以浙江医院血液透析中心为例,介绍血透原理及流程,分析血透信息化管理系统需求及其网络拓扑结构,阐述系统数据采集过程、功能实现与应用效果,指出该系统可降低医疗差错,提高血透管理效率.

目的：观察一次性真空采血装置在血液透析在线采血中的应用效果。方法分别采用一次性真空采血装置及5ml注射器于血液透析过程中在线采血，比较两种方法的采血时间及不良事件的发生情况。结果单管血标本采集：观察组20例41次，对照组25例47次；双管血标本采集：观察组14例15次，对照组13例15次。采血过程中无血样漏出、针尖误伤操作者，采血工具或试管内凝血等不良事件发生。单管采血时间：观察组（50.1±4.7）秒，对照组（54.2±5.6）秒；双管采血时间：观察组（58.1±3.6）秒，对照组（81.1±6.2）秒；差异均有统计学意义。结论一次性真空采血装置用于血液透析过程中在线采血安全便捷，可节约采血时间。

Objective To discuss the impact of perceived over-qualification on immersion of nurses from hemodialysis room.Methods A total of 236 nurses from hemodialysis room were recruited from eight tetiary hospitals in Zhejiang with convenience sampling method. They were investigated with perceived cognitive over-qualification questionnaire and immersion inventory. The status quo and relationship between perceived over-qualification and immersion of nurses from hemodialysis room were analyzed.Results The total score of immersion of nurses from hemodialysis room was (35.1±10.4). There were significant negative correlations between score of perceived over-qualification and score of immersion of nurses from hemodialysis room. After controlling demographic variables, regression analysis showed that the factor scores of perceived over-qualification such as not match perception could independently explain 17.2% of the variance for immersion.Conclusion Clinical managers should focus on the shortcomings of perceived over-qualification of nurses from hemodialysis room and take effective measures to improve their immersion.

OBJECTIVE To investigate the influence of double‐lumen venous catheter with cuff on infections in hemodialysis patients ,so as to find the best way to reduce infection rates .METHODS Totally 35 hemodialysis patients who received hemodialysis and double lumen venous catheter with cuff during Feb .2010 to Jan .2014 were enrolled .The prevention of related complications was strengthened ,and the service life of catheter ,infection rate ,complications and clinical results after treatment were observed .RESULTS Totally 7 out of 35 patients developed infections , the infection rate was 20 .0% . Advanced age , long catheter indwelling time , repeated catheter and thrombus formation were related factors for infections in catheterized patients , and the rate of infection due to these factors was respectively 50 .00% ,27 .78% ,40 .00% ,and 36 .36% .Totally 11 pathogens were isolated ,including 5 Staphylococcus aureus ,3 Staphylococcus epidermidis ,accounting for 45 .46% and 27 .27% .Six out of the 7 infected patients were cured and one in the 7 patients was dead due to infectious shock after the second extubation .CONCLUSION Double‐lumen venous catheter with cuff can reduce the incidence of infection in hemodialysis patients and improve clinical results .Clinicians should strengthen nursing management and master catheterization indications .

<正>因各种原因行透析的老年患者,透析中出现低血压较为突出,而低血压可使透析治疗不能顺利进行,影响患者透析的充分性。对于顽固性低血压,目前并无特效的处理办法,本院试用白蛋白预充纠正1例顽固性低血压患者,效果良好,具体情况如下。1资料和方法1.1一般资料:患者,男,93岁,离休干部,入院诊断:1)慢性肾炎综合征、慢性肾脏病5期、肾性贫血;

脓毒症是指感染和创伤等诱发的剧烈全身性炎症反应,并引起组织器官继发性损伤的临床症候群[1].严重脓毒症和脓毒性休克是重症监护患者最常见和主要的死亡原因,病死率可达20%～80%[1-3].连续性肾脏替代疗法(continuous renal replacement therapy,CRRT)是近年来血液净化技术的革新与进步,它具有清除血液中炎性细胞因子及代谢废物的功能,极大地提高了高分解代谢型急性肾功能衰竭、严重心力衰竭、重症胰腺炎、成人呼吸窘迫综合征、多器官功能衰竭等抢救水平,临床疗效日益被肯定[4].

随着透析技术的进步和透析质量的提高,透析人群中老年患者比例大量增加.高龄患者多伴有心血管并发症.透析治疗中常因低血压诱发心律失常,甚至循环衰竭,严重危害健康及生命[1],因此及时有效地预防透析过程中的低血压尤为重要.本文通过对26例老年透析病人(共1616次透析)按不同时间采取不同的干预方法比较其低血压发生率,发现低温可调钠透析结合参附制剂可有效预防高龄患者低血压的发生.现报告如下:

随着我国正步入老龄化社会,进行血液透析的高龄患者也日益增多.高龄透析患者往往在透析前已存在营养不良,进行透析后,如营养管理不善,营养不良则更为明显.本科2007年6至12月对26例维持性血液透析高龄患者进行6个月的营养不良干预,取得了较好效果.报告如下.

老年人进行维持性血液透析时所建自体动静脉内瘘的成功率较低,且容易发生各种并发症,因此,各项护理措施十分重要.现将自体内瘘血管的老年维持性血液透析患者的护理体会介绍如下.