间断On-line血液透析滤过的临床观察与护理

Clinical observation and nursing of interrupted On - line hemodiafil-tration

目的:采用正确的护理措施确保On-line血液透析滤过顺利地进行,观察间断On-line血液透析滤过治疗尿毒症的临床疗效。方法:HDF组采用费森尤斯4008S+On-line透析机,聚砜膜F60滤器,面积1.4㎡,每周HD2次,HDF1次。HD组采用费森尤斯4008B、2008A、AK200,每周HD3次,两组透析时间均为4h,血流量为200￣250ml/min,透析液流量为500￣800ml/min。在联机HDF或HD治疗期间分别观察治疗前后尿毒症毒素清除率,每月第1次HDF或HD前后测BUN、SCr、Ca、β-M、Sp连续观察6个月。同时加强护理,严密观察生命体征及病情变化,严格把好安全过滤器和细菌过滤器的安全使用,严格遵守消毒隔离制度及无菌技术操作规程,保证充足的血流量,密切观察出血倾向及凝血情况,加强对病人的饮食护理。结果:HD通过扩散作用能有效地清除小分子毒素,但对大中分子物质的清除有限,而HDF则是利用扩散、滤过两种清除原理,能有效清除BUN、SCr、Sp等中小分子物质,对β-M的清除明显优于HD组(P﹤0.01)。结论:应用费森尤斯4008S+On-line透析机进行HDF,由于透析机自产置换液可直接使用,降低了病人的医疗费用,具有操作简便、出入量平衡、控制准确、置换液温度适宜等优点,值得推广使用。同时有效的护理是保证治疗顺利进行的关键。

Objective To observe the chnical therapeutic effect of treating uremia by interrupted On-line hemodiafiltration. Method Fresensius dialysis machine 4008S＋On-line , F60 filtrate, area 1.4m^2,HD 2 times per week, HDF 1 time were used in HDF Group. Fresensius 4008B, 2008A, AK200, HD 3 times per week were used in HD group. 4 hours were dialyzed in both group, with the blood flow of 200～250ml/min. and the flow of dialysis of 500～800ml/min. Ca, β-M, Sp were observed consecutively within 6 months.Nursing： Life signs and the changes in course of disease were observed carefully, the safety use of safety filter and germs filter should be followed strictly, sterilization and quarantine system and aseptic technique operation principle should be obeyed severely, sufficient blood flow should be ensured, the tendency of hemorrhage and the condition of blood clotting should be observed intently, the dietary of the patients should be strengthened. Results Small molecule toxin could be cleared effectively by diffusion but big and medium molecule substances were cleared in limit. Both principle of diffusion and filtration was used in Co- HDF, BUN, Scr, Sp, etc. edium and small molecule. substances could be cleared effectively and was apparently better than HD group in clearing β-M （P〈0.01）. Conclusion Fresensius dialysis machine 4008S＋On-line were used in HDF because of direct of the dialysis machine self-produce replacement fluid, reduce the medical cost of patients, with the advantages of easily operation, accurate balance control of the in and out volume, suitable temperature of replacement fluid, etc. It was worthy to popularize the efficacious nursing.