via peripheral venipuncture in advanced lung cancer chemotherapy[J]. Med Equip,2022,35(2):173-175.
