静脉血液透析滤过治疗严重脓毒症患者的护理探讨
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摘要
目的探讨严重脓毒症患者应用静脉血液透析滤过治疗的临床护理效果。方法研究对象为我院2014年9月～2017年10月收治的146例静脉血液透析滤过治疗法严重脓毒症患者,所有患者均符合严重脓毒症的诊断标准,将患者随机分为研究组(n=73)和对照组(n=73),两组脓毒症患者均选择静脉血液透析滤过治疗,对照组的73例患者接受常规护理,研究组的73例患者接受针对性护理干预,比较两组患者的医院焦虑抑郁情绪测量表(HAD量表)评分,临床指标(血红蛋白、CVP、MPAP、PCWP)以及满意率。结果研究组患者护理后抑郁评分、焦虑评分分别为(29.66±1.74)分、(39.25±1.28)分,明显低于对照组的护理后的(49.36±2.25)分、(56.25±3.54)分;研究组患者护理后的血红蛋白、CVP、MPAP、PCWP分别为(114.9±3.3)g/L、(11.2±0.8)mmHg、(18.3±0.9)mmHg、(8.6±0.6)mm Hg优于对照组的(103.3±1.8)g/L、(11.6±1.3)mmHg、(25.6±1.8)mmHg、(13.6±0.7)mmHg;研究组患者护理后其不良事件发生率为12.33%,明显低于对照组的42.47%。此外,研究组的满意率明显高于对照组。结论针对严重脓毒症患者静脉血液透析滤过治疗后采用针对性护理干预可以起到较好的效果,降低不良反应的发生率,改善患者的焦虑和抑郁情绪,提高患者的满意率。
Objective To investigate the clinical nursing effect of venous hemodiafiltration in patients with severe sepsis.Methods 146 patients with severe sepsis treated with venous hemodiafiltration in our hospital from September 2014 to October 2017 were enrolled. All patients met the diagnostic criteria for severe sepsis and were randomly divided into study group(n=73) and control group(n=73). Venous hemodiafiltration treatment was selected in both groups of sepsis patients.73 patients in the control group received routine care, and 73 patients in the study group were treated with targeted nursing intervention. The hospital anxiety and depression measures( HAD scale) scores, clinical indicators(hemoglobin, CVP, MPAP, PCWP) and satisfaction rates between two groups were compared. Results The post-nursing depression score and anxiety score of the study group were(29.66±1.74) and(39.25±1.28), which were significantly lower than(49.36±2.25) and(56.25±3.54) of the control group. After nursing, the hemoglobin, CVP, MPAP, and PCWP of the study group were(114.9±3.3) g/L,(11.2±0.8) mmHg,(18.3±0.9) mmHg, and(8.6±0.6) mmHg, respectively, which were superior to(103.3±1.8) g/L,(11.6±1.3) mmHg,(25.6±1.8) mmHg,(13.6±0.7) mmHg in the control group. The incidence of adverse events in the study group was 12.33%, significantly lower than that in the control group(42.47%). In addition,the satisfaction rate of the study group was significantly higher than that of the control group. Conclusion Targeted nursing intervention for patients with severe sepsis after venous hemodiafiltration can achieve good results, reduce the incidence of adverse reactions, improve patients' anxiety and depression, and improve patient satisfaction rate.
Objective To investigate the clinical nursing effect of venous hemodiafiltration in patients with severe sepsis.Methods 146 patients with severe sepsis treated with venous hemodiafiltration in our hospital from September 2014 to October 2017 were enrolled. All patients met the diagnostic criteria for severe sepsis and were randomly divided into study group(n=73) and control group(n=73). Venous hemodiafiltration treatment was selected in both groups of sepsis patients.73 patients in the control group received routine care, and 73 patients in the study group were treated with targeted nursing intervention. The hospital anxiety and depression measures( HAD scale) scores, clinical indicators(hemoglobin, CVP, MPAP, PCWP) and satisfaction rates between two groups were compared. Results The post-nursing depression score and anxiety score of the study group were(29.66±1.74) and(39.25±1.28), which were significantly lower than(49.36±2.25) and(56.25±3.54) of the control group. After nursing, the hemoglobin, CVP, MPAP, and PCWP of the study group were(114.9±3.3) g/L,(11.2±0.8) mmHg,(18.3±0.9) mmHg, and(8.6±0.6) mmHg, respectively, which were superior to(103.3±1.8) g/L,(11.6±1.3) mmHg,(25.6±1.8) mmHg,(13.6±0.7) mmHg in the control group. The incidence of adverse events in the study group was 12.33%, significantly lower than that in the control group(42.47%). In addition,the satisfaction rate of the study group was significantly higher than that of the control group. Conclusion Targeted nursing intervention for patients with severe sepsis after venous hemodiafiltration can achieve good results, reduce the incidence of adverse reactions, improve patients' anxiety and depression, and improve patient satisfaction rate.
引文
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[8]金海姣,方炜,卞正乾,等.自动化腹膜透析在腹膜透析患者腹壁疝修补术后过渡期透析中的应用[J].中国血液净化,2015,9(9):521-524.
[9]唐芳,张波,沈俊.维持性血液透析对患者血清降钙素原、白细胞介素-6及超敏C反应蛋白的影响[J].贵州医科大学学报,2018,(4):478-481.
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[16]张汀,王艳,阿胜,陈孟华.日间静静脉血液透析滤过在脓毒血症合并急性肾损伤的应用[J].中国血液净化,2016,10(11):606-609.
[17]李婉婉.协同心理护理程序在肿瘤化疗病人护理中的应用效果[J].糖尿病天地,2018,15(4):98.
[18]王连竹.人性化护理对提高急诊患者护理满意度的效果评价[J].中国实用护理杂志,2011,27(36):40-41.
[19]闫柏令.心理护理在整体护理工作中的重要性[J].国际护理学杂志,2010,29(8):1233-1234.
[20]陈闪.社会支持干预对维持性血液透析患者生活质量的影响[J].齐鲁护理杂志,2018,24(1):73-75.
[2]柏林.高通量血液透析联合左卡尼汀治疗尿毒症心肌病的临床研究[J].中国医学创新,2017,14(26):52-55.
[3]高戈,冯拮,常志刚,等.2012国际严重脓毒症及脓毒性休克诊疗指南[J].中华危重病急救医学,2013,25(8):501-505.
[4]李雪婷,王蕊花.局部枸橼酸抗凝在连续性肾脏替代治疗中的应用[J].世界最新医学信息文摘,2018,(28):103-105.
[5]杨宁.血液净化对热稀释法测量脓毒性休克患者血流动力学参数准确性的影响[J].临床医药文献电子杂志,2017,4(16):3162.
[6]曾庆煌.血液透析治疗全身炎症反应综合征并发中毒性脑病预后影响的研究[J].白求恩医学杂志,2016,14(6):726-728.
[7]张秀安.血液透析患者导管相关性血流感染危险因素的临床研究[D].福建医科大学,2017.
[8]金海姣,方炜,卞正乾,等.自动化腹膜透析在腹膜透析患者腹壁疝修补术后过渡期透析中的应用[J].中国血液净化,2015,9(9):521-524.
[9]唐芳,张波,沈俊.维持性血液透析对患者血清降钙素原、白细胞介素-6及超敏C反应蛋白的影响[J].贵州医科大学学报,2018,(4):478-481.
[10]刘红艳.连续性血液透析滤过对多器官功能障碍犬血浆炎性相关介质的影响[D].新疆医科大学,2017.
[11]刘曾华.连续性血液透析滤过对多器官功能障碍犬细胞因子的影响[D].新疆医科大学,2017.
[12]姚建辉,李卫民.体外循环血液净化新技术治疗急危重症患者的研究进展[J].医学综述,2017,19(20):3720-3722.
[13]陆煜.连续低效每日血液透析滤过联合血液灌流治疗脓毒血症并急性肾损伤的疗效观察[A].//中华医学会、中华医学会急诊医学分会.中华医学会急诊医学分会第十六次全国急诊医学学术年会论文集[C].中华医学会、中华医学会急诊医学分会:,2017,9(10):54-56.
[14]袁静.贵阳市维持血液净化患者病因构成及治疗现况调查[D].第三军医大学,2016.
[15]许烨,王会玲,陆石,等.血液透析患者蛋白质-能量消耗与内源性糖皮质激素水平和胰岛素抵抗的临床研究[J].中国血液净化,2017,11(10):548-551.
[16]张汀,王艳,阿胜,陈孟华.日间静静脉血液透析滤过在脓毒血症合并急性肾损伤的应用[J].中国血液净化,2016,10(11):606-609.
[17]李婉婉.协同心理护理程序在肿瘤化疗病人护理中的应用效果[J].糖尿病天地,2018,15(4):98.
[18]王连竹.人性化护理对提高急诊患者护理满意度的效果评价[J].中国实用护理杂志,2011,27(36):40-41.
[19]闫柏令.心理护理在整体护理工作中的重要性[J].国际护理学杂志,2010,29(8):1233-1234.
[20]陈闪.社会支持干预对维持性血液透析患者生活质量的影响[J].齐鲁护理杂志,2018,24(1):73-75.