新型腹膜透析导管固定腰带的临床应用效果观察

doi:10.16138/j.1673-6087.2026.03.06

摘要/Abstract

摘要：

目的：探讨新型腹膜透析（peritoneal dialysis, PD）导管固定腰带的临床应用效果。方法：选取2023年7月至2024年4月在上海某三级甲等医院长期随访的PD患者100例，采用随机数字表法分为观察组和对照组，各50例。观察组采用新型PD腰带固定导管，以无菌开口纱布覆盖出口处。对照组采用传统PD腰带固定导管，以无菌敷贴（6 cm × 7 cm）覆盖出口处。2组患者分别于干预后第1、7、30、90天各进行1次出口评分系统评分和《PD导管固定腰带临床应用调查表》评价。结果：观察组在出口处周围皮肤医用黏胶相关性皮肤损伤（medical adhesive-related skin injury, MARSI）发生率、导管弯折和导管牵拉发生率、PD换液操作便捷性、耗材费用等方面均显著优于对照组（P<0.05）。结论：新型PD腰带的使用能降低出口处周围皮肤MARSI发生率，有效保障PD导管安全性，并降低PD导管出口处日常维护的经济成本。

关键词: 腹膜透析, 出口处评分, 医用黏胶相关性皮肤损伤

Abstract:

Objective To investigate the clinical application effect of a new type of peritoneal dialysis (PD) catheter holder belt. Methods From July 2023 to April 2024, 100 long-term follow-up PD patients in a tertiary hospital in Shanghai were randomly divided into an observation group of 50 patients and a control group of 50 patients. In the observation group, the novel PD belt was used to secure the catheter, and the exit site was covered with a sterile gauze with an opening. In the control group, a traditional PD belt was used to secure the catheter, and the exit site was covered with a sterile dressing (6 cm×7 cm). The 2 groups were evaluated at 1, 7, 30, and 90 days after intervention using the exit-site scoring system and the "Clinical Application Questionnaire of the PD Catheter Holder Belt". Results The observation group was significantly superior to the control group in terms of the incidence of medical adhesive-related skin injury (MARSI) around the exit site, the incidence of catheter bending and catheter traction, the convenience of PD fluid exchange, and the cost of consumables (all P<0.05). Conclusions The use of the novel PD belt can reduce the incidence of MARSI around the exit site, effectively ensure the safety of the PD catheter, and reduce the economic cost of PD catheter exit-site care.

Key words: peritoneal dialysis, exit-site scoring, medical adhesive-related skin injury

中图分类号:

卫诺, 黄晓敏, 张春燕, 陈伟红. 新型腹膜透析导管固定腰带的临床应用效果观察[J]. 内科理论与实践, 2026, 21(03): 240-245.

WEI Nuo, HUANG Xiaomin, ZHANG Chunyan, CHEN Weihong. Clinical application of a novel belt for securing peritoneal dialysis catheters[J]. Journal of Internal Medicine Concepts & Practice, 2026, 21(03): 240-245.

图/表 8

图1

表1

表2

表3

表4

表5

表6

表7

参考文献 15

[1]	马小琴, 马芳霞, 李霞, 等. 医用腹膜透析管路护理腰带的改良设计与应用[J]. 护士进修杂志, 2017, 32(8): 754-756.
	Ma XQ, Ma FX, Li X, et al. Improved design and application of nursing belt for medical peritoneal dialysis catheter[J]. J Nurses Train, 2017, 32(8): 754-756.
[2]	张春燕, 章倩莹, 杨俪, 等. 老年腹膜透析患者合并腹膜炎的预后及临床危险因素分析[J]. 内科理论与实践, 2026, 21(2): 132-137.
	Zhang CY, Zhang QY, Yang L, et al. Analysis of prognosis and clinical risk factors in elderly peritoneal dialysis patients with peritonitis[J]. J Intern Med Concepts Pract, 2026, 21(2): 132-137.
[3]	McNichol L, Lund C, Rosen T, et al. Medical adhesives and patient safety: state of the science: consensus statements for the assessment, prevention, and treatment of adhesive-related skin injuries[J]. Orthop Nurs, 2013, 32(5): 267-281.
[4]	Li PK, Szeto CC, Piraino B, et al. Peritoneal dialysis-related infections recommendations: 2010 update[J]. Perit Dial Int, 2010, 30(4): 393-423. doi: 10.3747/pdi.2010.00049
[5]	阳晓, 田娜, 路万虹, 等. 2023年版更新的国际腹膜透析学会导管相关感染推荐概览[J]. 中华肾脏病杂志, 2023, 39(12): 964-968.
	Yang X, Tian N, Lu WH, et al. Outline of 2023 updated International Society for Peritoneal Dialysis catheter-related infection recommendations[J]. Chin J Nephrol, 2023, 39(12): 964-968.
[6]	Farris MK, Petty M, Hamilton J, et al. Medical adhesive-related skin injury prevalence among adult acute care patients: a single-center observational study[J]. J Wound Ostomy Continence Nurs, 2015, 42(6): 589-598. doi: 10.1097/WON.0000000000000179
[7]	李霞, 胡艳玲, 万兴丽. 《预防医用粘胶相关皮肤损伤的最佳实践国际共识》解读[J]. 护理研究, 2021, 35(10): 1693-1696. doi: 10.12102/j.issn.1009-6493.2021.10.001
	Li X, Hu YL, Wan XL. Interpretation of international consensus on best practices for prevention of medical adhesive-related skin injury[J]. Chin Nurs Res, 2021, 35(10): 1693-1696. doi: 10.12102/j.issn.1009-6493.2021.10.001
[8]	Ter N, Yavuz M, Aydoğdu S, et al. The effect of 2 adhesive products on skin integrity used for fixation of hip and knee surgical dressings: a randomized controlled trial[J]. J Wound Ostomy Continence Nurs, 2015, 42(2): 145-150. doi: 10.1097/WON.0000000000000112
[9]	Kim MJ, Jang JM, Kim HK, et al. Medical adhesives-related skin injury in a pediatric intensive care unit: a single-center observational study[J]. J Wound Ostomy Continence Nurs, 2019, 46(6): 491-496. doi: 10.1097/WON.0000000000000592
[10]	谢婷, 张桂屏, 张娟, 等. ICU患者医用粘胶相关性皮肤损伤发生风险预测模型的建立与验证[J]. 护士进修杂志, 2024, 39(20): 2173-2178.
	Xie T, Zhang GP, Zhang J, et al. Establishment of risk prediction model for medical adhesive-related skin injuries in ICU patients and its validation[J]. J Nurses Train, 2024, 39(20): 2173-2178.
[11]	顾梦倩, 曹松梅, 陈圣枝, 等. 成人患者医用粘胶剂相关性皮肤损伤预防与管理的最佳证据总结[J]. 军事护理, 2023, 40(4): 75-79. doi: 10.3969/j.issn.2097-1826.2023.04.019
	Gu MQ, Cao SM, Chen SZ, et al. Prevention and management of medical adhesive-related skin injuries in adults: best evidence summary[J]. Mil Nurs, 2023, 40(4): 75-79. doi: 10.3969/j.issn.2097-1826.2023.04.019
[12]	乔婕, 芦丽霞, 何玉婷, 等. 真菌性腹膜透析导管出口感染合并隧道感染1例[J]. 北京大学学报（医学版）, 2023, 55(4): 748-754. doi: 10.19723/j.issn.1671-167X.2023.04.029
	Qiao J, Lu LX, He YT, et al. Fungal peritoneal dialysis catheter-related exit-site infection combined with tunnel infection: a case report[J]. J Peking Univ Heal Sci, 2023, 55(4): 748-754. doi: 10.19723/j.issn.1671-167X.2023.04.029
[13]	门春翠, 芦丽霞, 乔婕, 等. 腹膜透析导管出口周围疖肿的发生情况及影响因素分析[J]. 中国血液净化, 2024, 23(6): 474-479.
	Men CC, Lu LX, Qiao J, et al. Study on the occurrence and influencing factors of furuncle around the exit of peritoneal dialysis catheter[J]. Chin J Blood Purif, 2024, 23(6): 474-479.
[14]	刘丹阳, 张广清, 朱露, 等. 腹膜透析患者导管出口感染的微生物特征及治疗转归分析[J]. 中华肾脏病杂志, 2024, 40(10): 798-803. doi: 10.3760/cma.j.cn441217-20240429-00443
	Liu DY, Zhang GQ, Zhu L, et al. Microbiological characteristics and treatment outcome analysis of exit-site infection in peritoneal dialysis patients[J]. Chin J Nephrol, 2024, 40(10): 798-803. doi: 10.3760/cma.j.cn441217-20240429-00443
[15]	丁萃萃, 付玉芳, 宋鹤, 等. 一种挂引流袋的舒适可调节腰带的设计与应用[J]. 军事医学, 2023, 47(10): 799-800. doi: 10.7644/j.issn.1674-9960.2023.10.016
	Ding CC, Fu YF, Song H, et al. Design and application of a comfortable adjustable belt for hanging a drainage bag[J]. Mil Med Sci, 2023, 47(10): 799-800. doi: 10.7644/j.issn.1674-9960.2023.10.016

项目	0分	1分	2分
肿胀	无	仅限于出口，<0.5 cm	≥0.5 cm，和（或）隧道
痂皮	无	<0.5 cm	≥0.5 cm
发红	无	<0.5 cm	≥0.5 cm
疼痛	无	轻微	严重
分泌物	无	浆液性	脓性

项目	观察组	对照组	χ²/t	P
性别[n(%)]			0.164	0.685
男性	28(56.0)	30(60.0)
女性	22(44.0)	20(40.0)
年龄（岁）	46.24±12.86	46.72±13.92	−0.179	0.858
透析时间 (月)	33.32±20.34	37.44±39.12	−0.661	0.511
工作情况[n(%)]			3.098	0.334
在职	20(40.0)	26(52.0)
无业	0(0.0)	1(2.0)
退休	17(34.0)	15(30.0)
其他	13(26.0)	8(16.0)
文化程度[n(%)]			7.402	0.116
小学	0(0.0)	1(2.0)
初中	1(2.0)	0(0.0)
高中	30(60.0)	21(42.0)
大学	16(32.0)	27(54.0)
研究生及以上	3(6.0)	1(2.0)

时间	观察组	对照组	t	P
第1天	0.18±0.39	0.18±0.39	0.000	1.000
第7天	0.18±0.44	0.24±0.59	0.577	0.565
第30天	0.16±0.42	0.30±0.61	1.328	0.188
第90天	0.22±0.51	0.32±0.68	0.831	0.408

时间	观察组	对照组	χ²	P
第1天	0(0.0)	0(0.0)
第7天	1(2.0)	4(8.0)	0.235	0.170
表皮剥离	0(0.0)	1(25.0)
接触性皮炎	1(100.0)	2(50.0)
表皮剥离+接触性皮炎	0(0.0)	1(25.0)
第30天	1(2.0)	7(14.0)	0.125	0.030
表皮剥离	0(0.0)	2(28.6)
接触性皮炎	1(100.0)	3(42.9)
表皮剥离+接触性皮炎	0(0.0)	2(28.6)
第90天	2(4.0)	8(16.0)	0.219	0.045
表皮剥离	1(50.0)	3(37.5)
接触性皮炎	1(50.0)	3(37.5)
表皮剥离+接触性皮炎	0(0.0)	2(25.0)

时间	观察组（n=50）	对照组（n=50）	t	P
第1天	4.92±0.27	4.90±0.37	0.338	0.736
第7天	4.68±0.68	4.40±0.61	2.168	0.033
第30天	4.60±0.57	4.36±0.60	2.052	0.043
第90天	4.54±0.68	4.16±0.58	3.006	0.003