护理干预预防老年尿毒症患者透析中低血压

摘要

目的 通过观察对老年尿毒症患者血液透析中低血压的临床表现,发现血透中低血压的前期症状,探讨其发生相关因素并提出所采取的护理干预措施.方法 回顾我院于2007年1月～2010年12月期间的19例60岁以上老年病人,共接受血液透析5766次,对其中256例次低血压患者及366例次出现低血压前期症状患者的临床资料进行分析.总结其血透中发生低血压时伴随症状及前期症状,在低血压发生之前采用提前控制透析脱水速度,在透析过程中降低血液流量,提高钠浓度,降低透析液温度,静脉推注高渗葡萄糖等预防和治疗透析中低血压.结果 本组5766例次血液透析,256例次在透析中出现低血压,并有头晕、恶心、呕吐、大汗淋漓、抽搐等伴随症状.经及时治疗处理后241例次低血压病人血压恢复正常,继续完成血液透析,未出现其他严重并发症；15例次被迫中断透析,其中两例经抢救无效死亡.同时发现366例在血液透析过程中出现不同程度的打哈欠、腰背酸困、视物模糊、胸闷、心悸等前期症状,给予提前实施相应的护理干预,继续发生低血压的仅79例,给予进一步处理后血压均能回复正常,并能完成血液透析.结论 老年尿毒症患者生理调节机能较差,在血液透析过程中较容易出现低血压.加强高龄尿毒症患者在透析过程中护理巡查,及时发现低血压,并快速有效地对症处理,是纠正低血压的关键.提前实施多层次全方位的护理干预,能够有效预防透析中低血压的发生.%Objective By observing the clinical manifestations of Low blood pressure elderly patients who suffer from the uremia during hemodialysis ( HD ),to find early symptoms of hypotension during the process and discuss the related factors of occurring hypotension and take some nursing care intervention measures.Methods Review the 19 cases of 60 years or older patients from January 2007 to December 2010 who were undergoing HD 5766 times together,Analyzed the patient's clinical data,including 256 times low blood pressure cases and 366 times appearing before the aura symptoms of low blood pressure cases.Make dialysis dehydration speed control before hypotension happened.Through reducing blood flow,improving sodium concentration,reducing dialysate temperature and injection of high permeability glucose into the veins etc,prevented and treated the dialysis hypotension.Results For those aged 60 HD patients were more than 5766 times,256 times appeared in dialysis hypotension and had dizziness,nausea,vomiting,sweating,convulsions,etc.,with symptoms and after the prompt treatment the 241 times blood pressure returned to normal and continue to finished HD,did not appear any other serious complications;15 times were forced to interrupt the dialysis,including two cases of death disables via rescue.and 366 times found in the blood dialysis appeared in the process different degrees of yawning,waist sour trapped,inspect content faintness,bosom frowsty,palpitations,etc early symptoms and give implement the corresponding nursing intervention in advance,continue to happen only 79 cases had lower blood pressure and give further processed were to return to normal blood pressure and completed HD.Conclusions Elderly uremic patients' physical adjustment function is poorer and hypotension more easily happened in HD process.Strengthen uremic patients age in dialysis process patrolled the timely discovery hypotension nursing rapidly and effectively received alimta is the key to correct hypotension.The implementation of multi-level and all-round ahead of the nursing intervention can effectively prevent hypotension happened in HD.