老年急性肾损伤患者床边间歇性血液透析的护理研究

摘要

目的 总结床边间歇性血液透析(IHD)治疗老年急性肾损伤(AKI)患者的护理经验.方法 行床边IHD的老年AKI患者60例,平均年龄(64.4±6.2)岁.比较患者IHD治疗前后APACHE III评分、24h尿量、脉搏血氧饱和度(SpO2)、中心静脉压(CVP)、血清肌酐(SCr)、血清氮末端-前体脑钠肽(NT-proBNP)的变化及IHD过程中并发症的发生率.结果 60例患者院内存活23例(38.3%).生存患者经床边IHD治疗后APACHE III评分、CVP、SCr及NT-proBNP显著降低(P<0.01),24h尿量显著增多(P<0.01),SpO2显著升高(P<0.01).IHD过程中心血管系统并发症包括血压异常、急性左心衰竭和心律失常的发生率最高(50.95%).结论 床边IHD可以显著改善老年AKI患者的临床预后.床边透析专科护士必须具备一定的心血管内科专科知识,透析前根据病情制定个体化的透析护理方案.%　　Objective To summarize the nursing experience of bedside intermittent hemodialysis (IHD) for acute kidney injury (AKI) in old patients. Methods Sixty patients whose average age was (64.4±6.2) years old were treated with bedside IHD for AKI. APACHE III score, 24h urine volume and the levels of pulse oxygen saturation (SpO2), central venous pressure (CVP), serum creatinine(SCr), amino-terminal pro-B-type natriuretic peptide (NT-proBNP) before and after IHD were analyzed in patients. The incidence of complications during IHD was also recorded. Results Twenty-three patients survived in hospital. After bedside IHD, the survival patients had a greater reduction of APACHE III score and the levels of CVP, SCr and NT-proBNP (P<0.01), higher 24h urine volume and SpO2 (P<0.01).  Cardiovascular complications including abnormal blood pressure, acute left heart failure and arrhythmias had the highest complication incidence (50.95%) during bedside IHD. Conclusion Bedside IHD can improve the prognosis of old patients with AKI. The specialized nurses in charge of bedside IHD must have essential knowledge on cardiology. Individual nursing program must be made before IHD according to the patient's condition.