联机血液透析滤过的临床疗效观察与护理

目的 观察联机血液透析滤过的临床疗效,探讨其技术并发症产生因素及护理措施,为临床上使用联机血液透析滤过技术提供依据或线索.方法 对60例行血液透析治疗的慢性肾功能衰竭患者行联机血液透析滤过治疗1036例次,通过对临床资料回顾性研究,采用自身对照,观察血液透析滤过与血液透析治疗中临床症状及溶质的变化,总结护理体会.结果 血液透析及联机血液透析滤过治疗后血肌酐、尿素氮显著下降,有统计学意义(P<0.01);联机血液透析滤过对B:微球蛋白清除有统计学意义(P<0.01),血液透析对β2微球蛋白清除无统计学意义(P>0.05);与血液透析比,联机血液透析滤过时低血压、肌肉痉挛、恶心呕吐、骨关节疼痛、皮肤瘙痒等症状的发生率有统计学意义(P<0.01);首次使用滤器综合征10例次,血液透析滤过器内凝血3例次,无一例次热原反应及置换液异常输入.结论 联机血液透析滤过能同时清除中、小分子尿毒症毒素;具有较好的血流动力学稳定性和耐受性;实施正确护理可减少血液透析滤过技术相关并发症,保证其安全进行.

Observation on clinical effect of the online hemodiafiltration and nursing

Objective To observe the clinical effcet of the online hemediafitration (online-HDF) and discuss the occurrence factors of complications and the suitable nursing measures, so as to give a basis or clue for the application of online-HDF in clinic. Methods 60 chronic renal failure patients underwent the hemedialysis therapy were treated by online-HDF (totally 1036 times). Through studying the clinical data retrospectively and adopting the self-control, the clinical symptoms and solutes changes during the online-HDF and the hemedialysis treatment. Then the nursing experiences were summarized. Results Both blood creatinine and urea nitrogen levels after the hemodialysis and online-HDF dropped significantly ( P<0.01). As to the β2-mieroglobulin removal effect, the hemodialysis had no obvious influence (P>0.05), while the online-HDF had (P<0.01). The common complications when receiving online-HDF included hypotension, muscle spasm,vomiting, bone arthrosis ache, and skin itch. The occurrence rates of these complications of online-HDF were smaller than those of the hemodialysis group (P<0.01). There were 10 cases with first-use syndrome of filter and 3 cases with coagulation in the hemedialysis filter, while no cases with heat sources reaction or displacement liquid abnormal importation. Conclusions The online-HDF could remove the median and small molecule uremia poison simultaneously. The patients could tolerate it with stable hemodynamics. The suitable nursing can lessen the HDF-related complications and guarantee the safety.