Objective To study the influence of social support and coping style on quality of life in elderly patients with maintenance hemodialysis (MHD).Methods From January 2015 to August 2016 in our hospital,152 elderly patients undergoing MHD were chosen as the research objects,and all patients were required to finish the patient's quality of life (QOL) survey including WHO BREF (WHOQOL-BREF),social support rating scale (SSRS) and medical coping questionnaire (MCMQ) survey.QOL of patients was investigated,and the correlation of SSRS score and MCMQ score with the quality of life score of patients were analyzed.Results 138 patients (90.79％) had finished all the questionnaires.Total score of quality of life was 47.58 ± 7.69.The total score of social support (rsocial support =0.384) and different coping styles (rconfrontation =0.395,ravoiding=0.324,rsubmission =-0.338)were significantly correlated with the total score of QOL (P≤ 0.05).Conclusions Favorable social support and positive coping modes could exert effect on QOL in MHD patients.

目的:总结特重烧伤并发急性肾功能不全患者早期进行血液透析治疗的临床治疗及护理体会.方法:回顾分析5例烧伤总面积80％-95 ％TBSA(其中Ⅲ°烧伤面积50％～85 ％TBSA)特重烧伤患者在伤后4天内即进行血液透析的临床病例资料和护理措施.结果:5例特重烧伤并发急性肾功能不全患者伤后4天内即行血液透析,透析时间5-28天,有效保护了肾功能、纠正了水电解质失衡等并发症,无严重并发症,患者治愈出院.结论:特重烧伤患者早期进行血液透析是安全有效的.但要特别注意强化液体管理,处理好特重烧伤早期需大量液体复苏和肾功能不全需适当限制液体输入的矛盾;血管通路的维护、滤器凝血的预防、创面出血和感染的防治也是其整体护理中的关键环节.

[目的]了解影响长时间血液透析病人生活质量的主要危险因素,为提高病人生活质量提供依据。[方法]对我院37例透析10年以上的病人进行临床观察研究,内容包括营养状况评估、钙磷代谢紊乱、继发性甲状旁腺功能亢进等相关指标的检查、血管通路回顾性分析以及病人生活状况的调查。[结果]37例透析病人透析时间最长25年,10年~15年26例,16年~20年6例,20年以上5例。近期透析前血液检查结果血红蛋白>100 g/L 者29例,白蛋白>30 g/L 者24例,磷<1.7 mmol/L 者27例,血钾<6.0 mmol/L者35例。甲状旁腺激素<500 pg/mL 者25例,500 pg/mL~1000 pg/mL 者6例,1001 pg/mL~2000 pg/mL 者3例,2000 pg/mL以上者3例；行甲状旁腺手术9例；现有血管通路：自体动静脉内瘘31例,人造动静脉内瘘1例,临时管1例,长期管2例,直穿者2例；入科方式：步行来院者26例,扶行者3例,轮椅送来者8例。[结论]长期行维持性血液透析病人生活质量较差。原发病、透析时间、血管通路类型、曾经造瘘次数及是否做过甲状旁腺手术与透析病人的生活质量无关。

[目的]分析维持性血液透析病人自体动静脉内瘘(AVF)、聚四氟乙烯人造血管(AVG)、直接动静脉穿刺3种血管通路常见并发症的发生情况,为临床护理干预提供理论指导。[方法]选择血液净化中心2011年维持性血液透析病人310例,随访12个月,回顾性观察AVF、AVG、直接动静脉穿刺3种不同类型血管通路常见并发症(血管闭塞和动脉瘤)的发生情况。[结果]310例血液透析病人中以AVG血管通路闭塞并发症的发生率最高(42.86%),AVF最低(3.58%);直接动静脉穿刺穿刺点动脉瘤并发症的发生率最高,AVG通路穿刺点动脉瘤为0。[结论]AVF透析病人常见血管闭塞并发症发生率远低于AVG通路血管闭塞并发症,其应用时间最长、生活质量最高,是长期血管通路的首选。直接动静脉穿刺穿刺点动脉瘤并发症的发生率较高,但在其他血管通路无法建立时,仍是挽救生命所必需的血管通路。

[目的]分析维持性血液透析病人自体动静脉内瘘(AVF)、聚四氟乙烯人造血管(AVG)、直接动静脉穿刺3种血管通路常见并发症的发生情况,为临床护理干预提供理论指导.[方法]选择血液净化中心2011年维持性血液透析病人310例,随访12个月,回顾性观察AVF、AVG、直接动静脉穿刺3种不同类型血管通路常见并发症(血管闭塞和动脉瘤)的发生情况.[结果]310例血液透析病人中以AVG血管通路闭塞并发症的发生率最高(42.86％),AVF最低(3.58％)；直接动静脉穿刺穿刺点动脉瘤并发症的发生率最高,AVG通路穿刺点动脉瘤为0.[结论]AVF透析病人常见血管闭塞并发症发生率远低于AVG通路血管闭塞并发症,其应用时间最长、生活质量最高,是长期血管通路的首选.直接动静脉穿刺穿刺点动脉瘤并发症的发生率较高,但在其他血管通路无法建立时,仍是挽救生命所必需的血管通路.

目的 探讨降低动静脉内瘘(AVF)感染发生率的有效的护理方法.方法 选择2009年与2010年在我科维持性血液透析患者244例为对照组和293例为干预组.干预组在实施常规感染控制措施的基础上结合综合干预措施:积极开展健康教育；采用科学的穿刺方法,如不固定穿刺点,采取阶梯式或纽扣式穿刺方法,穿刺方式采用顺穿、反穿交替进行；去除致敏原；积极治疗和控制皮肤瘙痒；于透析结束24 h后采用木瓜酒湿敷以保护AVF.结果 干预组在维持性血液透析患者AVF感染的人数明显降低(P＜0.05).结论 在实施常规感染控制措施的基础上结合综合干预措施可有效降低AVF感染发生率,减少患者住院率、减轻经济负担、提高生活质量。

Objective To explore impact of fistula puncture directions on function of arteriovenous fistula(AVF).Methods Totally,150 maintenance hemodialysis patients with AVF were randomized into 3 groups of 50.By using rope-ladder puncture technique along the fistula,the 3 groups received either unidirectional puncture with the needles directed to the heart(group 1),retrograde puncture with needles running away from the heart(group 2),or both punctures(group 3) respectively.Incidence rate of dialysis adequacy,fistula pseudoaneurysm and stenosis were compared among 3 groups after 2 years.Results One hundred and forty-three patients finished the study.No significant difference was found in dialysis adequacy among the 3 groups(P>0.05).Incidence of fistula pseudoaneurysm or stenosis among the 3 groups had statistical differences(P<0.05 for both),with the highest incidence of pseudoaneurysm in group 2 and the highest incidence of stenosis in group 1.Conclusion Fistula puncture by using both unidirectional and retrograde methods can achieve satisfactory dialysis adequacy and reduce incidence of fistula pseudoaneurysm and stenosis.

Objective To analyze the status of clinical common complications occurrence among maintenance hemodialysis patients with difference blood vessel access types,so as to provide evidence for clinical nursing intervention.Methods Totals of 401 maintenance hemodialysis patients were involved,and their clinical information included blood vessel access types were collected and were flowed-up 12 months.Five difference types of blood vessel such as self arteriovenous fistula,PTFE artificial blood vessels,long-term venipuncture,temporary venipuncture,direct arteriovenous puncture were observed and analyzed,and common complications occurrence were compared.Results Among 401 patients,the highest ratio of embolization complication was 42.86% in PTFE artificial blood vessel,the highest ratio of infection complication in temporary venipuncture was 19.77%,while the lowest common complication incidence was arteriovenous fistula.Conclusion Arteriovenous fistula should be the first selection for maintenance hemodialysis patients,because it has a lowest common complication incidence.When arteriovenous fistula cannot be built,other four types are still important for those patients.

Obiective:To probe into the influence of implementation of high quality of nursing services on the nutritional status of maintenance hemodialysis patients.Methods:A total of 401 cases of patients were randomly assigned to the charge nurses for management,and every nurse was in charge of 9 cases or 10 patients,then to observe the changes of laboratory parameters and health education score of patients after implementation of high quality of nursing service model for 1 year.Results:The all laboratory parameters of the patients were significantly improved(P<0.05),and patients mastering health education knowledge was better after the implementation of high quality nursing service(P<0.05).Conclusion:Implementation of high quality of nursing service has promoting effect for improving nutrient management of hemodialysis patients.

目的 探讨维持性血液透析患者动-静脉内瘘血管的有效护理方法.方法 将180例维持性血液透析患者按随机数字表法分为观察组(84例)和对照组(96例).观察组采用木瓜酒湿敷的方法保护自体动-静脉内瘘,对照组采用常规方法进行护理.比较两组护理方法对自体动-静脉内瘘保护上的差异.结果 观察组患者的自体动-静脉内瘘血流量不足、血管闭塞和血管硬结的发生率与对照组比较差异有统计学意义(P<0.05).结论 木瓜酒保护自体动-静脉内瘘疗效显著,制作简单且费用低廉,值得推广应用.

目的提高神经内科临床护理带教水平,提升护生临床实习效果和综合素质。方法将神经内科实习护生80人分为对照组和观察组各40人,对照组采用传统带教模式;观察组采用护生自评式带教模式,即入科第1天先发放评估表,护生自评后将信息反馈给带教老师,带教老师有针对性、有计划地进行授课及带教,实习第3周再次自评,调整带教计划。结果观察组出科理论、操作考试成绩显著优于对照组,对带教的满意度显著高于对照组(均P<0.01)。结论自评式带教模式重视评估,针对问题因人施教,有效提高了神经内科临床护理带教质量。

Objective To prevent complications of arteriovenous fistula (AVF) in hemodialysis patients.Methods A total of 180 hemodialysis patients were randomly divided into two groups.The control group (n=96) were used hirudoid cream on AVF during hemodialysis,and applied fresh potato 24 h after hemodialysis.The observation group (n=84) were given papaw wine for external use on AVF 24 h after hemodialysis.Results The tested parameters such as blood pressure,hematocrit,BUN,serum creatinine,serum albumin,serum transferrin,C-reaction protein,KT/V showed no significant differences between the two groups (P>0.05 for all);the rate of insufficient blood flow of AVF,vascular occlusion and vascular scleroma in the observation group were significantly lower than those of the control group (P<0.05,P<0.01).Conclusion Using papaw wine to protect AVF is effective and convenient,it can prolong service time of AVF.

Objective To explore the influence of individualized sodium concentration dialysate on the incidence of common clinical indexes and adverse reactions in maintenance hemodialysis patients.Methods 100 maintenance hemodialysis patients were included as the subjects for this study.First,they were offered an 8-week conventional hemodialysis with the sodium concentration being 140 mmol/L.Then in the second stage,they were given an 8-week hemodialysis with individualized sodium concentration in light of the specific condition of the disease.Comparisons were made of the changes in the patients'blood pressure,body mass,hematocrit,serum creatinine,serum urea nitrogen and Kt/V,and the incidences of adverse reactions during the hemodialysis at the end of the two stages.Results There was no statistically significant difference in clinical indexes between the two stages.But the incidence rates of hypertension and hypotension during the second stage were distinctly lower(P<0.05),while the difference in the incidence rate of other adverse reactions such as hypoglycemia,muscle jerk,arrhythmia,heart failure and dialysis dysequilibrium had no statistical significance.Conclusion Individualized sodium concentration dialysis Can effectively lower the incidence rate of adverse reactions among maintenance hemodialysis patients,having a good effect of stabilizing the blood pressure during the dialysis.

Objective:To investigate the effects and safety of relatively low sodium dialysate in uremic patients. Methodology:One hundred and twenty uremic patients with hypertension were randomly divided into A and B group.In A group,patients were treated with low sodium dialysate hemodialysis(sodium concentration 135 mmol/L) for 8 weeks.In B group,patients were treated with common sodium dialysate hemodialysis(sodium concentration 142 mmol/L) for 8 weeks.The blood pressure,body mass,body mass index,serum urea nitrogen and creatinine,Kt/V and left ventricular ejection fraction(LVEF) were compared between two groups before and after eight-week treatment.The safety of low sodium dialysate hemodialysis was also evaluated by analysing dialysis adverse reactions between two groups. Results:Clinical data of two groups had no statistical difference before treatment.However,after 8 weeks treatment for A group patients,the blood pressure and body mass were decreased marketly,and their LVEF was improved significantly.Other indexes in A group and all indexes in B group had no statistical changes when compared with that before the treatment.Patients of A group had higher incidence rate of intradialysis hypotension and dialysis disequilibrium symptom when compared with B group,and no statistical difference was found in other adverse reactions between two groups. Conclusion:Relatively low sodium dialysate hemodialysis is valid to eliminate water-sodium retention,decrease blood pressure and improve cardiac function in uremic patients.But it may increase the incidence of intradialysis hypotension and dialysis disequilibrium symptom.

目的探讨延长维持性血液透析患者动-静内瘘使用"寿命"的护理。方法对本中心218例使用动-静内瘘透析的患者加强内瘘护理,严格执行无菌操作,掌握正确穿刺方法及透析后采取正确压迫止血法,强化健康教育,提高患者自我护理意识。结果有效地延长了患者动-静内瘘使用寿命,平均使用寿命达5年以上,最长达16年之久。结论掌握个体化的穿刺方法,提高穿刺技术是延长动-静内瘘使用寿命的关键。

透析患者的腕管综合征(CTS)被认为是长期血液透析(HD)患者的主要并发症之一[1].据报道,透析患者的CTS发生率达2%～31%[2];随透析时间和患者年龄增长而增加,HD超过lO年者100%发生透析相关性淀粉样变(DRA)[3].DRA首先在患CTS的透析病人中发现,DRA的主要原因是β2-微球蛋白(β2-MG)沉积,系大量β2-MG压迫正中神经所致.近年来,透析患者CTS的治疗多局限于改用高通量透析器等保守治疗,手术治疗的相关护理文献报道较为鲜见,故将本科1例长期HD患者CTS术后的效果观察及护理报道如下.

总结对7例患者进行12次血浆分离吸附疗法的护理经验:加强血管通路的护理,严格控制血流速度,密切观察静脉压及跨膜压变化,注意观察生命体征及出血情况。治疗过程顺利,无出现不良反应,患者病情有不同程度减轻,APACHEII评分均提高5～7分。透析护士不仅要掌握常规透析操作技术,还应熟练掌握特殊血液净化技术的操作方法及护理要点,提高专科护理水平。

Objective:To standardize the health education mode for patients undergoing hemodialysis （HD）, to reduce the waste of health education resource, and to raise the quality of health education of HD patients. Method:A total of 150 maintenance HD patients were investigated by filling out questionnaires on hemodialysis in blood purification center in our hospital.Based on existed problems, corresponding health education clinical path for them were made out.Result:After health education, HD patients’ abilities on mastering diseases related knowledge, self-care of internal arteriovenous fistula and diet control were promoted remarkably.Conclusion:For HD patients, health education path is a mode suited to the characteristics of blood purification center.