医护一体化动态管理在重症监护病房危重患者连续性肾脏替代治疗中超滤量管理的应用效果  

Research on application effect of continuous renal replacement therapy managed by curing and nursing integrative dynamic for critical patients in intensive care unit

作　　者：徐晓微[1] 王晓蓉[1] 周慧芬[1] 范栩妃[1] 范兴恳 何爱文[1] 林碎钗[1] 陈小华[1] Xu Xiaowei;Wang Xiaorong;Zhou Huifen;Fan Xufei;Fan Xingken;He Aiwen;Lin Suichai;Chen Xiaohua(The First Affiliated Hospital of Wenzhou Medical University,Wenzhou 325000,Zhejiang,China;Cangnan Affiliated Hospital of Wenzhou Medical University,Wenzhou 325899,Zhejiang,China)

机构地区：[1]温州医科大学附属第一医院,浙江温州325000 [2]温州医科大学附属苍南医院,浙江温州325899

出　　处：《中国中西医结合急救杂志》2020年第3期301-305,共5页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：浙江省温州市公益性科技计划项目(2017Y0997);浙江省医药卫生科技计划项目(2019KY455)。

摘　　要：目的 探讨医护一体化动态管理在重症监护病房(ICU)危重患者连续性肾脏替代治疗(CRRT)中超滤量管理的应用效果.方法 选择2017年9月至2018年4月入住温州医科大学附属第一医院ICU采用常规管理的49例CRRT患者作为常规组;以2018年5月至12月入住ICU实施CRRT医护一体化动态管理的49例患者作为干预组.比较两组患者的治疗目标达成率和急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)的差异;并观察两组患者低血压、心律失常、肺水肿等CRRT并发症的发生率.结果 干预组溶质控制指标、供给剂量/处方剂量比值及有效治疗时间等治疗目标达成率明显高于常规组(分别为97.96%比83.67%,93.88%比77.55%,95.92%比81.63%,均P<0.05).两组患者第1个24 h APACHEⅡ比较差异无统计学意义(P>0.05);干预72 h后,干预组APACHEⅡ评分明显低于常规组(分:14.31±4.72比19.57±6.83,P<0.05).干预组低血压、心律失常、肺水肿等CRRT并发症的发生率明显低于常规组〔6.12%(3/49)比24.48%(12/49),P<0.05〕.结论 对ICU危重CRRT患者实施医护一体化动态管理,能有效提高治疗目标达成率,降低血压、心律失常、肺水肿等CRRT并发症的发生率,值得临床推广.Objective To discuss the effect of applying curing and nursing integrative dynamic method in management of ultrafiltration amount in continuous renal replacement therapy(CRRT)for critical patients in intensive care unit(ICU).Methods Forty-nine CRRT patients were selected to be in a conventional group managed routinely from September 2017 to April 2018 in the ICU of the First Affiliated Hospital of Wenzhou Medical University;other 49 CRRT patients were arranged in an intervention group and managed by curing and nursing integrative dynamic method in the ICU of this hospital from May to December 2018.The differences in achievement rate of therapeutic goal and acute physiology and chronic health evaluationⅡ(APACHEⅡ)score were compared between the two groups;the incidences of CRRT complications including hypotension,arrhythmia,pulmonary edema,etc.in the two groups were observed.Results The achievement rates of therapeutic goals including solute control index,supply dose/prescription dose ratio and effective treating time of intervention group were significantly higher than those in the conventional group(97.96%vs.83.67%,93.88%vs.77.55%,95.92%vs.81.63%respectively,all P<0.05).The difference of first 24 hours APACHEⅡbetween the two groups had no statistical significance(P>0.05);the APACHEⅡscore of intervention group was significantly lower than that in the conventional group after 72 hours of intervention(14.31±4.72 vs.19.57±6.83,P<0.05).The incidence of CRRT complications such as hypotension,arrhythmia and pulmonary edema in the intervention group was significantly lower than that in the conventional group[6.12%(3/49)vs.24.48%(12/49),P<0.05].Conclusion Applying curing and nursing integrative dynamic management for ICU CRRT critical patients can effectively raise the achievement rate of treatment goals and lower the incidence of CRRT complications including hypotension,arrhythmia and pulmonary edema,which is worthy of clinical promotion.

关 键 词：医护一体化动态管理 重症监护病房危重患者 治疗目标达成率 连续性肾脏替代治疗 超滤量 并发症 

分 类 号：R47[医药卫生—护理学]