连续性静脉-静脉血液滤过治疗儿童危重症的护理体会及相关并发症防范措施
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摘要
目的分析连续性静脉-静脉血液滤过治疗儿童危重症的护理体会及相关并发症防范措施。方法选取2017-06至2018-06在泉州市儿童医院·妇幼保健院重症医学科诊治的危重患儿56例,对其资料进行回顾性分析,所有患儿均行连续性静脉-静脉血液滤过治疗,总结护理体会,分析并发症发生原因并提出防范措施。结果 (1)56例患儿中肾衰竭所占比例最大,所有患儿平均住院天数为(13.53±4.12)d,好转出院48例,家属放弃治疗死亡8例,所有患儿中无并发症所致死亡病例的发生。(2)本次研究56例患儿中常见并发症为血糖升高、体温下降、血压下降等。结论随着血液净化技术的不断完善和发展,连续性静脉-静脉血液滤过在危重患儿应用中广泛开展,治疗中密切观测患儿病情变化、及时防止并发症,可提高救治机会。
Objective The objective of this study was to analyze the nursing experience of continuous veno-venous hemofiltration in the treatment of children with critical illness and the preventive measures for related complications. Methods A total of 56 critically ill children from June 2017 to June 2018 in the department of critical care medicine, Quanzhou Women's and Children's Hospital were selected. The data were analyzed retrospectively. All children were treated with continuous veno-venous hemofiltration. Nursing measures were summarized, the causes of complications were analyzed and preventive measures were put forward. Results(1) Renal failure accounted for the largest proportion of 56 children. The average length of hospitalization was(13.53±4.12) days for all children, 48 patients were discharged from hospital for improvement, and 8 children died of family members' abandoning the treatment. There was no mortality due to complications occurred in all children.(2) The common complications of 56 children in this study were elevated blood sugar, hypothermia and decreased blood pressure. Conclusions With the continuous improvement and development of blood purification technology, continuous veno-venous hemofiltration is widely used in critically ill children. Close observation of children's condition changes and timely prevention of complications during treatment can improve the chances of treatment.
Objective The objective of this study was to analyze the nursing experience of continuous veno-venous hemofiltration in the treatment of children with critical illness and the preventive measures for related complications. Methods A total of 56 critically ill children from June 2017 to June 2018 in the department of critical care medicine, Quanzhou Women's and Children's Hospital were selected. The data were analyzed retrospectively. All children were treated with continuous veno-venous hemofiltration. Nursing measures were summarized, the causes of complications were analyzed and preventive measures were put forward. Results(1) Renal failure accounted for the largest proportion of 56 children. The average length of hospitalization was(13.53±4.12) days for all children, 48 patients were discharged from hospital for improvement, and 8 children died of family members' abandoning the treatment. There was no mortality due to complications occurred in all children.(2) The common complications of 56 children in this study were elevated blood sugar, hypothermia and decreased blood pressure. Conclusions With the continuous improvement and development of blood purification technology, continuous veno-venous hemofiltration is widely used in critically ill children. Close observation of children's condition changes and timely prevention of complications during treatment can improve the chances of treatment.
引文
[1]中国医师协会儿科医师分会血液净化专业委员会.儿童血液灌流临床应用专家共识[J].中国小儿急救医学,2018,25(8):561-568. DOI:10.3760/cma.j.issn.1673-4912.2018.08.001.
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[13]陈克娇,陈清秀.严重脓毒症患儿行连续血液净化的护理[J].护士进修杂志,2017,32(7):636-638. DOI:10.16821/j.cnki.hsjx.2017.07.020.
[14]赵燕,朱利娟,汤增洁,等.早期保温护理干预减少儿童血液净化过程中低体温风险的效果研究[J].中国实用护理杂志,2016, 32(19):1480-1482. DOI:10.3760/cma.j.issn.1672-7088.2016.19.010.
[15]张文燕,朱笑笑,杨巾夏,等.充气式加温毯预防危重症患儿连续性血液净化中低体温的效果观察[J].护理实践与研究,2016,13(15):142-143. DOI:10.3969/j.issn.1672-9676.2016. 5.061.
[2]刘华,易著文.中国儿童血液净化的现状[J].临床儿科杂志,2013,31(3):291-294.DOI:10.3969/j.issn.1000-3606.2013.03.025.
[3]管向东,张晔.连续血液净化技术在重症医学科中的地位[J/OL].中华重症医学电子杂志(网络版),2017,3(1):2-4. DOI:103877/cma.j.issn.2096-1537.2017.01.002.
[4]何泳,张新,周焕,等.不同连续性肾脏替代治疗模式溶质清除和体外循环通路抗凝效果的比较[J].临床肾脏病杂志,2018,18(4):21-24. DOI:10.3969/j.issn.1671-2390.2018.04.004.
[5]乔小军.连续性静脉-静脉血液滤过与血液透析治疗肾衰竭合并左心衰竭病人的护理[J].护理研究,2017,31(12):1527-1529. DOI:10.3969/j.issn.1009-6493.2017.12.041.
[6]王莉.连续性血液净化中患者相关凝血风险及护理预防措施[J].血栓与止血学,2017,23(1):140-142.DOI:10.3969/j.issn.1009-6213.2017.01.046.
[7]杨雪,钱素云,祝益民,等.连续血液净化技术在中国儿童重症医学领域的普及情况调查[J].中华儿科杂志,2018,56(2):128-133. DOI:10.3760/cma.j.issn.0578-1310.2018.02.011.
[8]徐达良,朱亚凤,江家云,等.连续性血液净化治疗危重症患儿急性肾损伤的临床疗效及其机制研究[J].中国全科医学,2017,20(36):4501-4505. DOI:10.3969/j.issn.1007-9572.2017.00. 31.
[9]李军,张素芳,林霞,等.局部枸橼酸钠抗凝在高危出血倾向患儿连续血液净化中应用观察[J].中国实用儿科杂志,2016,31(12):933-936.DOI:cnki:sun:zsek.0.2016-12-018.
[10]王梅英,张月辉,邹世海,等.连续性血液净化对重型狼疮性肾炎合并急性肾损伤患者PYK2信号转导途径的影响[J].中国血液净化,2017,16(1):20-25. DOI:10.3969/j.issn.1671-4091.2017.01.006.
[11]李雷雷,陆国平.中国38家医院儿童重症医学科连续血液净化技术应用现况调查[J].中华儿科杂志,2014,52(3):201-204. DOI:10.3760/cma.j.issn.0578-1310.2014.03.008.
[12]高海涛,孙颖,齐玉凤,等.血液净化在婴幼儿重症治疗中的护理进展及展望[J].中国循证心血管医学杂志,2016,8(3):381-382. DOI:10.3969/j.issn.1674-4055.2016.03.40.
[13]陈克娇,陈清秀.严重脓毒症患儿行连续血液净化的护理[J].护士进修杂志,2017,32(7):636-638. DOI:10.16821/j.cnki.hsjx.2017.07.020.
[14]赵燕,朱利娟,汤增洁,等.早期保温护理干预减少儿童血液净化过程中低体温风险的效果研究[J].中国实用护理杂志,2016, 32(19):1480-1482. DOI:10.3760/cma.j.issn.1672-7088.2016.19.010.
[15]张文燕,朱笑笑,杨巾夏,等.充气式加温毯预防危重症患儿连续性血液净化中低体温的效果观察[J].护理实践与研究,2016,13(15):142-143. DOI:10.3969/j.issn.1672-9676.2016. 5.061.