回顾性分析37例接受过4个月强化营养护理干预的顽固性低白蛋白血症腹膜透析患者的营养指标，结果显示在不额外增加营养补充剂的情况下，强化营养护理干预2个月后患者的蛋白和能量摄入量较基线值升高（均 P<0.05）；干预4个月时，患者的蛋白和能量摄入量较干预2个月时下降。强化营养护理干预前后患者的血清白蛋白、血清前白蛋白、转铁蛋白、体重指数和改良定量主观综合营养评分等指标的差异无统计学意义（均 P>0.05）。提示单纯强化营养护理对改善腹膜透析患者顽固性低白蛋白血症的疗效欠佳。

报道1例腹膜透析行胃肠镜检查后肠壁出血继发腹膜炎病例，经积极治疗和护理，患者无肠壁再出血，腹膜炎治愈出院。我们认为仔细评估内镜诊治风险、重视预防性使用抗生素、注重个体化管理是主动性预防内镜相关性并发症和腹膜炎发生的关键。

目的:探讨分析护理干预在肾穿刺活检术的作用及其与手术成功率的相关性研究.方法:以2017年7月至2018年6月间赴本科室进行肾穿刺术治疗患者644例为研究对象,2017年7月至2017年12月实施常规护理,设为对照组,2018年2月至2018年6月实施综合护理,设为观察组.对照组与观察组各322例.对照组实施传统的护理干预,观察组实施综合护理干预,比较两组患者肾穿刺活检成功率、并发症,以及手术指标的情况.结果:观察组患者肾穿刺活检成功率为93.3％,对照组为成功率为70.0％,观察组明显由于对照组;观察组和对照组并发症的总发生率分别为6.6％、26.7％;与对照组进行比较,观察组患者的手术指标均优于对照组,存在明显的差异(P<0.05).结论:护理干预在肾穿刺活检术的作用及其与手术成功率中具有积极的作用.

目的:探讨应用潮式腹膜透析(tidal peritoneal dialysis,TPD)改善新置管腹膜透析患者临床症状的效果.方法:选取本院新置管的腹膜透析患者118例,按照随机数字表法将其分为试验组和对照组,各59例.试验组采用TPD模式,对照组采用间歇性腹膜透析(intermittent peritoneal dialysis,IPD)模式,观察两组患者的临床症状改善情况.结果:腹膜透析1周后,试验组失眠或嗜睡、乏力、味觉障碍或口有氨味、厌食、恶心、呕吐、皮肤瘙痒等主观症状均较对照组明显改善,比较差异均有统计学意义(P<0.01);两组体液失衡、高血压、血清白蛋白、血红蛋白、Scr/H等客观症状比较,差异均无统计学意义(P>0.05).结论:TPD模式应用于新置管腹透患者可有效改善患者的主观症状,提高患者的生活质量.

Objective To investigate the application of the careful continuing nursing in patients with continuous ambulatory peritoneal dialysis. Methods 54 cases of uremic patients with CAPD treatment in the department of nephrology of our hospital from March 2011 to March 2013 were selected as the research objects.They were randomly divided into two groups by using the digital table method,27 patients in control group were given conventional nursing,and 27 patients in observation group were given peritoneal dialysis routine nursing and careful continuing nursing.Then Hamilton depression rating scale for depression (HAMD) and activity of daily living scale (ADL) were used to statistical analysis the mental depression,activities of daily living and complication occurrence of two groups of patients discharged from hospital after 7 days,14 days,21 days,28 days. Results HAMD scores of the two groups were all decreased with the prolongation of time.But ADL scores were increased with the prolongation of time.The differences were statistically significant (P < 0.05).The incidence of complications of control group was 14.81%, and the incidence of complications of observation group was 7.40%, the difference was statistically significant (P < 0.01). Conclusion The careful continuing nursing can improve depression in patients with peritoneal dialysis,accelerate the recovery of the ability of daily life,and effectively reduce the occurrence of peritoneal dialysis related complications in a certain extent,and improve patient’s treatment and rehabilitation effect.So it is worthy of further clinical promotion.

Objective To investigate the effect and safety of early incremental peritoneal dialysis after catheter implantation.Methods 161 patients with uremia implanted catheter and taking peritoneal dialysis first time were selected as study objects.They were treated with IPD and CAPD with incremental model 72 hours to 2 weeks after surgery,2 weeks from then the model was transferred to traditional CAPD.The dialysis effect and early complications were observed.Results The levels of blood urea nitrogen,serum creatinine,serum albumin serum phosphorus,and serum potassium were obviously lower and the serum calcium and carbon dioxide combining power were much higher 3 days and 1 month after operation than before catheter implantation in the patients (P ＜ 0.05).The incidence of peritoneal leakage,poor healing,or abdominal mural hernia was 1.0％ and that of catheter migration or omental wrap was 2.47％.Conclusions Early incremental peritoneal dialysis after catheter implantation is effective and safe.

Objective To measure the condition of different vascular access recirculation in hemodialysis patients and to analysis their relative factors,then to facilitate the implementation of nursing countermeasures. Methods 118 cases of hemodialysis blood dialysis patients given hemodialysis in our hospital from January 2013 to May 2015 were carried on different vascular access and reverse connection of recirculation monitoring by Transonic HD02 hemodialysis monitors respectively.The related factors that may influence the recycling of hemodialysis patients were analyzed. Results The comparison of measurement of access recirculation was showed no statistically significant difference (P>0.05) when the different vascular access was lined normally. Recirculation rate of AVF was lower than the internal jugular or femoral vein (P < 0.05),they had statistically significant difference.But comparison of the internal jugular vein and femoral vein showed no statistically significant difference (P>0.05).When AVF was normal or reversed,recirculation was higher A-V distance<5cm than A-V distance>5cm,they had statistically significant difference (P<0.05). Conclusion AVF is the best choice when hemodialysis,A-V distance must be 5cm or more,so it can reduce recirculation rate.When AVF can’t be used,the temporary vascular access can be made,such as the internal jugular or femoral vein,but it must avoid reversed lines,reducing the recirculation rate.

目的 观察应用潮式腹膜透析对腹膜透析新置管患者疼痛及引流不畅的影响.方法 将100例自动化腹膜透析患者按随机数字表法分为观察组和对照组各50例,观察组采用潮式腹膜透析模式,对照组采用间歇性腹膜透析模式,观察两组患者的透析效果、透析过程中的疼痛程度及引流情况.结果 两组患者透析效果比较,差异无统计学意义(均P＞0.05);观察组患者透析过程中引流不畅、疼痛发生率较对照组显著降低(P＜0.05,P＜0.01).结论 潮式腹膜透析模式应用于腹膜透析新置管患者可减轻疼痛程度,降低引流不畅发生率.

[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 探讨护理干预对老年维持性血液透析患者治疗依从性及治疗效果的影响.方法 将120例老年维持性血液透析患者随机分为对照组与观察组各60例.给予对照组患者常规护理,观察组患者在常规护理基础上给予系统的健康教育及心理护理.采用抑郁自评量表(SDS)和焦虑自评量表(SAS)对患者干预前后负性情绪进行评估,比较2组干预前及干预后3个月后实验室指标、治疗依从性及负性情绪的改变.结果 干预后观察组患者SAS及SDS评分显著低于对照组；观察组患者治疗依从性显著高于对照组；观察组血清肌酐、尿素氮、红细胞及血红蛋白等指标的水平均显著优于对照组.结论 加强对老年维持性血液透析患者的健康教育及心理护理,可有效缓解患者负性情绪,提高治疗依从性及临床疗效。

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.

目的 总结连续性血液净化(continuous blood purification,CBP)治疗心血管术后急性左心衰竭的护理要点.方法 回顾性分析血液净化治疗53例心血管术后急性左心衰[左室射血分数(LVEF)＜30％,肺动脉楔压(PAWP)＞20 mm Hg(1 mm Hg=0.133 kPa)]的护理措施.早期短时间内大量滤出体内水分,之后根据监测数据的变化和患者出入量来调整超滤量,使机体达到负平衡或出入平衡(以小时为单位).结果 CBP平均治疗4d后心功能显著改善,维持血管活性药使平均动脉压(MAP)回升＞ 90 mm Hg,PAWP维持10～12 mm Hg,48例患者心功能完全恢复,2例患者心功能逐渐恢复后并发感染死亡,1例患者心功能恢复后死于残余动脉夹层破裂,2例患者心功能未完全恢复自动出院.本组患者治疗后各项生化指标较治疗前均有显著改善.结论 应用CBP治疗心血管术后减低心脏前负荷,减少心脏做功,具有良好的心血管稳定性,给顿抑心肌提供恢复的时间,心脏得以充分的休息而康复,效果显著.而熟练掌握CBP技术及高水平的专业体外循环监护是CBP治疗获得成功的重要保证.

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.

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.