加强夜间护理观察

严密观察病情,是衡量护理质量的重要标志,尤其在夜间,由于特定的环境和病人的病理,生理的变化的特点,任何放松警惕和麻痹大意,都会造成不良后果。1夜间护理观察1.1夜间病人进入安静睡眠状态交感神经被抑制迷走神经占优势,不少疾病尤其是心血管疾病,此时心跳和血流缓慢,心肌力降     

老年病人夜间病情观察与护理

老年病人往往同时患有多种疾病,而且病情变化隐袭、发展快;尤其在夜间,由于迷走神经兴奋性增强,导致冠状动脉痉挛,心肌缺血,呼吸变浅慢,病情变化多端,夜间病死率高.近四年来我科共死亡28例病人,其中夜间死亡18例,占64%.因此做好老年病人夜间病情观察与护理,提高急危重症病人抢救成功率具有特殊重要意义.一、夜间观察护理的方法及内容老年病人的夜间观察与护理,除进行一般生命体征观察外,还有其独特的方法及内容.     

夜间护理观察不容忽视

严密观察病情，是衡量护理质量的重要标志，尤其在夜间，由于特定的环境和病人的病理，生理的变化的特点，任何放松警惕和麻痹大意，都会造成不可弥补的损失。1．夜间护理观察夜间病人进入安静入睡，此时，交感神经被抑制迷走神经占优势，不少疾病尤其是心血管疾病，此时心跳和血流缓慢，心肌力降低，心肌供血相对减少，往往容易导致心搏抑制甚至停掉，这是不少病人易有夜间死亡的重要原因之一。如：冠心病，引起心绞痛或心肌梗塞[1]，左心衰竭者也容易有夜间发生。二氧化碳大量潴留可引起高碳酸血症，对中枢神经系统的毒性作用，而诱发肺性…     

饮食干预延缓慢性肾衰病情进展的护理

慢性肾功能衰竭(CRF)是各种慢性肾脏疾病发展至终末期引起的系列临床综合征,到目前为止是不可逆转无法治愈的慢性疾病。因此,采取积极有效的方法控制病情的进展,提高生活质量,延长患者生命尤为重要。目前大多数学者对低蛋白饮食(LPD)治疗CRF持肯定态度,但也有认为低蛋白饮食极易造成患者营养不良,使病情恶化。对蛋白饮食是否有效、以及如何延缓慢性肾衰病情进展存在争议,因此,医护人员进行合理的饮食干预是极其重要的,而如何实施正确的饮食干预,延缓慢性肾衰病情进展值得进一步探讨。1饮食干预延缓慢性肾衰病情进展的有效性慢性肾衰患者…     

中药结肠透析治疗慢性肾衰的护理体会

慢性肾衰是以肾功能减退，代谢产物潴留，水、电解质及酸碱平衡失调为主要表现的一组综合征。尿毒症是慢性肾衰的晚期，预后较差。我科采用中药结肠透析治疗疗效满意。现就中药结肠透析护理体会，报告如下。     

特重度烧伤病人的夜间护理探讨

特重度烧伤病人因伤势严重,病情复杂,所以死亡率高.在临床护理中,我们发现烧伤病人死亡率夜间较日间偏高,为此,我们就特重度烧伤病人的夜间护理进行回顾和归纳分析,以寻找危重病人夜间护理的特点,总结经验,指导今后的工作.     

浅谈全程护理干预对老年慢性肾衰患者治疗依从性的影响

目的 浅谈全程护理干预对老年慢性肾衰患者治疗依从性的影响.方法 选取2016年5月-2017年5月我院收治的老年慢性肾衰患者92例作为研究样本,以抽签的方法随机分为观察组(n=46)和对照组(n=46),对照组采取常规护理,观察组在此基础上配合全程护理干预.而后对比两组患者生活质量改善情况、肾功能情况以及依存性.结果 观察组患者生活质量改善情况、肾功能情况以及依存性与对照组比较,存在明显差异,即P<0.05.结论 全程护理干预对老年慢性肾衰患者治疗依从性的影响颇深,值得临床推广.     

尿毒症患者神经精神症状的观察与护理对策

目的对尿毒症患者神经精神症状进行观察并总结其护理特点.方法对126例尿毒症患者的神经精神症状进行分类总结,分析和总结护理经验,并将患者分为尿毒症脑病组和尿毒症非脑病组,观察两组间某些生化指标差异.结果尿毒症脑病组尿素氮、肌酐水平显著高于尿毒症非脑病组(P＜0.01),而血红蛋白显著低于尿毒症非脑病组(P＜0.01).通过加强对尿毒症患者神经精神症状相对应的护理措施,改善了预后,提高了疗效,也加强了医护之间的沟通与配合.结论加强对非神经专科而有神经精神症状的尿毒症患者的观察与护理,可提高护理质量及疗效.     

慢性肾功能衰竭患者合并结核的诊治

目的:分析慢性肾功能衰竭(CRF)患者结核感染的诊断及治疗特点,以期早期诊治。方法:以1995年1月~2005年1月我院收治住院的42例合并结核的CRF患者为研究对象,回顾分析其临床表现、实验室检查特点及抗痨治疗反应。结果:CRF患者结核感染率为5.8%,其中半数以上是不典型肺外结核;随着肾衰程度的加重,合并结核的发生率逐渐升高;抗结核抗体和PPD阳性率(16.6%,20.8%)显著低于普通结核患者(65.3%,70.6%,P<0.05);多数病例对抗痨治疗反应良好,治疗总有效率为83.2%。结论:CRF患者结核感染率较高,特别易并发不典型肺外结核,临床表现不典型,实验室检查敏感性低,应加强监测以期早期诊断早期治疗。     

高通量血液透析对慢性肾功能衰竭尿毒症患者血清因子及近期预后影响

目的探讨高通量血液透析对慢性肾功能衰竭尿毒症患者血清β2-微球蛋白(β2-MG)、胱抑素C(CysC)、甲状旁腺素(PTH)水平及近期预后的影响。方法选取自2015年1月至2017年5月收治的140例慢性肾功能衰竭尿毒症患者为研究对象。根据治疗方法不同,将所有患者分为A组(n=68)与B组(n=72),A组给予普通透析联合血液透析滤过治疗,B组给予高通量血液透析治疗。比较两组患者的小分子毒素水平,血清CysC、β2-MG、PTH水平,尿素透析充分性及病死率。结果两组患者治疗后血磷、血钾、血尿酸、血肌酐及血尿素氮水平均显著降低(P<0.05);B组血磷水平明显低于A组(P<0.05)。两组患者治疗后CysC、β2-MG、PTH水平均显著降低(P<0.05);B组CysC、PTH水平显著低于A组(P<0.05)。两组患者尿素透析充分性比较,差异均无统计学意义(P>0.05)。B组病死率为13.9%(10/72),显著低于A组的27.9%(19/68),两组比较,差异有统计学意义(P<0.05)。结论高通量血液透析可以显著提高慢性肾功能衰竭尿毒症患者的CysC、β2-MG、PTH的清除效果,降低心脑血管疾病病死率,改善患者近期预后。     

CVVHDF治疗重症急性胰腺炎伴急性肾功能衰竭的护理

连续性血液净化，是目前临床上一种新的生命支持技术。它对清除血液中的中、小分子物质、超滤清除体内过多水分，对各种炎症介质的清除作用已在许多研究中得以证实口’，成为急救医学的重要部分，对降低重危患者的死亡率有重要意义。现将我们在对5例重症急性胰腺炎（SAP）伴急性肾功能衰竭（ARF）应用连续性静脉——静脉血液透析滤过（CVVHDF）救治过程中的护理体会报告如下。     

Metaphyseal sclerosis in patients with chronic renal failure

We reviewed radiographs of the hands and wrists of 33 patients with immature skeletons and chronic renal disease. Various radiographic manifestations of renal osteodystrophy were seen, including osteopenia in 23 patients (70%), subperiosteal resorption in 20 (61%), distal tuft resorption in 14 (42%), sclerosis of vertebral bodies in 2 (6%), and soft-tissue calcification in 1 (3%). We also noted that 13 patients (39%) exhibited metaphyseal sclerosis adjacent to the growth plates. Five of these 13 showed persistent sclerosis years after the growth plates had fused. None of the patients showed other radiographic changes of rickets, and there was no correlation between the serum calcium, phosphorus, or aluminum levels and the presence of metaphyseal sclerosis. Neither was there any association with the underlying cause of renal failure, method of treatment, presence of a transplant, or type of dialysis. We view this finding as another manifestation of renal osteodystrophy. The importance of distinguishing it from other sclerotic lesions is discussed.     

氧气治疗肢端慢性溃疡病的护理观察

肢端慢性溃疡的发生 ,其原因主要是局部循环障碍 ,缺血缺氧及感染造成的组织水肿 ,炎性细胞浸润等病理改变 ,影响组织细胞再生能力 ,阻碍创面的愈合。当创面过大时可进行皮肤移植术或进行高压氧治疗 ,但创面较小时 ,临床上普遍用的处理方法是以双氧水清洗创面 ,用庆大霉素或凡士林纱条换药等 ,耗时长 ,愈合差。我们试用氧气治疗装置对溃疡伤口进行纯氧气治疗 ,效果好、时间短、费用少 ,现报告如下 :1　临床资料1 1　一般资料　本组 11例 ,其中男性 5例 ,女性 6例。创面在上肢者 4例 ,在下肢者 7例 ,6 0岁以上者 8例 ,35～ 39岁 2例 ,10岁以…     

Iodine trapping and organification in patients with chronic renal failure

In vitro thyroid function tests were studied in 30 patients on regular hemodialysis. In addition, 8 patients (one not yet dialyzed) underwent perchlorate discharge testing and the salivary to plasma ratio of¹³¹I was measured to identify defects in iodine uptake or organification. When compared with 35 healthy controls, uremic patients had lower total T4 (5.8±0.4 vs 8.6±0.3 μg/100 ml) and total T3 (81±6 vs 124±5 ng/100 ml) but T3RU was higher in dialysis patients (35.5±0.9 vs 28±0.5%,P<0.01). The TSH levels were not different from those of controls. The RAI uptake 1 h after perchlorate was significantly higher than the control valve (0.6±0.14 vs 0.06±0.04,P<0.05). Similarly, the salivary to plasma ratio of¹³¹I was higher in patients with chronic renal failure (70±10:1 vs 40±4:1). It is concluded that there is altered iodine trapping in CRF patients but iodine organification appears to be normal.     

前列地尔对慢性肾功能衰竭患者微炎症状态的影响

目的 探讨前列地尔对慢性肾功能衰竭患者微炎症状态及水通道蛋白2(AQP2)产生的影响.方法 将2012年1月～2014年6月治疗的慢性肾功能衰竭患者98例,随机分成对照组与观察组,各49例.对照组接受慢性肾功能衰竭的常规治疗,观察组给予常规治疗联合前列地尔治疗.结果 治疗后,观察组的血β2-微球蛋白(β2-MG)、尿β2-MG、血尿素氮(BUN)、血肌酐(CREA)、核因子活化B细胞K轻链增强子(NF-κB)、白介素6(IL-6)及水通道蛋白2水平均明显低于对照组,而血红蛋白(HGB)水平则明显高于对照组(P＜0.01);观察组的治疗总有效率(87.76％)明显高于对照组(71.43％)(P＜0.05).结论 前列地尔用于治疗慢性肾功能衰竭疗效确切,可显著改善患者的肾功能,减轻炎症反应,并纠正水代谢紊乱.     

Pharmacokinetics of iopentol in patients with chronic renal failure.

Iopentol 350 mg I/ml was injected in doses of 265 to 533 mg I/kg b.w. (mean 417 mg I/kg b.w.) in 10 patients with advanced nondiabetic chronic renal failure (S-creatinine 672 +/- 259 mumol/l (mean +/- SD)). Urine (10 patients) and feces (7 patients) were collected at 24 h intervals for 5 days after the injection. The elimination of iopentol was delayed. Five days after injection a mean of 54% (range 35-79%) of the dose was recovered in urine, and 11% (0-20%) in feces. Mean elimination half-life was 28.4 h, about 14 times the half-life found in healthy volunteers. The apparent volume of distribution was 0.27 l/kg b.w., indicating distribution only to extracellular fluid. Using renal iopentol clearance as reference value, GFR was overestimated by 40 to 60% with iopentol total clearance, showing extrarenal elimination of iopentol. The difference was most pronounced in patients with low GFR. In conclusion, this study shows an extrarenal elimination of iopentol and demonstrates a substantial increase in the fecal elimination in patients with severe renal failure.     

Pharmacokinetics of Gd-DTPA in patients with chronic renal failure.

We investigated the pharmacokinetics of dimeglumine gadopentetate (Gd-DTPA), a contrast agent for magnetic resonance imaging (MRI), in 24 patients with chronic renal failure whose creatinine clearance ranged from 7.2 to 70.0 mL/minute (median 25.4 mL/minute). After single intravenous administration of 0.1 mmol/kg, the serum levels of Gd-DTPA were monitored up to five days and urine and feces were collected quantitatively up to two days. The pharmacokinetic parameters were calculated from the concentration-time profile in the serum and urine using an open two-compartment model. No changes in the volume of distribution (Vc and Varea) or in the half-life of distribution were found for patients with chronic renal failure as compared to patients with normal renal function. However, in correlation with the reduced glomerular filtration rate in patients with chronic renal failure, the half-life of elimination was prolonged and serum and renal clearance were decreased. The recovery of Gd-DTPA in urine was 92.1% +/- 12.1% of the dose administered, and extrarenal elimination was less than 0.4%, indicating that glomerular filtration remains the predominant route of elimination. Only for patients with highly impaired renal function (creatinine clearance less than 20 mL/minute) was the recovery in the urine less than complete.     

Salivary function in patients with chronic renal failure undergoing hemodialysis

PURPOSE: The aim of this study was to evaluate the changes in salivary gland function in patients with chronic renal failure (CRF) undergoing hemodialysis. METHODS: The group consisted of 23 patients with CRF (13 female, 10 male; mean age: 40 +/- 13 yr) and 14 healthy control subjects (mean age: 40 +/- 13 yr). All underwent dynamic salivary gland scintigraphy with gustatory stimulation. After intravenous administration of 99mTc pertechnetate, first, perfusion images at 2 seconds per frame were acquired for 1 minute, then dynamic images at 1 minute per frame were acquired for 45 minutes. At 30 minutes after injection, 10 ml lemon juice was given for 15 minutes as a gustatory stimulus. We obtained time-activity curves derived from regions of interest centered over the four major salivary glands. The following functional indices were calculated for each gland: the time of maximum radioactivity (Tmax) for the prestimulated period, the time of minimum radioactivity (Tmin), as an indicator of velocity of secretion after stimulation, and the Lem E5% value as an indicator of the secretion function. RESULTS: When the patients with CRF undergoing hemodialysis were compared to the controls, there were statistically significant differences in Tmax, Tmin and Lem E5% values for bilateral parotid glands, and Tmin values for bilateral submandibular glands (p < 0.05), there were no statistically significant differences in Tmax and Lem E5% values for bilateral submandibular glands. There were also significant differences in Tmax and Lem E5% values for bilateral parotid glands between mild oral problems and severe oral problems in patients with CRF (undergoing hemodialysis). CONCLUSION: In this study, prolonged Tmax and Tmin values, and decreased Lem E5% values for parotid glands and prolonged Tmin values for submandibular glands on salivary scintigraphy pointed out decreased parenchymatous and excretory function in patients with CRF undergoing hemodialysis.