不同抗凝策略在马蜂蜇伤患者CRRT治疗中的应用及护理  

Application of different anticoagulant strategies in CRRT for patients with wasp stings and its nursing care

作　　者：唐玮[1] 张恬[1] 黄彦[2] 甘秀妮[1] 

机构地区：[1]重庆医科大学附属第二医院肾内科,重庆400010 [2]重庆市中医院药物临床实验机构办公室,重庆400021

出　　处：《重庆医科大学学报》2017年第9期1200-1203,共4页Journal of Chongqing Medical University

基　　金：重庆市卫生计生委医学科研资助项目(编号:2016ZDXM008)

摘　　要：目的:比较不同抗凝策略在马蜂蜇伤患者连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)中的应用效果及护理对策。方法:回顾性分析我科31例马蜂蜇伤患者,93次CRRT治疗时分别采用无肝素、局部肝素抗凝、低分子肝素钠抗凝的治疗方案,观察3组患者CRRT治疗过程中滤器使用时长、静脉壶凝血程度、有无活动性出血,根据不同的抗凝方式开展针对性护理。结果:无肝素组滤器使用时长与其他2组差异有统计学意义(P<0.05)。3个组别之间静脉管路凝血严重程度差异具有统计学意义(P=0.000)。无肝素组发生1次因体外凝血导致无法回血情况。3组发生活动性出血情况差异具有统计学意义(P=0.017)。结论:CRRT治疗马蜂蜇伤时应根据患者病情采用个性化抗凝护理,从而减少或避免意外凝血及出血相关并发症的发生,使CRRT发挥最大治疗效果。Objective：To analyze and compare the efficacy of different anticoagulation strategies in continuous renal replacement therapy（CRRT）for patients with wasp stings and its nursing care. Methods：The clinical data of 31 patients with wasp stings in our department were retrospectively. Anticoagulated modes of CRRT such as none-heparin, local anticoagulant heparin or low molecular heparin sodium were used during 93 therapies. The lifetime of filter,the degree of venous pot coagulation and active bleeding index in three groups of patients with CRRT treatment were observed. Suitable nursing care was given according to the different ways of anticoagulant. Results：The lifetime of filter with none-heparin anticoagulation was significant different from that in the other groups（P〈0.05）. There were significant differences in venous blood coagulation severity among three groups of patients（P=0.000）. One patient can’t complete bleed return because of blood coagulation in vitro. There were significant differences in active bleeding among three groups of patients（P =0.017）. Conclusion：Patients with wasp stings should be given corresponding anticoagulated modes according to the state of illness in CRRT treatment and the patients’ individual condition. Effective condition monitoring and nursing care can reduce or avoid unexpected anticoagulant blood clotting and hemorrhagic complications,as well as get the maximum therapeutic effect.

关 键 词：连续性肾脏替代治疗 马蜂蜇伤 抗凝 护理 

分 类 号：R473.5[医药卫生—护理学]