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摘要静脉采血是儿科疾病诊断中非常重要的操作，对于支气管哮喘患儿来说更为特殊。为了避免哮喘发作，提高一次性静脉穿刺成功率以及引发不必要的医患矛盾，本文选取支气管哮喘患儿作为研究对象，对基于罗伊适应模式与沟通技巧多元化干预进行深入研究。本研究有两个子研究组成。

研究一：探讨沟通技巧在支气管哮喘患儿静脉采血中的应用及其临床意义。采取随机分组对照法，以在门诊进行静脉采血的支气管哮喘患儿100例作为研究对象，对照组进行常规护理静脉采血，实验组在常规护理的基础上进行沟通技巧的干预。比较两组患儿采血情况（采血时间、穿刺后止血压迫时间、一次性穿刺成功率）、患儿家属满意度（技术专业性，服务态度，沟通技巧）以及穿刺时疼痛情况。结果表明：患儿在进行静脉采血时接受沟通技巧的干预，在一定程度上提高了一次性穿刺成功率防止了哮喘发作、从心理上降低了患儿的疼痛感、以及提高了患儿家属满意度。但是干预方法太单一，还存在一些不足，为了更有效的提高一次性穿刺成功率防止哮喘发作，减少家属负性情绪，使患儿在更舒适的适应状态下更容易提高其静脉采血依从性，引入了第二个研究。

研究二：探讨基于罗伊适应模式的多元化干预对支气管哮喘患儿静脉采血依从性及家属负性情绪的影响。采用了随机分组对照法，以在门诊进行静脉采血的支气管哮喘患儿108例作为实验对象，对照组通过常规的护理模式进行操作，实验组接受基于罗伊适应模式理论的多元化护理干预。比较两组患儿一次性静脉穿刺成功率、淤血发生率、静脉采血的依从性、静脉采血时间、静脉采血时不哭人数、疼痛面容持续时间、采血结束20s后啼哭时间>5s的人数，对两组患病儿童静脉穿刺过程中（采血前1min、采血时、采血后1min、采血后5min）FLACC评分、Wong-Baker量表评分、心率和收缩压变化情况，比较两组患儿家属在患儿采血前和采血后负性情绪评分变化情况、家属满意度在静脉采血依从性和静脉采血时间中的中介分析。研究结果表明：应用基于罗伊适应模式的多元化干预，更好的提高了患儿静脉采血的配合程度以及一次性穿刺成功率，一次性穿刺成功率的提高更加有效防止了哮喘的发作，更好的缓解了患儿与家属的负性情绪。研究二在研究一的基础上丰富了多元化的干预措施，弥补了研究一中单一干预方法的不足。多元化的护理干预包括对患儿生理和心理模式以及适应性的分析，针对性给予健康教育、心理干预、环境布置、针对性护理、应急处理、调节患儿心理应激程度等以及针对性的给予家属健康教育、普及医学知识及心理干预等。

沟通技巧与罗伊适应模式多元化干预作为比较成熟的护理理论，已经得到世界各国的广泛临床使用和认可。我国进行了大量的理论和实践研究，为该护理模式在患儿静脉采血中的广泛应用提供了依据。

AbstactVenous blood collection is a very important operation in the diagnosis of pediatric disease, especially for children with bronchial asthma. In order to avoid asthma attack, improve the success rate of disposable intravenous puncture and cause unnecessary conflicts between doctors and patients, this paper selected children with bronchial asthma as the research objects, and carried out an in-depth study on diversified intervention based on Roy adaptation mode and communication skills.This study consists of two sub-studies.

Study 1: To explore the application and clinical significance of communication skills in venous blood collection of children with bronchial asthma. 100 children with bronchial asthma who underwent venous blood collection in outpatient department were randomly divided into two groups. The control group received venous blood collection with routine nursing, while the experimental group received intervention of communication skills on the basis of routine nursing. Blood collection (blood collection time, hemostatic compression time after puncture, success rate of disposable puncture), satisfaction of family members of children (technical professionalism, service attitude, communication skills) and pain during puncture were compared between the two groups. The results showed that the intervention of communication skills during venous blood collection improves the success rate of disposable puncture to a certain extent, prevents asthma attack, and psychologically reduces the pain of children and improves the satisfaction of their family members. However, there are too single intervention methods and some shortcomings. In order to effectively improve the success rate of disposable puncture to prevent asthma attack, reduce the negative emotions of family members, and make it easier for children to improve their compliance with venous blood collection in a more comfortable adaptive state, the study 2 was introduced.

Study 2: To explore the effects of multiple interventions based on Roy adaptation mode on compliance of venous blood collection and negative emotions of family members of children with bronchial asthma. 108 children with bronchial asthma were randomly divided into two groups. The control group received routine nursing mode, while the experimental group received multiple nursing intervention based on Roy adaptation mode theory. The success rate of disposable intravenous puncture, the incidence of congestion, the compliance of venous blood collection, the time of venous blood collection, the number of people who did not cry during venous blood collection, the duration of painful face, and the number of people who cried for more than 5s at 20 s after blood collection of were compared between the two groups. The changes in FLACC score, Wong-Baker scale score, heart rate and systolic blood pressure (1min before blood collection,during blood collection, 1min after blood collection, 5min after blood collection) were studied，and the changes of negative emotion scores for family members of the two groups were compared when the children were before and after blood collection and Intermediary analysis of family satisfaction in venous blood collection compliance and venous blood collection time. By comparing and observing the above indicators, the results showed that the application of diversified intervention based on Roy adaptation mode can better improve the cooperation degree of venous blood collection and the success rate of disposable puncture. The improvement of the success rate of disposable puncture can more effectively prevent the attack of asthma and better alleviate the negative emotions of children and their family members.Study 2 enriched multiple intervention measures on the basis of study 1, and makes up for the deficiency of single intervention method in study 1. Diversified nursing intervention includes analysis on physiological and psychological models and adaptability in children, targeted health education, psychological intervention, environmental layout, targeted nursing, emergency treatment, adjustment of psychological stress degree in children, targeted health education for family members, popularization of medical knowledge and psychological intervention, etc.

As a mature nursing theory, multi-intervention of communication skills and Roy adaptation mode has been widely used and recognized in clinical practice all over the world. A large number of theoretical and practical studies have been carried out in China, which provides a basis for the wide application of this nursing mode in venous blood collection of children.