自动化腹膜透析在紧急起始腹膜透析患者中的护理  

Nursing care of the patients with urgent-start peritoneal dialysis using automated peritoneal dialysis

作　　者：孙娟 范立卓 王海玲[1] 朱丽颖[1] 徐晨[1] SUN Juan;FAN Li-zhuo;WANG Hai-ling;ZHU Li-ying;XU Chen(Department of Nephrology,Beijing Chaoyang Hospital Affiliated to Capital Medical University,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院肾内科,北京100020

出　　处：《中国血液净化》2020年第5期342-345,共4页Chinese Journal of Blood Purification

摘　　要：目的观察自动化腹膜透析在紧急起始腹膜透析患者的治疗效果、临床症状及并发症,总结应用自动化腹膜透析合理科学的护理方法。方法对在首都医科大学附属北京朝阳医院肾内科采用自动化腹膜透析(automsted peritoneal dialysis,APD)方式的患者30例,另随机选取30例手工腹膜透析方式(continuous ambulatory peritoneal dialysis,CAPD)的患者,观察2组患者在紧急起始腹膜透析过程中的临床指标、导管相关并发症及超滤量等。结果治疗1周APD组平均超滤量为(721.133±392.830)ml,CAPD组平均超滤量为(354.833±157.011)ml,APD组高于CAPD组(t=1.743,P<0.001);APD组血肌酐为(655.295±161.847)μmol/L,CAPD组血肌酐为(763.629±301.200)μmol/L,2组结果无统计学差异(F=3.011,P=0.088);APD组尿素氮为(18.803±6.122)mmol/L,CAPD组尿素氮为(25.542±7.364)mmol/L,APD组低于CAPD组(F=14.855,P<0.001)。治疗2周后APD组血肌酐为(568.706±133.833)μmol/L,CAPD组血肌酐为(716.389±267.045)μmol/L,ADP组低于CAPD组(F=7.333,P=0.009);APD组尿素氮为(17.269±5.499)mmol/L,CAPD组尿素氮为(21.637±6.383)mmol/L,ADP组低于CAPD组(F=8.061,P=0.006)。治疗4周后APD组血肌酐为(520.512±111.881)μmol/L,CAPD组血肌酐为(657.069±281.012)μmol/L,ADP组低于CAPD组(F=6.115,P=0.016);APD组尿素氮为(14.376±4.502)mmol/L,CAPD组尿素氮为(18.197±4.583)mmol/L,ADP组低于CAPD组(F=10.614,P=0.002),并发症方面:1个月内腹膜炎APD组0例,CAPD组1例(χ^2=1.017,P=0.313);渗漏APD组0例,CAPD组1例(χ^2=1.017,P=0.313);外出口及隧道感染2组各1例(χ^2=0.000,P=1.000);腹腔出血APD组1例,CAPD组2例(χ^2=0.351,P=0.554);腹痛2组各2例(χ^2=0.000,P=1.000);管路移位APD组0例,CAPD组2例(χ^2=2.069,P=0.150);引流不畅2组各4例(χ^2=0.000,P=1.000),均无统计学差异。结论自动化腹膜透析作为新置管术后开始紧急腹膜透析方式具有可行性、减少护士工作量、不影响患者术后休息及培训。Objective To observe the therapeutic effect,clinical parameters and complications of automated peritoneal dialysis(APD)for patients with urgent-start dialysis,and to summarize the suitable and scientific nursing methods for APD.Methods Thirty patients treated with APD in the Department of Nephrology,Beijing Chaoyang Hospital Affiliated to Capital Medical University were enrolled as the APD group,and 30 patients treated with continuous ambulatory peritoneal dialysis(CAPD)were randomly selected as the CAPD group.Clinical parameters,catheter-related complications and ultrafiltration volume in the processes of urgent-start peritoneal dialysis were observed in the two groups.Results In the first week,the average ultrafiltration volume was higher in APD group than in CAPD group(721.133±392.830 ml vs.354.833±157.011 ml;t=1.743,P<0.001);serum creatinine was similar between APD group and CAPD group(655.295±161.847μmol/L vs.763.629±301.200μmol/L;F=3.011,P=0.088);urea nitrogen was lower in APD group than in CAPD group(18.803±6.122 mmol/L vs.25.542±7.364 mmol/L;F=14.855,P<0.001).In the second week,serum creatinine was lower in APD group than in CAPD group(568.706±133.833μmol/L vs.716.389±267.045μmol/L;F=7.333,P=0.009);urea nitrogen was lower in APD group than in CAPD group(17.269±5.499 mmol/L vs.21.637±6.383 mmol/L;F=8.061,P=0.006).In the fourth week,serum creatinine was lower in APD group than in CAPD group(520.512±111.881μmol/L vs.657.069±281.012μmol/L;F=6.115,P=0.016);urea nitrogen was lower in APD group than in CAPD group(14.376±4.502 mmol/L vs.18.197±4.583 mmol/L;F=10.614,P=0.002).Complications occurred in the two groups:peritonitis within the first month,0 case in APD group and one case in CAPD group(χ^2=1.017,P=0.313);leakage,0 case in APD group and one case in CAPD group(χ^2=1.017,P=0.313);exit or tunnel infection,one case in each group(χ^2=0.000,P=1.000);intraperitoneal hemorrhage,one case in APD group and 2 cases in CAPD group(χ^2=0.351,P=0.554);abdominal pain,2 cases in each group(χ^2=0.00

关 键 词：自动化腹膜透析 紧急腹膜透析 护理 

分 类 号：R473[医药卫生—护理学]