血液净化论文文献

护理医学论文2000字

论文题目： 探讨留置导管的护理措施以降低其感染的发生

慢性肾衰竭发展到晚期形成尿毒症，为了维持生命，血液透析[1]成为最主要的诊疗手段。稳定可靠的血管通路是进行有效血液透析的重要前提条件。最理想的血液透析通路为动、静脉内 瘘 ，但很多患者由于周围血管条件的限制，无法行自体血管造 瘘 手术，而股静脉留置插管技术的应用可为肾衰患者在自身未建立动静脉内 瘘 前或动静脉内 瘘 建立失败后提供良好的血管通路，进行有效血液透析;如果股静脉留置导管在血液透析期间护理不当，会出现以导管感染为主的一系列并发症[1]。

1 资料与方法

1.1一般资料

采用随机数字表法将我院2007年3月至2010年3月期间收治的90例接受股静脉置管的患者分为两组，实验组45例，男性30例(66.67%)，女性15例(33.33%);年龄41～77岁，平均(59.1±18.7)岁，其中慢性肾炎18例，糖尿病肾病15例，痛风性肾病7例，高血压肾病5例;对照组45例，男性28例(62.22%)，女性17例(37.78%);年龄42～76岁，平均(58.8±17.5)岁，慢性肾炎20例，糖尿病肾病14例，痛风性肾病5例，高血压肾病6例。两组患者的性别、年龄、病因等临床资料比较差异无统计学意义(P>0.05)，具有可比性。

1.2 护理方法

1.2.1实验组护理方法

1.2.1.1置管前护理：由于患者及其家属对于置管操作了解较少，存在恐惧、紧张、担忧等心理，护理人员要平和耐心，每天和患者进行3-5次沟通交流，向患者说明病情，消除患者的紧张戒备心理，以乐观积极的心态对待治疗。

1.2.1.2 置管中护理：(1)安置患者于仰卧的体位，膝关节略微弯曲，垫高臀部，髋关节伸直并稍向外旋转;(2)保护患者的隐私部位;(3)插管时严格按照无菌要求操作，动作轻柔，尽量减少插管时间;(4)进行皮肤消毒时，应保证足够的消毒剂剂量及充足的消毒时间，对穿刺部位毛发较多患者应予以剪除而非剃除，备皮范围应>8cm，减少感染诱因。

1.2.1.3置管后护理：(1)工作人员戴无菌手套，消毒导管口，用20ml生理盐水冲洗导管，再注入导管容量等量的肝素封管液，然后拧紧消毒的肝素帽，导管口用无菌敷料包扎并妥善固定;(2)密切观察穿刺处皮肤有无红肿、出血等症状，一旦发现置管脱出有大出血状况时，要及时采取抢救措施;(3)嘱患者尽量注意休息，生活中避免抓挠穿刺处，大小便及翻身等的注意事项;(4)每天取下导管处敷料，用安儿碘消毒两次，每次消毒范围直径>5cm，注意保持敷料干燥、卫生;(5)换药时认真细心，严格遵守无菌操作规程，动作轻柔。

1.2.2对照组护理方法

对照组患者进行常规股静脉留置插管护理。

1.3疗效评价标准

导管感染判定标准：穿刺处红肿、疼痛;导管局部血培养与外周血培养出现相同细菌且数目远多于外周血培养的细菌数;每导管节段定量培养菌落记数>100cfu;患者出现发热、嗜睡、畏寒等症状。疗效判定标准：显效：血液透析顺畅，呼吸平稳、血压正常，患者无不良反应。有效：血液透析较为顺畅，呼吸不畅得到缓解、血压接近正常值。无效：患者股静脉留置导管脱落，呼吸急促，患者明显感到不适。

1.4 统计学方法

应用 SPSS l5.0软件分析，计量资料采用率表示，两组比较采用 t检验;P<0.05表示差异有统计学意义。

2、结果

2.1 患者的导管感染情况比较

两组患者经护理后对导管感染情况进行比较，实验组感染5例，感染率11.11%;对照组感染19例，感染率42.22%。经 t 检验，P<0.05表示差异具有统计学意义，具体结果见表1。

观察两组患者护理后的治疗效果，实验组39例患者精神气色明显好转，血液透析顺畅，血压等指标恢复在正常范围内，总有效率达到86.67%;对照组21例患者身体指标恢复正常范围，总有效率达到46.67%。经t检验，P<0.05表示差异具有统计学意义，股静脉留置导管在血液透析中护理效果显著。两组患者具体治疗效果见表2。

3.讨论

血液透析是重度肾功能不全患者维持生命的重要手段，而血液透析的'前提是具有良好的血管通路[2]，股静脉置管具有简便快捷的特点，且操作简单、迅速、安全，成功率高，并发症少、保留时间长，价格比人造血管便宜，透析效果也更好，因此股静脉置管被广泛应用于急性肾衰、慢性肾衰、内 瘘 成熟前、食物和药物中毒等血液透析的治疗。但留置导管也有一定的缺点，由于留置导管使用时间较长，导管感染几率于其使用时间呈正相关，降低导管感染成为留置导管护理的重要目标[3]。常规护理应用于周期相对较长的留置导管护理很难保证护理质量，致使导管感染几率较高，因此股静脉留置导管应进行针对感染诱因的重点护理，全面提高护理水平，力求降低导管感染率[3]。

综上所述，股静脉留置导管感染诱因较多，对股静脉置管患者进行针对感染诱因的重点护理可以有效降低导管感染几率，延长导管使用时间，减轻病人的痛苦，提高生存质量。

参考文献：

[1] 梅长林，叶朝阳，戎殳.实用透析手册[M].北京，人民卫生出版社.2009.53-59.

[2] 王磊.持续质量改进在预防维持性血液透析患者中心静脉导管相关感染中的应用[J].中国血液净化，2008，4 (4)：188

[3] 欧阳凌霞.血液透析导管相关感染[J].国外医学移植与血液净化分册，2005，5(3)：4-7.

[4] 程晓媚，周美珍.带涤纶环双腔导管在血液透析中使用的护理[J].浙江中西医结合杂志，2006，16(5)：329.

[5] 高同凤.股静脉留置插管的护理[J].现代护理，2003，9(11)：862.

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Introduction blood purification treatment Plasmapheresis is a separation, eliminate pathogens in patients with factor at the same time, health plasma and cellular components to lose in the method of treatment, to reduce the harmful substances on the human body, pathological damage to the plasma in various functional recovery factor , the regulation of the immune. Apply to hepatic coma, acute rejection after organ transplants, myasthenia gravis and crisis, rapidly progressive glomerulonephritis, autoimmune hemolytic anemia, rheumatism, thrombotic thrombocytopenic purpura, and other. Continuous renal replacement therapy is an effective clearance of acute renal failure in patients with excessive moisture, metabolic waste, and stability in the environment, improving the unstable hemodynamic conditions for a variety of treatment measures and the improvement of renal function protection is a variety of critically ill patients where necessary adjuvant therapy measures. Hemoperfusion artificial liver is used, plasma exchange, hemodiafiltration, molecular immunosorbent assay, and other methods of removal of bilirubin, endotoxin, maintaining sugar, fat and protein metabolism, such as balance, stability, complexity of the human body for the environment system. Serious infections, endotoxemia, severe gastrointestinal dysfunction, acute poisoning, severe peritonitis, severe pancreatitis, severe multiple trauma (severe liver injury), causing liver dysfunction or failure, artificial liver support system in the treatment of the majority will tide over their difficulties in gaining a new life. Specific adsorption bilirubin blood into the blood perfusion and adsorbent for full access, the use of bilirubin, the bile acid specific adsorption, removal due to liver failure resulting hyperbilirubinemia, mitigation condition , and create conditions for further treatment. ICU has advanced plasma exchange, bedside continuous hemofiltration, and liver dialysis equipment, with a professional physicians and nurses to choose suitable for patients with the blood purification treatment modalities, 24-hour continuous bedside monitoring, critically ill patients with organ function to provide strong support for the rescue and treatment can win time. 血液净化治疗简介 血浆置换 是一种分离、清除病人血浆中的致病因子，同时将健康血浆和细胞成分输回体内的治疗方法，能够减轻有害物质对人体的病理损害，有助于血浆中各种因子功能的恢复，调节免疫。适用于肝昏迷、器官移植后急性排异、重症肌无力及其危象、急进性肾小球肾炎、自身免疫性溶血性贫血、风湿病、血栓性血小板减少性紫癜等。 连续性肾功能替代治疗 是一种能够有效的清除急性肾功能衰竭患者体内过多的水分、代谢废物，稳定内环境，改善不稳定的血流动力学状况，为各种治疗措施和肾功能的改善提供保障，是多种危重病救治所必需的辅助治疗措施。 人工肝 是采用血液灌流、血浆置换、血液透析滤过、分子免疫吸附等多种方法组成的清除胆红素、内毒素、维持糖、脂肪、蛋白质等代谢平衡、稳定人体内环境的复杂治疗系统。严重感染、内毒素血症、重度胃肠功能紊乱、急性中毒、严重腹膜炎、重度胰腺炎、严重多发创伤(重度肝损伤)等造成的肝功能不全或衰竭，应用人工肝支持系统治疗可使多数患者度过难关，获得新生。 特异性胆红素吸附 将血液送入血液灌流器与吸附剂充分接触，利用对胆红素、胆汁酸的特异性吸附作用，清除由于肝功能衰竭而导致的高胆红素血症，缓解病情，为进一步治疗创造条件。重症监护病房拥有先进的血浆置换，床旁连续血液滤过、透析以及人工肝设备，配备有专业医师和护理人员，针对患者病情选择适宜的血液净化治疗模式，24小时不间断床旁监护，为危重症患者脏器功能提供有力的支持，为抢救和治疗赢得时间。Using food "purify" the blood Reduction of food "to remove free radicals in vivo. Radical oxidation processes in the human body is a by-product, it can damage the deoxy nucleic acid, collagen, destroy human tissue cells, a wrinkled, senile plaque, or even cause cancer, Alzheimer's and other disorders happen. to remove free radicals, should be more fresh food Reduction ", spinach, leeks, pumpkins, onions, Shizijiao, tomatoes, carrots and other vegetables, soybeans, walnuts, peanuts, pistachios, cashews, pine nuts, almonds, and other hard foods, and brown rice, and other Zhuganshang. Vegetable variety of fresh vegetables was weakly alkaline allows blood to Shen in the cell to the toxin dissolved, with the urine excreted. Such as carrot can accelerate the excretion of mercury, garlic helps cobalt emit. Green leaves and stem of the best vegetable juice drink without boiling speculation. Haicai rich in glial kelp, penetrated the human body to accelerate the release of radioactive material. Invasive from mung bean can help in the various toxins, including heavy metals and other hazardous substances, and promote the body's normal metabolism. Mushrooms can purify blood, excretion of toxic substances. Regular consumption in the environment can be clean. Pig blood plasma protein contains a lot of pig blood, after human digestive enzymes and acid decomposition, and the gastrointestinal tract dust, harmful metal particles, a chemical reaction, not easily absorbed into the waste was discharged. In addition, under normal circumstances, the human blood dominant slightly alkaline. If too many acidic ingredients, it will become a hotbed for various diseases. Fresh containing more than more basic ingredients and more food, in order to ensure the maintenance of blood Lue:pian alkaline normal conditions. 巧用食物“净化”血液 还原食物”可清除体内自由基。自由基是人体氧化过程中的副产品，它可损害脱氧核酸、胶原蛋白，破坏人体组织细胞，出现皱纹、老年斑，甚至引起癌症、老年痴呆等多种疾患的发生。要清除自由基，应多食还原食物”，菠菜、韭菜、南瓜、葱、柿子椒、番茄、胡萝卜等蔬菜，大豆、核桃、花生、开心果、腰果、松子、杏仁等硬壳类食物，以及糙米饭、猪肝汤等。 蔬菜 多种新鲜蔬菜可使血液呈弱碱性，让沉在细胞内的毒素重新溶解，随尿液排出体外。如胡萝卜可加速汞的排泄，大蒜则有助于钴的排出。绿叶根茎蔬菜最好榨汁饮用不经炒煮。海菜 含有丰富的海带胶质，可加快侵入人体内的放射性物质的排出。绿豆 能帮助排出侵入体内的各种毒物，包括各种重金属及其他有害物质，促进人体的正常代谢。蘑菇 能净化血液，排泄毒性物质。经常食用可净化体内环境。猪血 猪血含有大量血浆蛋白，经过人体胃酸和消化酶分解后，与侵入胃肠道的粉尘、有害金属微粒发生化学反应，变为不易吸收的废物而被排出。另外，正常情况下，人体血液中碱性略占优势。如果酸性成分过多，就会成为多种疾病的温床。多食以上含碱性成分多的食品，以保证血液维持在略偏碱性的正常状态。