糖尿病肾病患者腹膜透析初始心血管状态的分析及护理

Evaluation on Initial Cardiovascular States of Peritoneal Dialysis Patients with End Stage Diabetic Nephropathy and Nursing Strategies

目的了解终末期糖尿病肾病患者腹膜透析(peritoneal dialysis,PD)初始时心血管系统的状态,旨在为其PD后采取护理对策提供依据。方法将行PD的终末期肾功能不全患者按基础疾病分为糖尿病肾病(diabetic nephropathy,DN)组和原发性肾小球肾炎(chronic glomerinephritis,CGN)组,术前1周监测患者的血压、体重指数、心胸比、血肌酐、尿素氮、血红蛋白、血清白蛋白、尿量及心脏超声等数据,并进行分析。结果PD前患者均有明显的心脏病变,两组比较DN组患者年龄大、心脏受损明显、心胸比增大、左房内径增大、高血压发生率高、血红蛋白及血清白蛋白水平均低于CGN组,差异均有统计学意义(P<0.05)。结论DN组患者PD前心血管系统的改变尤为明显,在PD初期即要采取有效的护理对策,严格控制容量负荷,提高对贫血治疗的依从性,改善营养不良,动态监测心血管系统状态,以降低DN患者心血管并发症,减少护理风险的发生。

Objective To explore the initial cardiovascular states of peritoneal dialysis（PD） patients with end-stage diabetic nephropathy（ESDN） so as to provide a basis for nursing countermeasures after PD. Methods All the new PD patients were divided into the diabetic nephropathy （DN） group and chronic glomerinephritis （CGN） group, and the cardiovascular ultrasound, blood pressure, body weight index, cardio-chest radio, hemoglobin, serum creatinine, serum urea nitrogen, serum albumin, urine volume were compared a week before the PD treatment. Results All the pre-PD patients had a significant cardiovascular abnormality. There were older age,wore serious cardiac injury,higher cardio-chest radio,lager left atrium, higher hypertension incidence rate,lower hemoglobin and serum albumin level in the DN patients compared to those in the CGN group（P〈0.05）. Conclusion The DN patients had higher cardiovascular risk before PD treatment and required effective nursing countermeasures on initial stage of PD. It is recommeded to improve the anemia, the chronic infection states, the cardiovascular volume states and the control of blood pressure in ESDN patients to reduce the cardiovascular complications and nursing risks.