血液透析患者用药护理体会

The Nursing Experience of Medication for Hemodialysis Patients

目的总结对血液透析(血透)患者透析用药的护理方法,以提高用药的安全性。方法对2013年7月-12月行维持性血透的280例患者应用血透药物时的反应行观察及护理处置,积极防范各类血透药物在治疗中所引发的并发症。结果本组共26例患者发生药物不良事件,5例血透后发生中心静脉留置导管出血,均予以中心静脉留置导管处经采用更换敷料并压迫止血后予以止血;1例发生肝素相关性血小板减少者,后改用无肝素透析其未再发生;1例尿激酶过敏反应者,经回血和心肺复苏抢救后得以消除;1例(皮疹)促红素相关单纯红细胞再生障碍性贫血,此后停用促红素;其应用重组人促红素(商品名:济脉欣)过敏反应者,改用重组人促红素(商品名:益比奥)后,未再发生;2例高血压,经减少济脉欣用量血压恢复正常。1例使用右旋糖酐铁注射液(商品名:科莫非)过敏,经重症监护科抢救成功;6例严重低血糖反应,采用50%葡萄糖静脉推注,快速纠正低血糖;1例左卡尼汀注射液(商品名:可益能)不良反应,将给药频率降为每周1次后兴奋的症状缓解。2例注射生物制剂后出现相关流感样症状者停药后缓解。结论严密观察透析药物的不良反应,并及时采取应对处理措施,是确保患者血液透析用药安全性的根本。

Objective To summarize and improve the nursing skills of medication for hemodialysis patients. Methods We observed and took nursing measures for adverse medication events in 280 hemodialysis patients treated in our dialysis center from July 2013 to December 2013, and actively prevented all kinds of complications caused by medications. Results In this group of patients, 26 had adverse drug events. Five patients with bleeding after central venous catheter indwelling were cured by changing the dressings. One patient had heparin induced thrombocytopenia, and the complication disappeared after the use of non-heparin hemodialysis. One patient had urokinase allergic reaction, and the complication disappeared by cardio-pulmonary resuscitation. One patient had EPO associated pure red cell aplastic anemia, and the patient did not suffer from it any more by changing the EPO. Two patients with high blood pressure recovered to normal by reducing the use of blood for rHuePO. One had allergic reaction for Iron Dextran Injection and was successfully treated by ICU. Six patients with severe reactive hypoglycemia were corrected quickly by intravenous injection of 50% glucose injection. One patient with adverse reaction to levocarnitine was cured by lowering the frequency of medication to one time per week. Two patients had flu-like symptoms after the use of biological agents were cured by stoppage of the medicine. Conclusion Adverse drug effect should be carefully observed, and patients＇ education and nursing skills of medical workers should be improved to ensure the medication safety of hemodialysis patients.