行血液净化的肾病患者血管通路的护理

Vascular Access Nursing for Patients with Nephropathy Underwent Blood Purification

目的分析探讨行血液净化的肾病患者血管通路的护理方法。方法回顾分析2013年1—12月期间在该院接受治疗的肾病患者60例,所有患者均行血液净化治疗,并将其随机分为观察组与对照组,每组患者30例。对照组患者行常规护理,观察组患者在此基础上进行血管通路护理,对两组患者血管通路并发症的发生情况进行观察分析。结果经皮中心静脉导管并行内瘘术者共17例、动脉内瘘患者共28例、经皮中心静脉导管患者共15例。观察组30例患者中,仅有1例患者发生术侧肢体肿胀,其并发症发生率为3.3%。笔者对其原因进行分析并了解到,因患者在静脉离断后未及时建立相应的侧肢循环造成静脉回流受阻,进而引发术侧肢体肿胀。护理人员在指导患者适当抬高患肢后患者的肢体肿胀症状逐渐缓解,并于5 d后肿胀消除。其他患者均未发生明显的并发症,护理效果明显。对照组30例患者中,6例患者出现并发症,其并发症发生率为20%。组间差异有统计学意义(P<0.05)。结论 对行血液净化的肾病患者进行优质的临床护理,可有效降低血管通路并发症的发生率,改善患者预后,提高患者的生存质量。

Objective To analyze the vascular access nursing method for patients with nephropathy underwent blood purification. Methods A retrospective analysis was conducted on 60 cases with nephropathy treated in our hospital between January 2013 and December 2013. Blood purification was performed in all the patients. The patients were randomly divided into the observation group and the control group with 30 cases in each. The control group were given the conventional nursing, and the observation group were given the vascular access nursing based on the conventional nursing. And the incidence of vascular access complica-tions was compared between the two groups. Results Among them, a total of 17 cases underwent both percutaneous central venous catheterization and internal fistula, 28 cases underwent artery fistula, 15 cases underwent percutaneous central venous catheteriza-tion. Of the 30 cases in the observation group, only 1 case had operative limb swelling, the incidence of complications was 3.3%. The analysis indicated that the operative limb swelling was caused by obstructed venous return for corresponding collateral circu-lation was not formed timely after vein mutilation. The operative limb swelling was relieved gradually after lifting the affected limb guided by the nurisng staff, and reduced 5d later. The other cases had no obvious complications; the nursing efficacy was signifi-cant. Of the 30 cases in the control group, 6 cases had complications, the incidence of complications was 20%, the difference be-tween the two groups was statistically significant （P〈0.05）. Conclusion For patients with nephropathy underwent blood purification, high-quality clinical nursing can effectively reduce the incidence of vascular access complications, improve the prognosis and quality of life of the patients.