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尿毒症患者肾移植术前充分透析是提高术后存活率的一个重要环节。笔者总结我院血液净化中心从 1999年 8月~ 2 0 0 1年 8月同种异体肾移植术前行血液净化患者 32例 ,其中 30例行碳酸氢盐血液透析 (BHD) ,2例行持续性不卧床腹膜透析 (CAPD) ,兹就护理体会报告如下。资料与方法本组 32例 ,男 2 5例 ,女 7例 ;年龄 2 0岁~ 6 5岁 ,病程 3个月~ 6年。术前尿毒症患者行BHD ,部分行血液透析滤过 (HDF) ,采用德国Fresenius - 2 0 0 8C、2 0 0 8D、4 0 0 8B、4 0 0 8S容量控制型血透机 ,聚矾膜透析器 (F6 ) ,面积为 1.3… 相似文献
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目的:探讨连续性血液净化治疗在老年危重患者中的护理要点。方法:采用回顾性分析对河北联合大学附属医院2010年1月~2012年3月对60岁以上老年危重患者进行床旁连续性血液净化治疗中出现的护理问题及监测指标等,初步总结其护理要点。结果:护理的重点包括心理护理、舒适护理、管道护理、生命体征的观察、液体平衡和生化监测。结论:注重患者的心理护理、舒适护理、安全护理,保持血管路通畅,根据凝血现象调整抗凝剂用量,监测血糖、电解质和生命体征是成功、安全进行连续性血液净化治疗的保证。 相似文献
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连续性血液净化的护理体会 总被引:4,自引:0,他引:4
周小青 《中国中西医结合肾病杂志》2005,6(5):294-295
多脏器功能障碍综合征(MODS)是严重创伤、严重感染、外科大手术、病理产科等原发病发生后,同时或序贯出现两个或两个以上系统器官的功能不全或衰竭的临床综合征.继往报道其死亡率高达62.5%~85.0%[1].为了提高MODS的抢救成功率,本院自2002年1月~2004年8月对31例MODS患者应用连续性血液净化治疗(CBP),取得了较满意的疗效,现将护理体会报道如下. 相似文献
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中心静脉压在连续性血液净化治疗脓毒症护理中的意义 总被引:1,自引:1,他引:0
目的探讨中心静脉压(CVP)在连续性血液净化(CBP)治疗的脓毒症患者护理中的意义。方法选择脓毒症休克液体复苏后CVP20cmH2O的患者16例,均接受正压机械通气和CBP治疗。试验初CBP净超量为8ml/(kg.h),之后逐渐增加净超量使患者CVP在8h内降至目标值12cmH2O,期间CVP每下降1cmH2O,调节净超量为零,稳定约5min,观察CVP、平均动脉压(MAP)、心率(HR)和心指数(CI)的变化。两次测量的间隔时间不超过1h。CVP达12cmH2O终止试验。结果 CBP的净超量达到18ml/kg时CVP较前明显降低(P0.01);净超量为25ml/kg时,CI达到最大值,此时CVP降至(15.52±2.06)cmH2O;净超量≥18ml/kg时,CVP与净超量呈显著负相关(P0.01)。结论 CVP仅在一定范围内能够反映容量状态,护理的要点在于CVP结合CI准确判断患者的容量状况,并据此进行超滤量的调节,以维持患者的最佳容量负荷。 相似文献
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高素芳 《中国中西医结合肾病杂志》2001,2(3):175-176
基层医院就诊病人中 ,属中毒者时有发生 ,随着医疗技术的不断发展 ,我院近年来开展了血液净化抢救、治疗中毒的新技术 ,收到了良好的效果。本文拟对我院近 2年来采用血液净化技术抢救治疗中毒病人的治疗与护理体会总结如下。临床资料 1 病例 1998年 1月~ 2 0 0 0年 9月在本院住院并经血液净化技术抢救、治疗的中毒病人共 42例 ,其中男性 16例 ,女性 2 6例 ;年龄最大 70岁 ,最小 2 1岁 ,平均年龄 41 90岁。中毒途径 :均为口服中毒 ;中毒原因 :均为服毒自杀 ,其中有机磷农药中毒 2 6例 ,非有机磷农药中毒 4例 ,镇静安眠药中毒 6例 ,其… 相似文献
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急性中毒的血液净化治疗 总被引:1,自引:0,他引:1
急性中毒多系药物或毒物所致,是临床上多见的急危重症,急性中毒(以下简称中毒)患者的治疗包括:阻止毒物的吸收、促进毒物的排泄以及拮抗毒物的毒性。1955年血液净化技术首次成功地用于抢救阿斯匹林中毒患者。20世纪70年代首次使用被包裹的活性碳行血液灌流。在当前应用于中毒的血液净化治疗除血液透析外还有:血液滤过、血液灌流、连续血液净化、血浆置换、腹膜透析。血液净化对中毒患者的治疗作用包括:清除毒物,减少毒性;维持及替代重要脏器功能,特别是肾脏功能;维持内环境平衡。[第一段] 相似文献
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血液净化患者中心静脉置管常见并发症护理 总被引:3,自引:0,他引:3
血液净化需要把患者的血液引出体外,经过血路管动脉侧进入透析器后再通过血路管的静脉侧回到体内,该通路称为血液通路或血管通路。建立有效的血管通路是血液净化得以顺利进行的前提。按血管通路的使用时间,将血管通路分为临时性和长期性两种类型。临时性血管通路包括动、静脉直接穿刺,动静脉外瘘及中心静脉置管。由于动静脉直接穿刺和动静脉外瘘的并发症较多,对血管直接损伤,对心脏功能也有影响,目前较少采用,而中心静脉置管应用广泛。1临床资料1.1一般资料:中心静脉置管常用的部位有股静脉、锁骨下静脉及颈内静脉,我院1996~2005年对100例中… 相似文献
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《Liver transplantation》2000,6(5):603-613
Liver failure associated with excretory insufficiency and jaundice results in an endogenous accumulation of toxins involved in the impairment of cardiovascular, kidney, and cerebral function. Moreover, these toxins have been shown to damage the liver itself by inducing hepatocellular apoptosis and necrosis, thus creating a vicious cycle of the disease. We report a retrospective cohort study of 26 patients with acute or chronic liver failure with intrahepatic cholestasis (bilirubin level > 20 mg/dL) who underwent a new extracorporeal blood purification treatment. A synthetic hydrophilic/hydrophobic domain-presenting semipermeable membrane (pore size < albumin size, 100-nm thick) was used for extracorporeal blood detoxification using dialysis equipment. The opposite side was rinsed with ligandin-like proteins as molecular adsorbents that were regenerated online using a chromatography-like recycling system (molecular adsorbent recirculating system [MARS]). Bile acid and bilirubin levels, representing the previously described toxins, were reduced by 16% to 53% and 10% to 90% of the initial concentration by a single treatment of 6 to 8 hours, respectively. Toxicity testing of patient plasma onto primary rat hepatocytes by live/dead fluorescence microscopy showed cell-damaging effects of jaundiced plasma that were not observed after treatment. Patients with a worsening of Child-Turcotte-Pugh (CTP) index before the treatments showed a significant improvement of this index during a period of 2 to 14 single treatments with an average of 14 days. After withdrawal of MARS treatment, this improvement was sustained in all long-term survivors. Ten patients represented a clinical status equivalent to the United Network for Organ Sharing (UNOS) status 2b (group A1), and all survived. Sixteen patients represented a clinical status equivalent to UNOS status 2a, and 7 of these patients survived (group A2), whereas 9 patients (group B) died. We conclude that in acute excretory failure caused by a chronic liver disease, this treatment provides a therapy option to remove toxins involved in multiorgan dysfunction secondary to liver failure. (Liver Transpl 2000;6:603-613.) 相似文献
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血液净化患者行颈内静脉导管术的护理 总被引:10,自引:3,他引:7
目的探讨血液净化患者行颈内静脉导管术的护理方法.方法对80例血液净化颈内静脉导管术采用Seldinger法由颈内静脉插管患者,采用心理护理、预防感染、保证有效透析、预防各种并发症等护理措施.结果 80例次均插管成功,血流量在200 ml/min以上,留置时间为7 d至3个月,平均41.0 d.12例留置导管平均8.0 d出现栓塞,更换导管并封存低分子肝素后,拔管时未再出现导管栓塞情况.结论颈内静脉是较佳的临时血管通路,导管封存低分子肝素对留置时间具有较大的临床意义,科学的护理在颈内静脉导管术中起到重要作用. 相似文献
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对25例急性呼吸窘迫综合征(ARDS)患者在积极治疗原发病、机械通气、抗感染、激素治疗及营养支持的基础上予以连续性血液滤过(CVVH)治疗。结果存活16例,其中10例痊愈出院,6例好转转出ICU;存活者心率、血压、血气分析均较治疗前显著好转(均P〈0.05)。因原发病极其严重。并存多个脏器衰竭不能逆转而死亡7例;放弃治疗2例。提示在常规治疗的基础上应用CVVH治疗,可有效改善患者的临床症状,提高ARDS的治疗效果。做好CVVH监测与护理,包括保持血管路通畅、保证抗凝效果、及时处理低动脉压报警,严密观察病情,预防感染,加强营养支持,才能保证治疗效果。 相似文献
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连续性血液滤过治疗急性呼吸窘迫综合征患者的护理 总被引:5,自引:2,他引:3
对25例急性呼吸窘迫综合征(ARDS)患者在积极治疗原发病、机械通气、抗感染、激素治疗及营养支持的基础上予以连续性血液滤过(CVVH)治疗.结果 存活16倒,其中10例痊愈出院,6例好转转出ICU;存活者心率、血压、血气分析均较治疗前显著好转(均P<0.05).因原发病极其严重,并存多个脏器衰竭不能逆转而死亡7例;放弃治疗2例.提示在常规治疗的基础上应用CVVH治疗,可有效改善患者的临床症状,提高ARDS的治疗效果.做好CVVH监测与护理,包括保持血管路通畅、保证抗凝效果、及时处理低动脉压报警,严密观察病情,预防感染,加强营养支持,才能保证治疗效果. 相似文献
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James M. Courtney Sumuk Sundaram Nina M.K. Lamba Charles D. Forbes 《Artificial organs》1993,17(4):260-266
Abstract: A principal objective of monitoring the blood response in procedures such as hemodialysis and cardiopulmonary bypass is to achieve an enhanced understanding of the relationship between blood component alterations and the biomaterials employed. The aim in a study of blood-biomaterial interactions of deriving a correlation between a characteristic of the biomaterial and a representative parameter of the blood response can be influenced in a clinical situation by antithrombotic agents, multimaterial contact, device utilization, blood condition, drug therapy, and the nature of the application. The selection of parameters representative of the blood response may require a compromise between the advantages of multiparameter assessment and the benefit of measuring a single parameter by a consistent methodology. Representative parameters are protein adsorption, platelet reactions, intrinsic coagulation and the contact activation phase, fibrinolysis, leukocyte alterations, and complement activation. Assessment during clinical application can be approached by consideration of blood response patterns. 相似文献
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Maria Grazia Calabr Daniela Febres Gaia Recca Rosalba Lembo Evgeny Fominskiy Anna Mara Scandroglio Alberto Zangrillo Federico Pappalardo 《Artificial organs》2019,43(2):189-194
The CytoSorb adsorber, a blood purification therapy, is able to remove molecules in the 5–60 kDa range which comprises the majority of inflammatory mediators and some endogenous molecules. We aimed to evaluate CytoSorb therapy on clinical outcomes in critically ill patients. A retrospective case series study, from February 2016 to May 2017, was performed in 40 patients with multiple organ failure who received CytoSorb treatment. There were 28 patients with cardiogenic shock, 2 with septic shock, 9 with acute respiratory distress syndrome, and 1 with liver failure. Nineteen patients (47%) underwent extracorporeal membrane oxygenation, 11 (27%) had an intra‐aortic balloon pump, 9 (22%) were implanted with Impella, 6 (15%) had a ventricular assist device, and 18 (45%) were treated with continuous veno‐venous hemofiltration. After CytoSorb treatment, total bilirubin decreased from 11.6 ± 9.2 to 6.8 ± 5.1 mg/dL (P = 0.005), lactate from 12.1 ± 8.7 to 2.9 ± 2.5 mmol/L (P < 0.001), CPK from 2416 (670–8615) to 281 (44–2769) U/L (P < 0.001) and LDH from 1230 (860–3157) to 787 (536–1148) U/L (P < 0.001). The vasoactive‐inotropic score after 48 h of treatment was reduced to 10 points, P = 0.009. Thirty‐day mortality was 55% and ICU mortality was 52.5% at expected ICU mortality of 80%. Our study shows that CytoSorbTM treatment is effective in reducing bilirubin, lactate, CPK and LDH, in critically ill patients mainly due to cardiogenic shock. There is a need for randomized controlled trials to conclude on the potential benefits blood purification with CytoSorb in critically ill patients. 相似文献