混合稀释法在高原地区血液透析滤过治疗中的应用及护理观察  

Application and nursing observation of mixed dilution method in hemodiafiltration treatment in plateau area

作　　者：苟晶绮[1] GOU Jing-qi(Blood Purification Center, Qinghai People's Hospital, Xining, Qinghai 810007, China)

机构地区：[1]青海省人民医院血液净化中心

出　　处：《中国血液净化》2019年第10期728-731,共4页Chinese Journal of Blood Purification

摘　　要：目的探讨混合稀释法在高原地区血液透析滤过治疗中的应用及护理观察效果。方法选择76例患者随机分为2组,其中实验组39人采用混合稀释法,对照组37人采用后稀释法,对比研究2组患者的毒素清除效果,透析器凝血、肝素用量、报警频率情况,以及患者主观舒适度改善的护理观察效果等内容。结果取透析前后血样本,进行肾功能检查,相比于后稀释法和混合稀释法使患者的肌酐清除下降率、尿素氮清除下降率和β2微球蛋白清除下降率升高(t值分别为9.706, 5.571,7.669;P值分别为0.024,0.047,0.038);观察透析器凝血分级和患者的肝素用量,结果显示混合稀释法在改善透析器凝血等级方面有一定优势,其中肝素用量由6.32IU降至3.12IU,降低50.63%(t=25.469,P=0.010);采用适宜的量表进行患者主观舒适度的护理观察,结果显示混合稀释法使患者的生存质量评分和食欲评分升高,睡眠质量评分降低和皮肤瘙痒程度评分降低(t值分别为4.444,5.845,25.469,15.132;P值分别为0.035,0.042,0.028,0.036)。结论在保证血液透析滤过治疗效果的前提下,混合稀释法较后稀释法更适合于高原地区的血液透析患者,值得临床推广应用。Objective To observe the application and nursing of mixed dilution method in hemodiafiltration treatment in plateau area. Methods A total of 76 hemodialysis patients were randomly divided into experiment group(mixed dilution method, n=39) and control group(post-dilution method, n=37). The effects of toxin clearance, coagulation in dialyzer, amount of heparin used, alarm frequency, and the subjective comfort degree were compared between the two groups. Reults Blood samples were taken before and after dialysis,and renal function tests were performed. Compared with post-dilution method, mixed dilution method increased the decreased creatinine clearance rate by 25.47%(t=9.706, P=0.024), the decreased urea nitrogen clearance rate by 12.21%(t=5.571, P=0.047), and the decreased β2 microglobulin clearance rate by 14.41%(t=7.669, P=0.038). By the observation of coagulation grade in dialyzer and the amount of heparin used, the mixed dilution method also showed the advantages of improving coagulation grade in dialyzer and reducing heparin amount used by 50.63%(from 6.32 IU to 3.12 IU;t=25.469, P=0.010). The subjective comfort degree observed by a suitable scale demonstrated that mixed dilution method increased the quality of life score by38.66%(t=4.444, P=0.035) and appetite score by 37.28%(t=5.845, P=0.042), and decreased sleep quality score by 50.63%(t=25.469, P=0.028) and skin itching degree score by 44.55%(t=15.132, P=0.036). Conclusion With the prerequisite for adequate effect of hemodiafiltration, mixed dilution method is more suitable than post-dilution method for hemodialysis patients in plateau areas. Therefore, this method of hemodiafiltration is useful for clinical use.

关 键 词：高原地区 血液透析 混合稀释法 

分 类 号：R473[医药卫生—护理学]