老年多器官功能不全综合征患者行配对血浆滤过吸附治疗的护理

Nursing care for multiple organ dysfunction syndromes in the elderly managed with coupled plasma filtration absorption therapy

目的：对老年多器官功能不全综合征（ MODSE）患者行配对血浆滤过吸附治疗,浅谈护理体会。方法 MODSE患者4例入选,应用CPFA＋CVVHDF治疗8次。使用AQUARIUS机器（ CVVHDF模式）,血浆分离器OP-O8W,血滤器HF1200或AEF-10S,血液灌流器HA330-Ⅱ或HA330。血流速度180 ml/min,血浆分离速度35～50 ml/min,治疗时间10 h。灌流器5h更换一次,置换液1000～2500 ml/h,透析液1500～2500 ml/h。结果4例患者经CPFA ＋CVVHDF治疗后,死亡1例,自动出院1例,2例肾功能正常后停止血液净化治疗,治愈出院。结论 CPFA应用于老年多器官功能障碍综合征的治疗,取得了较好的疗效,要求护士有高度的责任心,敏锐的观察力,娴熟的专业技术,丰富的临床经验,较好的体力支持。

Objective Brief discussion on nursing experience in multiple organ dysfunction syndromes in the elderly （ MODSE） managed with coupled plasma filtration absorption therapy. Methods Four patients diagnosed with MODSE were selected and treated with CPFA＋CVVHDF eight times. Medical devices used were AQUARIUS （ CVVH-DF）, plasma separator OP-O8W, blood filter HF1200 or AEF-10S, and hemoperfusion cartridge HA330-Ⅱ or HA330. The velocity for blood flow and plasma separation was 180 ml/min and 35～50 ml/min respectively, curative time was 10 h. Hemoperfusion cartridge was changed every 5 h, substitution fluid and dialysis fluid were 1 000～2 500 ml/h and 1 500～2 500 ml/h respectively. Results From the four patients cured with CPFA ＋CVVHDF, one died, one was against-advice discharge and two ceased to be cured with blood purification treatment after their renal function worked well and discharged from our hospital. Conclusions Observed from application of CPFA in MODSE, nice cur-ative effect has been achieved. It demands nurses should have a strong sense of responsibility, sharp observation, adroit professional skills, abundant clinical experience and fair physical support.