不同补液方案对活体肾移植受者术后多尿期临床疗效和护理工作量的影响分析

目的比较不同补液方案对活体肾移植受者术后多尿期临床疗效和护理工作量的影响。 方法回顾性分析海军军医大学第一附属医院器官移植科84例活体肾移植受者临床资料，根据受者术后不同补液方案将其分为循环补液方案组(40例)和单一连续补液方案组(44例)。观察两组受者性别、年龄、体质指数、透析和高血压等一般资料，术后尿量，治疗效果(如血糖、电解质及血清肌酐等)和护理工作量(如医嘱转抄处理时间、配备液体时间、更换液体频次和总步数等)。符合正态分布的计量资料采用两独立样本t检验进行比较。计数资料采用卡方检验进行比较。P<0.05为差异有统计学意义。 结果循环补液方案组受者接受供者左、右侧供肾分别为27、13例，单一连续补液方案组分别为17、27例，差异有统计学意义(χ²＝6.998，P<0.05)，两组其余一般资料差异均无统计学意义(P均>0.05)。两组受者术后1、3、5、7、24及72 h尿量差异均无统计学意义(P均>0.05)。循环补液方案组受者术后第1天血糖为(13.9±5.6)mmol/L，高于单一连续补液方案组(8.7±2.2)mmol/L] ，差异有统计学意义(t＝－5.584，P<0.05)。循环补液方案组护师医嘱转抄处理时间、配备液体时间、更换液体频次和总步数分别为(72±6)s、(408±12)s、(18.2±3.4)次和(566±104)步，单一连续补液方案组分别为(39±3)s、(108±8)s、(9.1±1.6)次和(289±52)步，差异均有统计学意义(t＝31.710、133.601、15.409和15.240，P均<0.05)。 结论肾移植术后多尿期采用单一连续补液方案效果平稳、方案简便，可有效降低护理工作量。

Effect of different fluid therapy regimens on the clinical outcomes and nursing workload in living donor kidney transplantation recipients with polyuria

ObjectiveTo evaluate the effects of two different fluid infusion regimens on the clinical outcomes and the nursing workload in living donor kidney transplantation recipients with polyuria. MethodsA total of 84 living donor kidney transplant recipients in the Department of Organ Transplantation of the First Affiliated Hospital of Naval Medical University were recruited in this retrospective study. These recipients were divided into the circulating fluid infusion group (n=40) and single continuous fluid infusion group (n=44) in accordance with the post-operation fluid therapy regimens. The baseline characteristics (such as gender, age, body mass index, dialysis and hypertension), postoperative urine volume, prognostic outcomes (such as blood glucose, electrolyte and serum creatinine) and nursing workload (measured by time of managing doctor′s order and preparing fluids, frequency of changing fluids, and total steps) were observed and recorded. The measurement data conforming to normal distribution were compared by independent samples t test. The counting data were compared by Chi-square test. A P<0.05 was considered statistically significant. ResultsThe number of recipients receiving left/right kidneys in circulating fluid infusion group were 27/13, and those were 17/27 in single continuous fluid infusion group, the difference was statistically significant (χ²=6.998, P<0.05). There was no significant difference in other baseline characteristics between the two groups (all P>0.05). There was no significant difference in urine volume at 1, 3, 5, 7, 24, 72 hours post-operation between the two groups (all P>0.05). The blood glucose on one day post-operation in circulating fluid infusion group was (13.9±5.6) mmol/L, which was significantly higher than that in single continuous fluid infusion group (8.7±2.2) mmol/L] (t=-5.584, P<0.05). The time of managing doctor′s order, time of preparing fluids, frequency of changing fluids and total steps were (72±6) seconds, (408±12) seconds, (18.2±3.4) times and (566±104) steps in circulating fluid infusion group, and (39±3) seconds, (108±8) seconds, (9.1±1.6) times and (289±52) steps in single continuous fluid infusion group, and the difference had statistical significance (t=31.710, 133.601, 15.409 and 15.240, all P<0.05). ConclusionThe single continuous fluid infusion regimen was recommended to be applied in the diuretic phase after kidney transplantation due to the stable clinical outcomes, convenient operation and minimize nursing workload.