外科ICU腹腔感染患者行连续性血液净化的护理

Nursing of Continuous Blood Purification in Patients with Abdominal Infections in Surgical Intensive Care Unit

目的探讨外科ICU严重腹腔感染患者行连续性血液净化(continuous blood purification,CBP)的护理对策。方法回顾性总结2007年1月至2009年6月107例重症急性胰腺炎或肠瘘合并腹腔感染患者床边行CBP治疗的临床资料及护理体会。结果 107例患者中死亡11例,放弃治疗6例,余90例患者行CBP治疗24 h后症状、体征改善。所有患者在CBP治疗期间发生的并发症:导管感染32例(29.90%),意外拔管3例(2.80%),凝血8例(44.85%),血流动力学改变5例(14.01%)。结论腹腔感染患者行CBP治疗对清除炎症介质和细胞毒素、替代肾脏功能有较好的临床效果,但也带来了额外的风险;加强基础护理和心理护理、重视血流动力学监测和预见性护理对提高治疗效果、降低并发症的发生率有重要意义。

Objective To investigate the nursing strategies for continuous blood purification（CBP） in patients with severe abdominal infections in surgical intensive care unit（SICU）.Methods From January 2007 through June 2009,the clinical data and nursing experience were summarized retrospectively in 107 patients with severe acute pancreatitis or intestinal fistula and abdominal infections who undergone bedside CBP.Results Of the 107 patients,death occurred in 11 patients,abandoning therapy in 6 patients and improved symptoms and signs 24 h after CBP treatment in 90 patients.The complications occurred during CBP treatment included catheter infection in 32 cases（29.90%）,accidental extubation in 3 cases（2.80%）,coagulation in 8 cases（44.85%）,hemodynamic changes in 5 cases（14.01%）.Conclusion CBP in patients with severe abdominal infections is effective in eliminating inflammatory mediators and cytotoxins and replacing kidney function despite additional risks.It＇s significant to strengthen primary and psychological nursing and emphysize hemodynamic monitoring and nursing for improving therapeutic effects and reducing the incidence of complications