运用血液透析模式行腹水回输的护理

目的腹水浓缩回输术是应用腹水浓缩装置,在无菌和密闭的条件下,将腹水通过超滤、透折而浓缩,保留患者所需物质（如蛋白质）,清除不需要的物质（如水、尿素氮等）,然后再将含有高浓度蛋白质的浓缩腹水回输。我院于2005年1月至2008年1月运用金宝AK95透析机采取透析方法对15例肝硬化顽固性腹水患者进行28次腹水超滤浓缩回输术,提高了患者的生存质量和治疗效果。方法取脐与左/右髂前上棘连线中外1/3处为穿刺点,常规消毒左下腹和右上腹,铺双洞巾,实行局部麻醉,用16号透析专用穿刺针行两侧腹腔穿刺。待两侧腹腔穿刺成功后,先取一侧腹腔穿刺针与血路管道动脉端连接,打开血液透析机的血流调节器,血泵开始运转,排掉血路管道内的肝素生理盐水后,再将血路管道的静脉端与对侧腹腔穿刺针连接,以止血钳固定管道于双孔洞巾上。此时,血路管道内流动的是腹水,开始腹水净化体外循环,腹水流动速度设定在200ml/min。结果回输过程中,严密监测患者生命体征及有无腹痛、头晕恶心等症状,如出现上述异常情况,适当减慢腹水流动速度。一般一次腹水净化回输2～4h,回输量为24000～40000ml,除水量为4000～8000ml。准确、及时记录腹水引出量、脱水量,抽完腹水后测量体重、腹围,并记录。术后无菌纱布包扎穿刺口并用腹带加压包裹,以防止腹水迅速再生和腹水外渗。而且,合理安排饮食也是非常重要的。

Nursing to the Patients Accepted Ascites Reinfusion in Hemodialysis Mode

Objective Concentrated ascites reinfusion is a kind of method, which makes use of reinfusion device to concentrate aseites through ultrafiltration and dialysis under the sterile and sealed conditions, keeping the necessary compositions （eg. protein） and clearing the unnecessary （eg. water, urea nitrogen, etc. ）, and reinfuse the ascites with high-concentration protein. We chose 15 patients with intractable aseites of cirrhosis to implement concentrated aseites reinfusion through dialysis by AK95 Dialysis Machine from January 2005 to January 2008, improving the life quality of patients. Methods After making a routine disinfection to inferior-left abdomen and rigbt upper abdominal and giving local anesthesia, implement abdominal puncture on both sides with NO. 16 special puncture needle. When the puncture succeeds, connect puncture needle on one side with arterial part of hematogenous pipe. Open blood flow regulator and the pump starts working to remove heparin-saline within hematogenous pipe. And then connect the venous part of hematogenous pipe with puncture needle on the other side to fix the pipe with hemostatic forceps. At this time the flowing in hematogenous pipe is ascites, which velocity is 200 ml/min. Results During the reinfusion, nurses should carefully observe patients＇ vital sign and symptoms （eg. abdominal pain, dizziness and nausea）. With the abnormal situations above, slower the flow velocity of ascites. It takes 2 -4 h for ascites reinfusion after purification, with the amount of reinfusion 24 000 - 40 000 ml and 4 000 - 8 000 ml removing quantity. Make an accurate and timely record to the content of extraction and anlount of dehydration. After drawing ascites, measure the body weight and abdominal circumference, and then write them down. In order to prevent ascites regenerating and extravasating rapidly, bandage puncture with sterile gauze and enwrap it after the operation. And also, it＇ s very necessary to arrange diet rationally.