血液灌流联合连续性肾脏替代治疗在蝰蛇咬伤致急性肾损伤患者中的应用及护理  

Nursing interventions in patients with acute kidney injury caused by viper bite treated with hemoperfusion combined with continuous renal replacement therapy

作　　者：陈育君 聂岸柳 苏湘芬[1] 李剑锋[1] CHEN Yujun;NIE Anliu;SU Xiangfen;LI Jianfeng(Emergency Department,The First Affiliated Hospital of Guangzhou Medical University,Guangzhou City,Guangdong Province,510120,China)

机构地区：[1]广州医科大学附属第一医院急诊科,广东广州510120

出　　处：《蛇志》2023年第4期446-449,共4页Journal of Snake

基　　金：广东省卫生健康委员会医学科研基金(项目名称:基于机器学习构建EICU连续性肾脏替代治疗非计划下机的人工智能预警模型,项目编号:A2021380);广东省中医药局中医药科研项目(项目名称:中西医结合护理在毒蛇咬伤应用的多源证据体构建及临床实证研究,项目编号:20221238)。

摘　　要：目的探讨血液灌流(HP)联合连续性肾脏替代治疗(CRRT)在蝰蛇咬伤致急性肾损伤(AKI)患者的应用效果及护理措施。方法回顾性分析2018年1月至2021年1月我院急诊科收治的17例蝰蛇咬伤致AKI患者的临床资料,总结血液灌流联合连续性肾脏替代治疗基础上的护理对策,观察患者的凝血功能(纤维蛋白原、INR、APTT)、肝功能(谷丙转氨酶、谷草转氨酶)、肾功能(血尿素氮、血肌酐)以及血常规(白细胞、血小板计数、红细胞、血红蛋白)的变化和EICU住院时间。结果蝰蛇咬伤患者经过HP联合CRRT治疗后,血小板由(69.3±27.6)×10^(9)/L上升至(80.6±28.5)×10^(9)/L、纤维蛋白原由(1.7±0.4)g/L上升至(2.5±0.5)g/L;血尿素氮由(30.1±5.7)mmol/L下降至(12.4±3.8)mmol/L、血肌酐由(318.2±41.5)mmol/L下降至(149.4±28.6)mmol/L,变化具有统计学差异(P<0.05)。17例患者临床治愈率为100%,EICU住院时间中位数为15 d。结论蝰蛇咬伤患者易发生严重凝血功能障碍、AKI等并发症,HP联合CRRT治疗蝰蛇咬伤致AKI的疗效确切,同时实施科学有效的护理是提高治愈率的保证。Objective To explore the nursing measures and effects of hemoperfusion(HP)combined with continuous renal replacement therapy(CRRT)in patients with acute kidney injury(AKI)caused by viper bite.Methods The clinical data of 17 patients with acute kidney injury caused by viper bite admitted to the emergency department from January 2018 to January 2021 were retrospectively analyzed.The nursing measures on hemoperfusion combined with continuous kidney replacement therapy were summarized.The changes of coagulation function(fibrinogen,INR,APTT),liver function(alanine aminotransferase,aspartate aminotransferase),renal function(urea nitrogen,creatinine),blood routine(white blood cell,platelet count,red blood cell,hemoglobin),and length of stay in EICU were observed.Results After HP combined with CRRT treatment,patients’platelets increased from(69.3±27.6)×10^(9)/L to(80.6±28.5)×10^(9)/L,fibrinogen increased from(1.7±0.4)g/L to(2.5±0.5)g/L.Blood urea nitrogen was decreased from(30.1±5.7)mmol/L to(12.4±3.8)mmol/L and blood creatinine was decreased from(318.2±41.5)mmol/L to(149.4±28.6)mmol/L,with statistical differences(P<0.05).The clinical cure rate of 17 patients was 100%.The median length of stay in EICU was 15 days.Conclusion Patients with viper bite are at high risk of developing complications such as severe coagulation dysfunction and AKI.HP combined with CRRT has a definite effect on AKI caused by viper bite.At the same time,implementing scientific and effective nursing can improve the cure rate of patients.

关 键 词：蝰蛇咬伤 血液灌流 肾脏替代治疗 急性肾损伤 

分 类 号：R646[医药卫生—外科学] R473[医药卫生—临床医学]