静脉补铁在血液透析过程中的应用及护理

目的观察慢性血液透析过程患者静脉补铁改善贫血的效果及总结护理要点。方法109例患者共使用铁剂2398次,停药2w后抽血检查静脉补铁前后血红蛋白、红细胞压积、血清铁蛋白和转铁蛋白饱和度及促红细胞生成素使用剂量。结果1例患者首次使用右旋糖酐铁出现胸闷、心悸,立即停止使用并给予吸氧后缓解。治疗后患者平均血红蛋白升高幅度为21～52g/L,血红蛋白水平均达到目标值水平,红细胞压积升高幅度为4.5%～18.0%,血清铁蛋白升高幅度为230～342μg/mL,转铁蛋白饱和度均达到目标值水平（〉20%）,促红细胞生成素使用剂量为（112.4±20.8）U/kg/w,平均使用剂量下降11.1%。结论在血液透析过程中,静脉补充铁剂能有效改善患者的贫血状况,而且具有安全、快速、高效、方便的优点。同时良好的护理可避免血液透析患者静脉补铁时的不良反应,使治疗顺利进行,并提高患者生活质量。

Application and nursing of using intravenous iron in hemodialysis patients

Objective To observe the result of using intravenous iron to improve the anaemia in patients receiving continual hemodialysis, and to summarize the key points of nursing . Methods 109 patients received the treatment of intravenous iron for 2 398 times. Two weeks after the treatment, Hb, Hematocrit, Serum Ferritin, Transferrin Saturation and EPO before and after the treatment were assessed. Results One patient had the chest distress and palpitation at the first use of Ferrum Dextron. The Hb increased 21-52g/L post-treatment, and all patients achieved the goal value. The Hematocrit increased 4.5-18.0%, Serum Ferritin increased 230-342μg/mL, and the Transferrin Saturation achieved goal value （〉20%） too. The dosage of EPO was 112.4±20.8 U/kg/w, 11.1% lower in average. Conclusions Intravenous iron can improve anemia and it is safe, quick and convenient. Good nursing can avoid adverse effects, and improve the treatment and the quality of life.