汞作业观察对象驱汞治疗临床护理路径应用分析

Analysis on application of clinical nursing pathway in mercury displacement treatment to mercury exposed workers as observation objects

目的探讨汞作业观察对象驱汞治疗的临床护理路径及其应用价值。方法以52例汞作业观察对象患者为研究对象,在实施临床护理路径的基础上,采用二巯基丙磺酸钠进行驱汞治疗,分析治疗效果。结果治疗前,52例患者12 h自然排尿汞中位数（M）为38.02μmol/mol肌酐,第1疗程驱汞治疗时尿汞M为1 239.75μg/d。经3~7个疗程驱汞治疗后,尿汞水平均低于正常参考值（45.00μg/d）;驱汞治疗疗程次数与第1疗程尿汞水平呈中度正相关[Spearman秩相关系数（rS）为0.64,P〈0.01],与性别、工龄、年龄和12 h自然排尿汞水平均不相关（rS分别为-0.41、-0.01、-0.12和0.05,P〉0.05）。第1、2疗程驱汞治疗之间尿汞下降最快,其后疗程的尿汞下降趋于平缓。驱汞治疗后患者牙龈肿胀与出血、头晕和头痛、失眠多梦等症状均有改善或消失。出院后连续3年对52例患者进行跟踪随访,无发现诊断为职业性慢性汞中毒患者。结论实施临床护理路径对于汞作业观察对象的驱汞治疗有重要意义。

Objective To explore the application value of clinical nursing path effect in mercury displacement treatment to mercury exposed observation objects. Methods Fifty-two mercury exposed observation objects were selected as the research objects, on the basis of the implementation of clinical nursing path, they were treated using mercury displacement of mercapto propionic sulfonic acid sodium, and the therapeutic effects were observed and analyzed. Results Before treatment, the median of urinary mercury concentration within 12 hours in 52 objects under surveillance was 38.02 μmol/mol creatinine. After the first treatment course, the median of urinary mercury level was 1 239.75 μg/d. The urinary mercury levels were lower than the normal reference value （45.00 μg/d） after 3-7 courses of treatment. The relationship between the times of course and urinary mercury level during the first treatment course was moderate positive correlation [ Spearman correlation coefficient （ rs ） = 0. 64, P 〈 0. 01 ], but there was no correlation with gender （ rs = - 0.41, P 〉 0. 05 ）, length of serviee （rs = -0. 01, P 〉0. 05） , age （rs = -0. 12, P 〉0. 05） , and the urinary mercury level within 12 hours （rs = 0. 05, P 〉 0.05 ）. The fastest decline of urinary mercury level appeared within the first and the second courses, and then dropped gradually in other coarses. The symptoms of spongy gums, bleeding, dizzy, headache and insomnia were improved or disappeared after treatment. These 52 objects under surveillance were not diagnosed as occupational chronic mercury poisoning cases in the follow-up visit 3 years after hospital discharge. Conclusion The clinical nursing pathway has important significance in the mercury displacement treatment for the mercury exposed observation subjects.