慢性肾功能不全患者经皮冠状动脉介入术后血液净化治疗的护理措施及效果

Nursing measures and effect of blood purification therapy after percutaneous coronary intervention in patients with chronic renal insufficiency

目的探讨慢性肾功能不全患者经皮冠状动脉介入(PCI)术后血液净化治疗的护理措施及效果。方法研究对象为2017年1月至2019年12月在首都医科大学附属北京安贞医院行PCI术后接受血液净化治疗(在线血液透析滤过或连续性肾脏替代治疗)的265例慢性肾功能不全患者。因此类患者手术经常需要使用大剂量对比剂,对比剂肾病(CIN)的发生风险增加,为有效预防肾损伤,给予综合护理(心脏内科及血液净化专科护理常规、健康宣教、心理疏导等)及血液净化专科操作(把握治疗时机、合理抗凝、另辟蹊径的通路选择、保护血管资源、并发症的观察及处理),观察、对比患者PCI术前及血液净化治疗后第1、3天的敏感指标变化情况,了解血液净化治疗及护理的效果。结果265例患者在接受血液净化治疗后第1、3天血红蛋白、血肌酐、估算肾小球滤过率(eGFR)与PCI术前比较差异均无统计学意义[血红蛋白:(91.8±1.8)、(90.2±1.7)g/L比(92.9±2.1)g/L,血肌酐:(411±296)、(525±329)μmol/L比(512±345)μmol/L,eGFR:(12.7±2.8)、(9.5±2.5)ml/(min·1.73 m;)比(9.5±2.3)ml/(min·1.73 m;)](均P>0.05)。随访(7.2±1.1)d,无大出血、低血压及心脑血管事件发生。血液净化治疗中及随访期内无穿刺部位出血、血肿形成,无体外循环凝血的发生。患者出院前,运用"住院患者满意度调查表"对患者进行满意度评分,结果均在95分以上。结论慢性肾功能不全患者PCI术后密切的病情观察及个体化的护理措施可有效减少CIN的发生,防止肾功能恶化,保护患者的血管资源,提高患者的生活质量。

Objective To explore the nursing measures and effect of blood purification therapy after percutaneous coronary intervention(PCI)in patients with chronic renal insufficiency.Methods Totally 265 chronic renal insufficiency patients who received blood purification therapy(online hemodialysis filtration or continuous renal replacement therapy)after PCI were selected in Beijing Anzhen Hospital,Capital Medical University from January 2017 to December 2019.The patients needed to use high-dose contrast agents for surgery,which increased the risk of contrast induced nephronpathy(CIN).In order to effectively prevent renal injury,they were given comprehensive nursing(nursing routine,health education,psychological counseling of cardiology department and blood purification specialty department)and blood purification specialty operation(grasping the treatment opportunity,reasonable anticoagulation,alternative pathway selection,protection of vascular resources,observation and treatment of complications).In order to understand the effect of blood purification therapy and nursing,the changes of sensitive indexes between pre-PCI,the 1 st and 3 rd days after blood purification therapy were observed and compared.Results There were no significant differences in hemoglobin,serum creatinine and estimated glomerular filtration rate(eGFR)between patients on the 1 st,3 rd days after blood purification therapy and those before PCI[hemoglobin:(91.8±1.8),(90.2±1.7)g/L vs(92.9±2.1)g/L;serum creatinine:(411±296),(525±329)μmol/L vs(512±345)μmol/L;eGFR:(12.7±2.8),(9.5±2.5)ml/(min·1.73 m;)vs(9.5±2.3)ml/(min·1.73 m;)](all P>0.05).During(7.2±1.1)d follow-up,there were no major bleeding,hypotension,cardiovascular and cerebrovascular events.During the blood purification therapy and follow-up period,there were no bleeding at the puncture site,hematoma formation,and coagulation during cardiopulmonary bypass.Before discharged from the hospital,the"inpatient satisfaction questionnaire"was used to score the patients′satisfaction,and the results were more than 95.Conclusions After PCI in patients with chronic renal insufficiency,close condition observation and individualized nursing measures can effectively reduce the occurrence of CIN,prevent the deterioration of renal function,protect the vascular resources and improve the quality of life of patients.