加热法在无肝素血液灌流护理中的应用

Application of Heating Method in Care Management of Non-Heparin Hemoperfusion

目的探讨加热法在无肝素血液灌流中的效果,为探寻一种安全、实用的无肝素血液灌流方法的应用提供实验依据。方法将60例行无肝素血液灌流的重度有机磷农药中毒患者按随机数字表法分为对照组和研究组,各30例。在采用同等无肝素血液灌流的情况下,对照组给予常规的血液灌流护理;研究组在此基础上给予加热法,即灌流前将预冲液加热至37-38℃、灌流中恒温加热灌流器至37-38℃进行血液灌流。观察2组的灌流器凝血堵塞情况及寒颤（含畏寒）发生率、体温变化等。结果研究组无一例患者发生灌流器凝血;对照组7例（23.33%）发生灌流器发生凝血,2组比较差异有统计学意义（P〈0.05）。研究组灌流前后体温变化不大（P〉0.05）;而对照组灌流后较灌流前的体温显著下降[（35.80±0.10）℃）比（36.60±0.41）℃,P〈0.05];研究组灌流后的体温高于对照组（36.70±0.44）℃比（35.80±0.10）℃,P〈0.05）。研究组寒颤发生率低于对照组[6.67%（2/30）比60.0%（18/30）,P〈0.05]。结论在血液灌流中,加热法能有效地预防灌流器凝血,并持续保持患者体温的稳定,减少患者寒颤的发生。

Objective To investigate the efficacy of heating method in non-heparin hemoperfusion,and to provide an experimental basis for the application of safe and practical non-heparin hemoperfusion.Methods Sixty patients undergoing non-heparin hemoperfusion were randomly divided into control group and experimental group,with 30 patients in each group.All patients received conventional nursing care.In addition,the pre-perfusion liquid was heated to 37-38 ℃ before perfusion and the constant temperature perfusion apparatus was maintained at 37-38 ℃ during perfusion in the experimental group.The perfusion blockage,incidence of chills（including intolerance to cold）,and change in body temperature were observed in both groups.Results The incidence of blood coagulation in perfusion apparatus in experimental group（0.00%,0/30）was significantly lower than that in control group（23.33%,7/30）（P〈0.05）.No obvious change in body temperature was observed after perfusion in experimental group（P〉0.05）.However,compared with the value before perfusion,body temperature markedly decreased after perfusion in control group[（35.80±0.10）℃ vs（36.60±0.41）℃,P〈0.05].Furthermore,the body temperature in experimental group was higher than that in control group after perfusion[（36.70±0.44）℃ vs（35.80±0.10）℃,P〈0.05].The incidence of chills in experimental group was lower than that in control group（6.67% vs 60.0%,P〈0.05）.Conclusion Heating method can prevent the blood coagulation in perfusion apparatus,maintain the stability of body temperature and reduce the occurrence of chills in hemoperfusion.