腹带加压预防腹膜透析患者术后并发症的临床观察

目的探讨腹带加压对腹膜透析患者伤口拆线时间、伤口渗液、出血及隧道口炎、导管移位发生率的影响,为防治腹膜透析并发症提供新的治疗方法。方法根据腹膜透析术后是否采用腹部伤口腹带加压,将患者分为腹膜透析插管后3个月内腹带加压组(A组)和未使用腹带加压对照组(B组),观察两组患者的伤口拆线时间、伤口渗液、出血及透析管相关隧道口炎、导管移位的发生率。结果 (1)A组平均拆线时间为(11.2±0.8)d,B组平均拆线时间为(13.4±0.7)d,两组比较有统计学差异(P0.01)。(2)术后A组有1例患者发生伤口渗血,而B组有8例患者出现伤口渗血,明显高于A组(P0.05);术后A组有1例隧道口炎发生,而B组有7例患者在术后3个月发生隧道口炎,与A组比较有统计学差异(P0.05),两组患者予以规范抗感染治疗后均治愈。(3)A组有1例患者在术后第2天出现管周渗液,发生率为2.94%;B组有1例患者在术后第1天出现管周渗液,发生率为3.03%,两组比较无统计学差异(P0.05)。(4)A组有1例患者出现导管移位,发生率为2.94%;B组有1例患者出现导管移位,发生率为3.03%,两组比较无统计学差异(P0.05)。结论腹带加压可缩短手术后拆线时间,可减少术后腹部伤口渗血及隧道口炎的发生率,极大地减少了术后并发症的发生,可促进患者早日康复,能有效延长腹膜透析患者的透析时间和治疗效果,减少腹透早期退出率,提高患者生活质量。

Clinical observation of abdominal compression in prevention of postoperative complications of patients with peritoneal dialysis

Objective To discuss the effect of abdominal compression on the time of taking out the stitches in wound,wound discharge and bleeding,dialysis catheter related tunnel stomatitis and occurrence rate of catheter malposition,and to provide new treatment for the peritoneal dialysis complications. Methods The patients who underwent peritoneal dialysis were divided into group A and group B according to have abdominal compression or not,group A were given abdominal compression 3 months after peritoneal dialysis,while group B with no abdominal compression. The time of taking out the stitches in wound,wound discharge and bleeding,dialysis catheter related tunnel stomatitis and occurrence rate of catheter malposition of the two groups were compared.Results（ 1） The average time of taking out the stitches in wound of group A and B were（ 11. 2 ± 0. 8） and（ 11. 2 ± 0. 8） d,respectively,the difference between two groups had statistic significance（ P 0. 05）;（ 2） 1 case was of wound bleeding in group A,and 8 cases in group B,the difference between two groups had statistic significance（ P 0. 05）;（ 3） 1 case was of wound discharge in group A after 2 days of surgery,and 1 case in group B after 1 days of surgery,the incidence of wound discharge were 2. 94% and3. 03%,respectively,there was no statistical difference between the two groups（ P 0. 05）.（ 4） 1 case was of catheter malposition in both groups,the incidence of catheter malposition were 2. 94% in group A and 3. 03% in group B,there was no statistical difference between the two groups（ P 0. 05）. Conclusions Abdominal compression can reduce the time of taking out the stitches in wound,decrease postoperative complications and the incidence of wound discharge and bleeding,which can help rehabilitation of patients,effectively extend the duration of dialysis and treatment,reduce patient＇s dropout of peritoneal dialysis,improve the quality of life of patients.