糖尿病肾病患者血透护理中不同置管部位的连接方式对其血糖值的影响

摘要

目的 探讨糖尿病肾病患者血透护理中不同置管部位的连接方式对其血糖值的影响.方法 选取2010年5月至2012年6月行血液透析的糖尿病肾病患者125例,根据其置管情况分为A组(长期颈内静脉置管)42例、B组(临时颈内静脉置管)42例和C组(临时股静脉置管)41例,采用自身对照法进行研究,正向连接与反向连接以血液透析患者导管动静脉端及血管通路的动静脉端连接方式来确定,每位患者均进行正接和反接各一次.透析2h后于患者手指端及体外环管动脉端采血检测血糖.结果 三组患者正向连接血透时,其手指端和动脉端所测的血糖值比较,差异无统计学意义(P＞0.05),在反向连接血透中,C组动脉端所测的血糖值仅为(5.26±2.68) mmol/L,显著低于手指端的(8.12±3.15) mmol/L (P＜0.01).在置管感染方面,三组置管感染率比较差异有统计学意义(P＜0.01),其中以C组最高,为29.27％,A组次之,B组最低.结论 在糖尿病肾病患者血透护理中,无论是正向连接还是反向连接,长期颈内静脉置管和临时颈内静脉置管所测的血糖值准确性较高,但在安全性方面却以临时颈内静脉置管最高.而在临时股静脉置管反向连接时,应从患者体外环管动脉端进行采血才能获得准确的血糖值.%Objective To explore the influence of the different connection methods of dialysis tubes on the level of blood glucose in patients with diabetic nephropathy.Methods 125 patients with diabetic nephropathy undergoing hemodialysis from May,2010 to June,2012 were selected.According to the connection methods of dialysis tubes,the patients were divided into group A (n=42;long-term internal jugular vein catheter),group B (n=42;temporary internal jugular vein catheter),and group C (n=41;temporary shares venipuncture).Self-contrast method was used for the study.Usingpositive or reverse connectionwas determinedby the connection way of hemodialysis catheter's arteriovenous end and arteriovenous vascular access endin the patients.All the patients received a positive and a reverse connection.2 hours after hemodialysis,the blood from the finger and the external ring catheter of artery end was collected and then tested the level of glucose.Results Under positive connection hemodialysis,there were nostatistical differences in the level ofblood glucose of finger end and artery between thesethree groups(P ＞ 0.05);however,under reverse connection hemodialysis,the level of blood glucose of of artery was (5.26±2.68) mmol/L and that of finger end (8.12±3.15) mmol/L in group,with a statistical difference (P ＜ 0.01).There were statistical differences in catheter infection rates between thses three groups (P ＜ 0.01),with a highest of 29.27％ in group C,second in group A,and the lowest in group B.Conclusions Fornursing care in the hemodialysis for diabetic nephropathy,the accuracy of blood glucose level tested through both long-term andtemporary internal jugular vein catheterswhether positivelyor reversely connectedis high but the security is higher through the temporary.The blood glucose level is accurate only testing the blood from the artery end of external ring catheter when the catheter is reversely connected.