老年重症肾衰竭患者实施床边间歇性血液透析的预见性护理

Foreseeing nursing for elderly severe renal failure patients with bedside intermittent hemodialysis

目的 观察并探讨预见性护理干预在老年重症肾衰竭（SRF）患者实施床边间歇性血液透析（IHD）中的效果.方法 选择2012年3月-2014年1月在某院接受IHD的72例老年SRF患者,根据随机数字表法分为两组,各36例.干预组患者接受预见性护理干预（透析次数286次）,对照组患者接受常规护理（透析次数292次）.观察护理前后两组患者急性生理与慢性健康（APACHEⅢ）评分、24h尿量、脉搏血氧饱和度（SpO2）、中心静脉压（CVP）、血清肌酐（SCr）和血清氮末端-前体脑钠肽（NT-proBNP）水平,以及IHD过程中并发症发生情况.结果 两组患者透析前所监测指标相比,差异无统计学意义（P＞0.05）.护理后,干预组APACHEⅢ评分、CVP、SCr和NT-proBNP明显低于对照组,24 h尿量和SpO2明显高于对照组,差异有统计学意义（P＜0.05）;且观察组低血压、高血压、低血糖和心律失常发生率分别为6.3％,4.2％,4.9％和2.4％,对照组为16.4％,13.4％,10.6％和6.2％,两组相比差异具有统计学意义（x2值分别为14.700,15.070,6.588,4.823;P ＜0.05）.结论 预见性护理干预能明显改善SRF患者的状况,减少并发症的发生,值得在临床上进一步推广.

Objective To observe and explore the value of foreseeing nursing intervention for elderly severe renal failure （SRF） patients with bedside intermittent hemodialysis （IHD）.Methods Seventy two patients with SRF accepted IHD in our hospital from March 2012 to January 2014 were selected,who were divided into two groups according to random digits table,each group with 36 cases.Patients in the intervention group accepted foreseeing nursing intervention （286 times of dialysis）,the control group received routine care （292 times of dialysis）.Care Acute Physiology and Chronic Health （APACHE Ⅲ） score,24 h urine output,pulse oximetry （SpO2）,central venous pressure （CVP）,levels of serum creatinine （SCr） and serum N-terminal-a precursor of brain natriuretic peptide （NT-proBNP） of the two groups before and after nursing intervention was recorded,as well as complications during the IHD.Results The difference of monitoring indicators in two groups before dialysis was not statistically significant （P 〉 0.05）.After treatment,the intervention group APACHE Ⅲ score,CVP,SCr and NT-proBNP was significantly lower than the control group,24 h urine and SpO2 was significantly higher than the control group （P 〈 0.05） ; Incidence of hypotension,hypertension,hypoglycemia,and arrhythmia in the observation group was 6.3%,4.2%,4.9% and 2.4%,and was 16.4%,13.4%,10.6% and 6.2% in the control group,the difference was statistically significant （x2 =14.700,15.070,6.588,4.823,respectively;P 〈0.05）.Condusions Foreseeing nursing intervention can significantly improve the condition of SRF patients,as well as reduce the complications,it is worthy of further promotion in clinical practice.