两种血管通路血液透析患者透析效果比较及并发症的护理

The study of two types of vascular access in hemodialysis patients and the nursing care of complications

目的探讨以带涤纶套隧道双腔深静脉长期导管为血管通路进行透析治疗的充分性、并发症发生的情况及护理对策。方法选取我院肾内科维持性血液透析患者65例,其中留置带涤纶套隧道双腔深静脉导管的患者32例,自身动静脉内瘘的患者33例。对比分析两组患者透析充分性指标及并发症发生情况,针对并发症实施护理。结果两组患者的血红蛋白、白蛋白、总蛋白、总胆固醇、甘油三酯、KT/V、URR、PCR差异均没有显著的统计学意义(P>0.05)。导管组患者的平均年龄明显高于内瘘组患者的平均年龄(P<0.05);两组患者透析后的尿素氮、血肌酐以及尿酸水平都明显低于透析前的水平(P<0.05)。导管组血流不畅、血栓栓塞以及感染的并发症发生率均明显高于动静脉内瘘组的患者(P<0.05),而出血发生率低于动静脉内瘘组(P<0.05)。结论对于心肺功能差或血管条件差,动静脉内瘘难以建立的患者,采用带涤纶套隧道双腔深静脉长期导管为血液透析通路能够达到良好的效果。只要采取有效的预防护理措施,可减少并发症的发生,明显延长导管的使用寿命,保证维持性血液透析治疗的顺利进行,提高患者生活质量,延长透析患者的生存时间。

Objective To investigate the clinical effect,complication and nursing countermeasures of vascular access for dialysis therapy in hemodialysis patients. Methods 65 patients received hemodialysis including 32 patients with cuffed sili- cone dual lumen catheter and 33 patients with internal arteriovenous fistula were selected in our hospital. The dialysis adequacy index and complications, nursing for complications of both groups were compared. Results The KT/V, URR and PCR of both groups showed no statistically significant （P〉0.05）. The average age of the catheter group was significantly higher than that of internal fistula group （P〈0.05）. The concentration of urea nitrogen, creatinine and uric acid of both groups were significantly lower than that before the dialysis （P〈0.05）. The complication rates of blood flow was not smooth, thromboembolism and infec- tion of the catheter group were significantly higher than that of the internal arteriovenous fistula group （P〈0.05）. Conclusion Good results could be achieved by cuffed silicone dual lumen catheter for hemodialysis access, especially to the patients with poor cardiopulmonary function or vascular condition.