血浆置换联合维持性血液透析治疗在重症尿毒症患者中的应用与护理

The Effect of Treatment and Nursing of Severe Uremia Patients by Plasma Exchange Joint Maintenance Hemodialysis

目的:探讨血浆置换(PE)联合维持性血液透析(MH)治疗和护理对重症尿毒症患者的影响。方法:选取2008年4月-2013年12月本院确诊治疗的重症尿毒症患者45例,依据随机数字表法分为维持性血液透析组(MH组)、维持性血液滤过组(MF组)和血浆置换联合维持性血液透析组(PEMH组),每组15例患者。所有患者均给予常规护理、营养支持等综合治疗,MH组患者给予MH治疗,MF组患者给予MF治疗,PEMH组患者给予PEMH治疗及相应的护理,统计分析所有患者治疗前后血清中β2-微球蛋白(β2-MG)、总胆固醇(TC)水平和治疗后并发症发生情况以及生活质量。结果:治疗后,MH组血清中β2-MG、TC水平明均显高于MF组,MF组均明显高于PEMH组,差异均有统计学意义(P<0.05);治疗后,MH组总并发症发生率明显高于MF组,MF组均明显高于PEMH组,差异均有统计学意义(P<0.05);MH组躯体、认知、社会功能和健康状态评分明均显低于MF组,MF组均低于PEMH组,差异均有统计学意义(P<0.05)。结论:PEMH治疗和护理可有效提高重症尿毒症患者酸碱、电解质的改善作用,有助于提高疗效,降低治疗后不良情况的发生,改善患者生活质量,值得临床作进一步推广。

Objective：To discuss the effect of treatment and nursing of severe uremia patients by plasma exchange（PE） joint maintenance hemodialysis（MH）.Method：45 patients with severe uremia were selected from April 2008 to December 2013 in our hospital,according to the random distribution,all patients were divided into the maintenance hemodialysis group（MH）,the maintenance hemofiltration group（MF）,and the plasma exchange joint maintenance hemodialysis group（PEMH）,15 cases in each group,all patients were given conventional nursing,nutritional support,such as comprehensive treatment,MH group was treated with MH, and MF group was treated with MF,PEMH group patients were given PEMH treatment and corresponded nursing,statistical analysis of all patients before and after treatment serum β2-microglobulin（β2-MG）, total cholesterol（TC） level and the complications and quality of life after treatment.Result：After treatment, the MH group β2-MG in serum,TC level were obviously higher than that of the MF group, MF patients serum β2-MG,TC level were significantly higher than the PEMH group, the differences were statistically significant（P〈0.05）;the MH group of patients＇ physical, cognitive, social function and health score were lower than that in the MFgroup, the MF group of patients＇ physical, cognitive, social function and health score were lower than that in the PEMH group（P〈0.05）.Conclusion：PEMH treatment and nursing can effectively improve uremia patients with severe p H,the improvement of the electrolyte, help to improve curative effect, reduce the adverse situation before and after the treatment, improve patients＇ quality of life,it＇s worth for further clinical promotion.