妊娠合并尿毒症患者血液透析的护理

Nursing Care in Hemodialysis for Pregnant Women with Uremia

目的总结妊娠合并尿毒症患者血液透析的护理措施。方法回顾性分析2001年3月-2012年6月收治的15例妊娠合并尿毒症患者行血液透析的临床资料。患者年龄平均30.5岁;2例为早期妊娠,孕13周,其中1例伴有尿毒症急性发作,其余均为中晚期妊娠,孕24+周,均血清肌酐>445μmol/L(5 mg/dL),尿氮素>20 mmol/L。15例患者入院后即刻行血液透析治疗,治疗过程中进行必要的心理干预,在透析前、中、后护理中,密切观察患者心理状况,孕妇各项生命体征及胎儿胎心胎动等,择期终止妊娠。结果 9例经维持性血液透析治疗后,病情稳定,顺利产下胎儿;另外3例患者经血液透析治疗后病情稳定,其中1例产下一死婴,另2例行人工钳取术终止妊娠;还有3例患者由于经济条件限制而中途退出治疗。结论适时的干预和加强妊娠合并尿毒症患者血液透析的护理,可取得很好的治疗效果,有可能改变妊娠的结果。

Objective To sum up the nursing care in hemodialysis for pregnant women with uremia.Methods The clinical data of 15 pregnant female patients with uremia who had undergone hemodialysis were retrospectively analyzed.The mean age of the patients was 30.5 years old;two cases had early pregnancy with 13 weeks of pregnancy,in whom one was with acute uremia,and the others had middle and late pregnancy（with more than 24 weeks of pregnancy）,the serum creatinine was445 μmol/L（5 mg/dL）,and the blood urine nitrogen was20 mmol/L.All patients received immediately hemodialysis treatment after the admission and the necessary psychological intervention in the course of treatment.What＇s more,the psychological status of patients,the vital signs of pregnant women and fetal heart rate and fetal movement were closely observed through the dialysis care duration.After that,the patients were treated with elective termination of pregnancy.Results The patients＇ condition became stable and the fetuses were given birth successfully after maintenance hemodialysis in 9 cases.The patients＇ condition became stable after hemodialysis in 3 cases,but 1 gave birth to a dead infant and the other 2 had termination of pregnancy by operation.The other 3 cases dropped out of the treatment due to the self reasons.Conclusion Timely intervention and the careful care in hemodialysis for pregnant women with uremia could obtain good therapeutic effect,and might change the results of pregnancy.