临床路径预防老年冠心病患者造影剂肾病的临床观察与护理

摘要

Objective To study the effect of comprehensive nursing intervention and clinical pathway of nursing on preventing contrast induced nephropathy by hydration treatment in elderly patients with CAD to improve the patients’compliance. Methods 60 elderly patients with CAD aged more than 65 from January to December 2013 were enrolled and treated with comprehensive nursing intervention of hydration treatment by clinical pathway of nursing before and after coronary arteriography and CTA, respectively. The hydration treatment compliance were observed. Results Creati-nine clearance rate of 60 patients was significant reduced and renal function was damaged within 48 h after contrast administration (P<0.05). Renal function was recovered obviously at 5 days compared within 48 h afer contrast admin-istration (P< 0.05), but it was not as good as baseline. All patients received hydration treatment and the compliance rate was up to 100%. Conclusion Comprehensive nursing intervention in hydration treatment by clinical pathway of nursing can improve patients’compliance to hydration treatment, which is helpful for prevention and treatment of con-trast induced nephropathy.%目的：探讨以临床路径的工作模式实施综合性护理干预在水化治疗预防造影剂肾病中的作用，以提高老年冠心病患者水化治疗的依从性。方法将2013年1~12月住院行冠状动脉造影、冠状动脉CT成像检查介入诊疗的≥65岁冠心病患者60例均纳入研究对象，以临床路径的工作模式在水化治疗中实施综合性护理干预。观察患者水化治疗的依从性。结果60例患者，在应用造影剂后48 h，患者肾功能明显受损，肌酐清除率下降，差异有统计学意义(P<0.05)。造影后5 d肾功能较48 h明显恢复(P<0.05)，但仍未达到造影前水平。全部患者按要求完成水化治疗，患者的依从性为100%。结论按临床路径实施综合性护理干预落实水化治疗方案，提高了患者水化治疗的依从性，有助于防治造影剂肾病。