血液透析患者低转运肾性骨病的防治和护理  

Prevention and Nursing of Low Turnover Renal Osteodystrophy in Hemodialysis Patients

作　　者：曹蓓莉[1] 胡祎[1] 严斌泓[1] 路建饶[1] 

机构地区：[1]上海市第七人民医院肾病科,上海200137

出　　处：《解放军护理杂志》2015年第21期54-56,共3页Nursing Journal of Chinese People's Liberation Army

基　　金：上海市浦东新区科委科研基金(PKJ2012-105);浦东新区卫计委护理重点学科(PWZX2014-13);上海市第七人民医院医院新星资助项目

摘　　要：目的了解低钙透析液(含钙1.25mmol/L)对血液透析低转运肾性骨病患者钙磷代谢和甲状旁腺功能的影响及护理方法。方法 2014年1-6月,便利抽样法选择在上海市第七人民医院血液透析室行维持性血液透析(maintenance hemodialysis,MHD)的68例患者为研究对象,按随机数字表法将其分为观察组和对照组各34例,分别使用含钙1.25 mmol/L、1.5mmol/L的透析液进行血液透析,记录并比较患者治疗前和治疗后第3、6个月时白蛋白校正钙(albumin correction calciun,Ac-Ca)、磷(P)、钙磷乘积(Ca×P)和全段甲状旁腺激素(intact parathyroid hormone,iPTH)等指标的变化及不良反应的发生情况。结果观察组患者治疗后第3、6个月,Ac-Ca、P、Ca×P均较治疗前下降,iPTH升高,其中治疗后第6个月所有指标与治疗前比较,差异均有统计学意义(均P<0.05);对照组治疗后第3、6个月上述指标与治疗前比较,差异均无统计学意义(均P>0.05);观察组患者组肌肉痉挛的发生率明显高于对照组(P<0.05)。结论应用含钙1.25mmol/L的透析液对血液透析伴低转运肾性骨病患者进行低钙透析,能有效纠正钙磷代谢紊乱,改善被过度抑制的甲状旁腺功能,安全易行。Objective To study nursing methods and the influence of 1.25mmol/1 calcium dialysate on the calcium-phosphorus metabolism and parathyroid function in the maintenance hemodialysis（MHD） patients with low turnover renal osteodystrophy.Methods Totally 68 MHD patients were randomly selected and equally divided into observation group （calcium 1.25mmol/L of dialysate） and control group （calcium 1.5mmol/L of dialysate）.The changes of serum iPTH, calcium,phosphorus,calcium and phosphorus prod- uct before intervention and 3 and 6 months after intervention were observed and related adverse reactions were recorded.Results In third and sixth months of treatment, the Ac-Ca,P,CaXP were decreased com- pared with before treatment, while the iPTH increased. There was statistical significance of all indexes showed between six months of treatment and before treatment （all P〈0.05）.The above indexes showed no differences in control group after 3 and 6 months of treatment （all P〉0.05）. The incidence of muscle spasms in observation group was significantly higher than control group（P 〈0.05）.Conclusion The appli- cation of 1.25 mmol/L calcium dialysate in the maintenance hemodialysis patients with low turnover renal osteodystrophy can effectively control calcium-phosphorus metabolism disturbance, and improve the over suppressive,which is easy to perform and safe.

关 键 词：慢性肾功能衰竭 维持性血液透析 低转运肾性骨 低钙透析液 护理 

分 类 号：R459.5[医药卫生—治疗学]