腹膜透析患者心血管病变的临床特点与护理

Clinical features and nursing of cardiovascular disease in patients with peritoneal dialysis

目的了解采用腹膜透析（PD）治疗终末期肾脏疾病患者透析前心血管疾病的临床特点，为判断预后和掌握护理观察重点提供依据。方法回顾性分析接受PD治疗的165例终末期肾病患者的资料，根据是否患有糖尿病分为糖尿病肾病组（DN组）和非糖尿病肾病组（非DN组）；根据左心室是否增大分为左室增大组（LVH组）和无左室增大组（无LVH组）。于治疗前1周行心脏超声检查及相关实验室指标检查。结果本组透析前均有明显的心脏病变，主要表现为左房左室增大、室间隔增厚；其中DN组的心脏受损更明显，心胸比和左房内径明显增大；DN组合并高血压的比例明显高于非DN组，且血色素及血白蛋白水平均明显低于非DN组。结论应监测PD患者心血管系统的指标变化，尤其是原发病为DN的老年患者，早期采取护理干预措施，以便及时防治心血管并发症发生。

Objective To evaluate the clinical ieatures of cardiovascular disease before dialysis in patients with end-stage renal disease and receiving peritoneal dialysis （PD） , in order to provide evidence for judging the prognosis and mastering the emphasis of nursing observation. Methods The informations of 165 patients with end-stage renal disease who underwent PD were analyzed retrospectively. The patients were divided into the diabetic nephrosis group （Group DN） and the non-diabetic nephrosis group （Group non-DN） according to whether the patients had diabetes or not. The patients were divided into the left ventricular hypertrophy group （Group LVH） and the non-left ventricular hypertrophy group （Group non-LVH） according to whether the left ventrieular was hypertrophic or not. The ultrasonic examination of the heart and the examination of related laboratory indexes were conducted one week before the treatment. Results The groups had obvious cardiac disease before dialysis. The major exhibitions included left atrial hypertrophy, left ventricular hypertrophy and interventricular septum hypertrophy. Wherein the injury of heart in Group DN was more serious, and the eardiothoracie ratio and the left atrial dimension obviously enlarged. The proportion of hypertension in Group DN was higher than that in Group non-DN, and the levels of hemoglobin and blood albumin were significantly lower than those in Group non-DN （P 〈 0. 05）. Conclusions The index changes of the cardiovascular system of PD patients should be inspected, especially those elderly patients with the primary disease of DN. The nursing intervention measures should be adopted early so as to prevent the occurrence of cardiovascular complications in good time.