不同护理方案用于双重血浆置换治疗多发性骨髓瘤的效果比较

目的探讨不同护理方案用于双重血浆置换治疗多发性骨髓瘤的效果。方法将30例多发性骨髓瘤患者随机分为实验组和对照组，每组15例。对照组采用机器要求的预冲液进行管路预冲，治疗开始时给予低分子肝素钙，治疗中间断生理盐水冲洗管路。实验组采用改良后的预冲方法：用含肝素的生理盐水冲洗管路，治疗开始前20—30min给予低分子肝素钙，治疗中间断挤压动脉壶。比较两组的凝血情况及治疗参数。结果实验组Ⅱ-Ⅲ级凝血发生率为23．3％，对照组为75．0％，差异有统计学意义（x^2=37．95，P〈0．05）；对照组跨膜压指标、冲洗盐水总量高于实验组（t=9．76，P〈0．05），置换血浆量、废弃血浆量和治疗时间低于实验组（P〈0．05）。结论实验组在预冲方法、抗凝方案以及预防凝血冲洗方法上较对照组有效控制了凝血的发生，在保证治疗效果的同时，避免治疗中入液量过多而加重肾脏负担。

Comparison of different nursing methods in double plasma exchange treatment on multiple myeloma

Objective To study the effect of different nursing methods in double plasma exchange treatment on multiple myeloma. Methods 30 patients with multiple myeloma were randomly assigned to the experimental group (EG) and the control group (CG), 15 patients in each group. In the CG, the canal was washed by the priming fluids according to the machine requirements; patients were given the LMWHC at the beginning of the treatment. During the treatment, the canal was washed discontinuously by normal saline (NS).An improved priming method was adopted in the EG: the canal was washed with NS included heparin, patients were given the LMWHC. After 20 - 30 mins, the treatment started. Squeeze the artery pot discontinuously during the treatment; compare the clotting situation and treatment parameters of two groups. Results Level Ⅱ - Ⅲ clotting incidence rate of EG was 23.3% and of CG was75.0%. The difference between two groups was statistically significant (X2 =37.95,P ＜0. 05); TMP of CG were higher than those of EG[(17.32 ±5. 22)mm Hg vs (4.73 ± 3.27) mm Hg, t = 9. 76, P ＜ 0. 05]; total NS amount used, replacement plasma, waste plasma and treatment time of CG were lower than EG (P ＜ 0. 05). Conclusions Compared with CG, the priming methods, anticoagulation solutions and washing methods of EG have better control on the occurrence of clotting and require less amount of washing NS to reduce the burden on kidney without influencing the effect of the treatment.