血浆置换联合日间连续性血液滤过治疗肝衰竭并肾功能不全的护理  

Nursing care of plasma exchange combined with daytime continuous venous-venous hemofiltration in the treatment of liver failure accompanied with renal insufficiency

作　　者：李颖[1] 周莉[1] 陈占军[1] 郑素军[1] 段钟平[1] 

机构地区：[1]首都医科大学附属北京佑安医院人工肝中心,北京100069

出　　处：《中国医药导报》2015年第25期152-155,共4页China Medical Herald

基　　金：国家十二五科技重大专项项目(2012ZX10002004-006;2013ZX10002002-006);北京市卫生系统高层次卫生技术人才培养计划项目(2011-3-083);首都临床特色应用研究项目(Z131107002213019)

摘　　要：目的总结肝衰竭合并肾功能不全患者行血浆置换联合日间连续性血液滤过治疗的护理。方法选取首都医科大学附属北京佑安医院人工肝中心2013年1月～2014年5月进行血浆置换联合日间连续性血液滤过治疗的肝衰竭合并肾功能不全患者187例为研究对象，比较治疗前后的肝肾功能及凝血象指标。治疗前与患者沟通，治疗中密切观察、正确处理不良反应和有效护理干预，治疗后回访及健康宣教。结果患者治疗后的丙氨酸氨基转移酶[（220．2±109．9）比（366．4±153．3）U/L]、天门冬酸氨基转移酶[（148．2±71．7）比（219．8±90．0）U／L]、总胆红素[（283．0±78．2）比（420．0±106．3）μmol／L]、直接胆红素[（141．5±38．1）比（206．7±52．4）μmol／L]、尿素[（25．0±5．8）比（28．8±5．6）mmol／L]、肌酐[（176．6±38．6）比（290．7±63.3）μmol／L]较治疗前明显降低，白蛋白【（28．1±3．0）比（26．6±3．1）g／L]和凝血酶原活动度[（32．3±7．1）％比（27．7±7．0）％]较治疗前明显升高，差异有高度统计学意义（P〈0．01）。结论血浆置换联合日间连续性血液滤过治疗肝衰竭合并肾功能不全，为患者提供了新的治疗选择。治疗前、中、后的有效护理支持是保证治疗成功的关键。Objective To summarize the nursing care of plasma exchange combined with daytime continuous venous- venous hemofiltration in liver failure patients accompanied with renal insufficiency. Methods 187 liver failure patients accompanied with renal insufficiency received plasma exchange combined with daytime continuous venous-venous hemofihration in Artificial Liver Center, Beijing You＇an Hospital Affiliated to Capital Medical University from January 2013 to May 2014 were selected as research objects. Liver and kidney function and blood coagulation indexes before and after treatment were compared. The nursing measures included the pretreatment conversation with patient, close observation, correct handling to adverse reactions with effective nursing intervention during treatment, health education and follow up after treatment. Results Alanine transaminase [（220.2±109.9） vs （366.4±153.3） U/L], aspartate transaminase [（148.2±71.7） vs （219.8±90.0） U/L], total bilirubin [（283.0±78.2） vs （420.0±106.3） μmol/L], direct bilirubin [（141.5±38.1） vs （206.7±52.4） μmol/L], serum urea [（25.0±5.8） vs （28.8±5.6） mmol/L], creatinine [（176.6±38.6） vs （290.7±63.3） μmol/L] of patient after treatment was significantly lower than that before treatment respectively, albumin [（28.1±3.0） vs （26.6±3.1） g/L], prothrombin activity [（32.3±7.1）% vs （27.7±7.0）%] of patient after treatment was significantly higher than that before treatment respectively, with significantly statistical difference （P 〈 0.01）. Conclusion The combination of plasma exchange and daytime continuous venous-venous hemofihration provides a good option for treatment of liver failure patients accompanied with renal insufficiency. Nursing care support during the whole treatment procedures is the key of success.

关 键 词：血浆置换 血液滤过 肝衰竭 肾功能不全 护理 

分 类 号：R459.5[医药卫生—治疗学]