换瓣术后急性肾功能衰竭患者无抗凝剂行连续性静脉-静脉血液滤过治疗的护理

Observation and nursing in the treatment of acute renal failure after valve surgery with CVVH without anticoagulation

目的 探讨换瓣术后急性肾功能衰竭患者无抗凝剂行连续性静脉-静脉血液滤过 （CVVH）治疗的护理.方法 对28例心脏直视换瓣术后并发急性肾功能衰竭（ARF）的患者实施无抗凝剂CVVH治疗138例次,治疗过程中密切观察滤器和管道的血凝情况、采用定时冲洗管路等护理措施.结果 本组治疗138例次,滤器寿命3.5～24 h,多数为10～13 h,连续治疗者每天更换1～2套滤器及管路;1例在连续4次治疗中机械反复出现低压动脉报警,造成滤及管路在3.5～7 h凝血而更换滤器及管路,2例病人出现皮下出血点,1例病人出现血便.结论 对换瓣术后ARF的患者进行CVVH无抗凝剂治疗,结合相应护理措施,能使治疗能顺利完成,减小患者出血并发症.

Objective To study the observation and nursing with continuous veno- venous hemofiltration （CVVH） without anticoagulation therapy in acute renal failure after valve surgery.Methods During the treatment with 138 times of non-anticoagulant CVVH in open heart valve replacement surgery with concurrent acute renal failure （ARF） in 28 cases, the condition variation, filters and piping clotting conditions were closely observed, and regular flushing piping and other nursing measures were taken.Results In the treatment of 138 times, filter life was 3.5 ～ 24 h, 10 ～ 13 h in the majority; continuous treatment replaced 1 to 2 sets of filters and pipes one day; one case of 4 times treatment in a row occurred recurrent mechanical alarm of hypotension, causing coagulation in filters and pipes in 3.5 ～ 7 h and replacement of filters and pipes; 2 patients occurred subcutaneous bleeding, and 1 patient had bloody stools.Conclusions In the patients with ARF after valve surgery, CVVH without anticoagulation therapy, combined with the appropriate care measures, can make the successful completion of treatment and reduce bleeding complications in patients.