维持性血液透析患者高血压控制不良的相关因素分析及护理

目的探讨维持性血液透析(MHD)患者高血压控制不良的原因及其护理对策。方法回顾分析136例高血压MHD患者透析过程血压的情况,并分析出现高血压控制不良的原因。结果47例(34.6%)MHD患者血压控制不良,其中12例透析间期(两次透析之间)体重增加超过干体重的10%;5例为刚开始接受维持性血液透析的患者,透析时脱水未达到其干体重水平;7例为每周透析次数少于两次,两次血透间期血压高;11例没有遵医嘱服降压药,透析过程血压升高;12例未找到诱发或加重高血压的原因。结论MHD患者高血压发生率高,血压控制不良的主要原因有水钠摄入过多、脱水不充分、不按医嘱使用降压药,应采取针对性的护理措施,对患者进行健康教育,使患者获得相关的医疗、护理、自我保健的知识,自觉积极地进行治疗和自我保健。

Object To investigate the reasons and nursing of bad-controlled hypertension in patients with maintenance hemodialysis (MHD). Methods We retrospectively analyzed reasons of bad-controlled hypertension in 136 MHD patients. Results Forty seven out of 136 cases (34.5%) had bad-controlled hypertension. The increases of body weight in 12 of them during interval of dialysis were more than 10% of their dry weights. Five patients who just began to receive maintenance hemodialysis and dehydration during hemodialysis were less than their dry weights. Seven patients received hemodialysis with less than twice a week. Eleven patients who didn't take hypotensor regularly had high blood pressure during dialysis. Twelve patients had no significant reasons. Conclusions The main reasons of hypertension in MHD patients may be high fluid intake, insufficient dehydration and taking hypotensor irregularly. We should take corresponding nursing measures and provide health education to patients so that they can acquire health care related knowledge about medical treatment and nursing and control hypertension actively.