目的:探讨跨科延续优质护理对动静脉内瘘术后初始血液透析患者并发症、营养状况、心理情绪及生活质量的影响.方法:将动静脉内瘘术后初始血液透析患者88例用随机数字表法分为对照组和研究组各44例,对照组采取常规护理,研究组予跨科延续优质护理.比较两组患者心理情绪评分、营养状态、术后并发症发生率、生活质量及护理满意度.结果:研究组抑郁自评量表评分、焦虑自评量表评分、术后并发症发生率低于对照组(P<0.05),营养指标(血红蛋白、白蛋白)、满意度、生活质量量表评分高于对照组(P<0.05).结论:跨科延续优质护理可降低初始血液透析患者动静脉内瘘术后并发症的发生率,有助于改善患者营养状况和心理状况,提高其生活质量和满意度.

Peritoneal dialysis (PD) catheter implantation is necessary for patients with end-stage renal disease (ESRD) to maintain continuous ambulatory PD (CAPD). In this study, we aimed to introduce a half-percutaneous technique based on a modified trocar device for the placement of a PD catheter and to evaluate the safety and efficacy of this technique and its associated short-term postoperative outcomes. Eighty-four ESRD patients who underwent PD catheter implantation with the half-percutaneous technique were recruited retrospectively between September 2016 and October 2017 from the Guangdong Provincial Hospital of Chinese Medicine. All catheter implantation procedures were performed by the same three nephrologists. The surgical protocol was described in detail, and the general intraoperative parameters and short-term complications were evaluated. All ESRD patients underwent successful PD catheterization with our novel technique. Neither conversion from this method to traditional open surgery nor major intraoperative complications were observed. The mean operative time was 20.8 ± 4.5 min, and the incision length was 2.28 ± 0.53 cm. The operative cost was CN ¥ 1762.45 (US $261), and the length of hospital stay was 7.5 ± 0.58 days. One patient (1.19%) showed leakage, and one patient (1.19%) experienced bleeding 2 weeks after the surgery. Catheter dysfunction due to catheter tip migration occurred in nine patients (10.7%) 2 weeks after the procedure, and the placement of the catheter was corrected with conservative treatment. No visceral injuries or PD-related infections were observed up to 4 weeks after the catheters were implanted. This half-percutaneous technique for PD catheter implantation appears to be a safe, effective and feasible procedure. This technique has the advantages of reduced surgical trauma, a shorter operative time and faster postsurgical recovery. In particular, this novel technique is easy for nephrologists to perform and therefore may help to promote and popularize PD treatment.

腹膜透析(PD)是治疗终末期肾脏病的重要替代治疗方法之一,较血液透析而言,具有保护残余肾功能、治疗成本低、操作方便、无需体外肝素化、家庭和社会回归率高等优点,对心肺功能差、无法耐受血液透析、无法建立血管通路以及无条件行血液透析者,PD较为合适[1].PD通路是由PD导管(包括体内段、体外段)、钛接头和PD外接短管组成,PD通路的完好是PD正常进行的必备条件之一,然而随着PD时间的延长,任何原因引起的PD导管体外段、外接短管发生破裂渗漏,均可导致腹膜炎发生率的升高,重者可能需要退出PD治疗,其中部分甚至需给予拔除腹透导管并重新置管,不仅给患者带来痛苦且费用高,因此如何有效的预防导管、短管破裂渗漏、及时有效处理以及预防感染尤显重要,且目前PD发展迅速,国内各大小腹透中心逐渐建立发展,然而该并发症的发生率不高,目前针对病因、应急处理的报道尚少,且并无统一标准.

目的:观察甘遂末敷脐法治疗肾性水肿的疗效.方法:将67例肾性水肿患者随机分为观察组34例和对照组33例,两组均给予常规治疗及护理,观察组在此基础上加用甘遂末敷脐法治疗.结果:观察组总有效率为87.8％,对照组总有效率为69.7％,观察组优于对照组(P＜0.05);治疗后观察组体质量、腿围减少,24h尿量增加,且观察组优于对照组(P＜0.05).结论:甘遂末敷脐法治疗肾性水肿疗效显著.