重症抗NMDAR脑炎患者膜式血浆置换护理流程的优化  

Study on the optimal nursing process of membrane plasmapheresis for patients with severe anti-NMDAR encephalitis

作　　者：龚立超[1] 常红[1] 赵洁[1] 王召锋 李含笑 GONG Lichao;CHANG Hong;ZHAO Jie;WANG Zhaofeng;LI Hanxiao(Department of Neurology,Xuanwu Hospital Capital Medical University,Beijing,100053)

机构地区：[1]首都医科大学宣武医院神经内科,北京市100053

出　　处：《中国护理管理》2022年第3期475-480,共6页Chinese Nursing Management

基　　金：2019年宣武医院院级护理课题资助项目(XWHL-2019021)。

摘　　要：目的:优化重症抗N-甲基-D-天冬氨酸受体(N-Methyl-D-Aspartate-Receptor,NMDAR脑炎患者膜式血浆置换的护理流程并分析其应用效果。方法:采用便利抽样法,选取2019年6月至2021年5月北京市某三级甲等医院神经内科监护室行膜式血浆置换的重症抗NMDAR脑炎患者为研究对象,其中对照组为2019年6月至2020年5月的12例患者,行60例次膜式血浆置换,实验组为2020年6月至2021年5月的13例患者,行62例次膜式血浆置换。实验组采用优化护理流程,对照组采用常规护理流程。比较两组膜式血浆置换中并发症(不自主运动增加、低血压、管路凝血、滤器破膜)发生率、膜式血浆置换参数值(血流速度、置换分数、动脉压、静脉压、跨膜压、治疗时长)。结果:实验组不自主运动增加、低血压发生率低于对照组(P<0.05),其余并发症无差异;实验组血流速度、置换分数、静脉压高于对照组(P<0.05),动脉压低于对照组(P<0.05),治疗时长短于对照组(P<0.05)。结论:重症抗NMDAR脑炎患者膜式血浆置换优化护理流程可降低并发症发生率,提高膜式血浆置换治疗效率。Objective:To analyze the effects of the optimal nursing process for severe anti-NMDAR encephalitis patients receiving membrane plasmapheresis.Methods:Patients with anti-NMDAR encephalitis receiving membrane plasmapheresis in the intensive care unit of the neurology department of a tertiary grade A hospital in Beijing from June 2019 to May 2021 were selected using the convenience sampling method as the research subjects.A total of 12 patients receiving 60 plasma exchange from June 2019 to May 2020 were included as the control group,and another 13 patients receiving 62 plasma exchange from June 2020 to May 2021 as the experimental group.The experimental group was treated with the optimal nursing process,while the control group followed the routine process.The incidence of complications during plasma exchange including increasing involuntary movements,hypotension,clot in the tube and filter membrane rupture and the parameters of plasma exchange such as blood fow rate,plasma extraction ratio,arterial pressure,venous pressure,transmembrane pressure,and the treatment time were compared between the two groups.Results:The incidence of increasing involuntary movements,hypotension in the experimental group was lower than those in the control group(P<0.05),and no differences were observed in other complications.The blood fow rate,plasma extraction ratio and venous pressure in the experimental group were higher than those in the control group(P<0.05),while the arterial pressure and treatment time in the experimental group were lower than those in the control group(P<0.05).Conclusion:The optimal nursing process of membrane plasmapheresis for severe anti-NMDAR encephalitis patients can not only reduce the incidence of complications but also improve the efficiency of plasmapheresis.

关 键 词：重症抗NMDAR脑炎 膜式血浆置换 优化护理流程 

分 类 号：R47[医药卫生—护理学] R197[医药卫生—临床医学]