血液灌流(HP)器与血液透析(HD)器串联治疗尿毒症顽固性皮肤瘙痒的观察与护理(1)
【摘要】目的:探讨血液灌流(HP)器与血液透析(HD)器串联治疗尿毒症顽固性皮肤瘙痒的观察与护理。方法:维持性血液透析的尿毒症患者22例,随机分为两组,串联组(HP+HD组)12例,采用透析器与灌流器(HA型)串联进行治疗,每周2次;对照组(HD组)10例,单纯进行血液透析,外用乳化剂,口服抗组胺药物治疗皮肤症状,每周2次,每次4.5 h。血流量200 mL/min,透析液为碳酸氢盐,速度为500 mL/min。串联组先血液灌流及透析2 h后再单纯透析2.5 h,共治疗3个月,同时做好心理护理及血管通道的护理,密切观察病情变化。结果:串联组治疗前皮肤瘙痒(27.0±5.9)分,治疗3个月后为(13.0±1.5)分,治疗前后比较,差异有显著性意义(P<0.01),对照组全身皮肤瘙痒无明显改善,且有3例皮肤瘙痒症状加重。结论:血液灌流与血液透析联合治疗尿毒症皮肤瘙痒患者,配合精心护理,可获得良好的效果。
【关键词】血液灌流器与透析器;串联;尿毒症;顽固性皮肤瘙痒
The blood fills flows (HP) and hemodialysis (HD) the series treats uremia stubborn skin pruritus the observation and nursing
Song Na
【Abstract】Objective:To explore the observation and care of hemoperfusion combined with hemodialysis on the stubborn skin itches with uremia.Methods:Twenty-two maintenance hemodialysis patients with uremia were randomly divided into two groups:series group(n=12) and control group(n=10).The patients in series group were given hemodialysis combined with hemoperfusion twice a week;The patients in the control group were treated with hemodialysis alone and the external use emulsifier,took orally the antihistamine medicine treatment skin symptom,twice aweek,each time 4.5h.The blood current capacity was 200 mL/Min,the dialysis fluid was the supercarbonate with flow speed of 500 mL/Min.After the series connected group the blood fills first flows and the dialysis for 2 hours the pure dialysis 2.5 hours again.The treatment program was carried out for three months.Also,we should give good psychological care and vascular access care, close observation of changes in condition. Results:In(HP+HD )group before treatment, skin itching (27.0±5.9) points,3months after treatment (13.0±1.5) points, before and after treatment, the difference was significant (P<0.01),in HD group no significant improvement in total skin pruritus, and pruritus symptoms in 3 patients increased.Conclusions:Hemoperfusion combined with hemodialysis on the stubborn skin itches with uremia canget good results with intensive care.
【Key words】hemoperfusion with hemodialysis;uremia;the stubborn skin itches
【中图分类号】R473.71【文献标识码】B【文章编号】1002-574X(2010)07-0010-02
各种原因导致的慢性肾功能衰竭发生率逐年增高,血透是目前治疗尿毒症病人的可靠方法之一,但是仍有许多并发症,如顽固性皮肤瘙痒等。目前公认为这些临床问题存在是尿毒症另一种主要致病物质一中分子物质所致。血液透析(Hemodialysis,HD)对其清除很少,血液灌流(Hemoperfusion,HP)是血液经体外循环,通过吸附装置,清除血中外源性或内源性毒物,达到血液净化的一种方法,本文旨在探讨液灌流(HP)器与血液透析(HD)器串联治疗尿毒症顽固性皮肤瘙痒的临床效果与护理。
1资料
2008年4月至2010年3月于我院血透中心接受HD治疗的发生皮肤瘙痒较为严重的患者22例,均为慢性尿毒症患者,且无严重并发症。患者随机分为串联组和对照组,串联组12例,其中男7 例、女5 例,年龄30 -80岁,平均55.0 岁,对照组10例,男6例,女4例,性别和年龄经统计学处理无明显差异,出现瘙痒症状最短持续时间6个月,最长54个月。
2方法
2.1材料:血液透析采用德国费森尤斯公司4008B型血透机,透析器为三醋酸纤维膜,串联组所用灌流器采用珠海丽珠集团丽珠医用生物材料厂生产的HA型130树酯灌流器,透析液为碳酸氢 盐透析液。
2.2串联组治疗时将灌流器与透析器垂直固定在透析机支架上,灌流器串在透析器之前,以免治疗中经透析器脱水后,血液浓缩,使血液阻力增大,致灌流器凝血[1]。血流量200 ml/min,透析液流量500 ml/min。 先用5%葡萄糖注射液500 ml在灌流器内分布均匀,树酯颗粒吸湿后膨胀,轻轻敲打,帮助空气排除,然后,用2 000 ml氯化钠肝素注射液(每500 ml 0.9%氯化钠注射液内加20 mg肝素),以200 ml/min流量冲洗,用手轻拍和转动灌流器及透析器,以排除气泡并除去微粒。使全部血路管、灌流器及透析器均充满液体,并闭路循环20 min即可上机。肝素用量因人而易,有出血倾向者用低分子肝素,无出血倾向者肝素首剂用量25 mg静脉推注,追加肝素5 mg/h,并根据患者具体情况增减肝素用量。先灌流、透析2 h,达到饱和后取下灌流器,再继续透析2.5 h,共治疗4.5h。治疗前后观察其皮肤瘙痒情况并询问其睡眠情况。, 百拇医药(宋 娜)
【关键词】血液灌流器与透析器;串联;尿毒症;顽固性皮肤瘙痒
The blood fills flows (HP) and hemodialysis (HD) the series treats uremia stubborn skin pruritus the observation and nursing
Song Na
【Abstract】Objective:To explore the observation and care of hemoperfusion combined with hemodialysis on the stubborn skin itches with uremia.Methods:Twenty-two maintenance hemodialysis patients with uremia were randomly divided into two groups:series group(n=12) and control group(n=10).The patients in series group were given hemodialysis combined with hemoperfusion twice a week;The patients in the control group were treated with hemodialysis alone and the external use emulsifier,took orally the antihistamine medicine treatment skin symptom,twice aweek,each time 4.5h.The blood current capacity was 200 mL/Min,the dialysis fluid was the supercarbonate with flow speed of 500 mL/Min.After the series connected group the blood fills first flows and the dialysis for 2 hours the pure dialysis 2.5 hours again.The treatment program was carried out for three months.Also,we should give good psychological care and vascular access care, close observation of changes in condition. Results:In(HP+HD )group before treatment, skin itching (27.0±5.9) points,3months after treatment (13.0±1.5) points, before and after treatment, the difference was significant (P<0.01),in HD group no significant improvement in total skin pruritus, and pruritus symptoms in 3 patients increased.Conclusions:Hemoperfusion combined with hemodialysis on the stubborn skin itches with uremia canget good results with intensive care.
【Key words】hemoperfusion with hemodialysis;uremia;the stubborn skin itches
【中图分类号】R473.71【文献标识码】B【文章编号】1002-574X(2010)07-0010-02
各种原因导致的慢性肾功能衰竭发生率逐年增高,血透是目前治疗尿毒症病人的可靠方法之一,但是仍有许多并发症,如顽固性皮肤瘙痒等。目前公认为这些临床问题存在是尿毒症另一种主要致病物质一中分子物质所致。血液透析(Hemodialysis,HD)对其清除很少,血液灌流(Hemoperfusion,HP)是血液经体外循环,通过吸附装置,清除血中外源性或内源性毒物,达到血液净化的一种方法,本文旨在探讨液灌流(HP)器与血液透析(HD)器串联治疗尿毒症顽固性皮肤瘙痒的临床效果与护理。
1资料
2008年4月至2010年3月于我院血透中心接受HD治疗的发生皮肤瘙痒较为严重的患者22例,均为慢性尿毒症患者,且无严重并发症。患者随机分为串联组和对照组,串联组12例,其中男7 例、女5 例,年龄30 -80岁,平均55.0 岁,对照组10例,男6例,女4例,性别和年龄经统计学处理无明显差异,出现瘙痒症状最短持续时间6个月,最长54个月。
2方法
2.1材料:血液透析采用德国费森尤斯公司4008B型血透机,透析器为三醋酸纤维膜,串联组所用灌流器采用珠海丽珠集团丽珠医用生物材料厂生产的HA型130树酯灌流器,透析液为碳酸氢 盐透析液。
2.2串联组治疗时将灌流器与透析器垂直固定在透析机支架上,灌流器串在透析器之前,以免治疗中经透析器脱水后,血液浓缩,使血液阻力增大,致灌流器凝血[1]。血流量200 ml/min,透析液流量500 ml/min。 先用5%葡萄糖注射液500 ml在灌流器内分布均匀,树酯颗粒吸湿后膨胀,轻轻敲打,帮助空气排除,然后,用2 000 ml氯化钠肝素注射液(每500 ml 0.9%氯化钠注射液内加20 mg肝素),以200 ml/min流量冲洗,用手轻拍和转动灌流器及透析器,以排除气泡并除去微粒。使全部血路管、灌流器及透析器均充满液体,并闭路循环20 min即可上机。肝素用量因人而易,有出血倾向者用低分子肝素,无出血倾向者肝素首剂用量25 mg静脉推注,追加肝素5 mg/h,并根据患者具体情况增减肝素用量。先灌流、透析2 h,达到饱和后取下灌流器,再继续透析2.5 h,共治疗4.5h。治疗前后观察其皮肤瘙痒情况并询问其睡眠情况。, 百拇医药(宋 娜)
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