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find Author "秦敏" 16 results
  • 连续性血液净化治疗蜂蜇伤致急性肾功能衰竭的临床观察与护理体会

    目的:观察连续性血液净化(CBP)治疗蜂蜇伤致急性肾功能衰竭(ARF)的疗效分析及护理体会。方法:回顾2005~2007 年蜂蜇伤致急性肾功能衰竭17例,采用连续性静静脉血液滤过(CVVH)方式进行治疗,从存活率、治愈率及肾功能恢复时间等多个方面比较CVVH治疗蜂蜇伤致肾功能衰竭是否具有优越性,从护理角度总结CVVH过程中护理的经验和作用。结果:患者治疗前APACHE评分差异无统计学意义。(1)CVVH:17 例患者早期行持续性静静脉血液滤过,CVVH治疗1~4次,总治疗时间(38.6±14.8)h,情况稳定后给予间歇性血液透析(间歇性血液透析)治疗。16例患者好转出院,1例患者死亡。⑵在CVVH治疗过程中严密监测生命体征、液体管理、预防出血、预防感染、血管通路的护理是CVVH治疗护理重点。结论:早期CVVH可能有利于患者受损器官功能的恢复,缩短患者的住院时间。在CVVH治疗过程良好的护理和密切的观察是保证CVVH顺利进行的重要保障。

    Release date:2016-09-08 10:00 Export PDF Favorites Scan
  • 腹膜透析液加药小技巧

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  • Application of Continuous Quality Improvement Measures in Prevention of Peritoneal Dialysis Related Peritonitis

    ObjectiveTo investigate whether continuous quality improvement (CQI) measures can reduce the episodes of peritonitis. MethodsWe analyzed the data of 114 cases of peritoneal dialysis related peritonitis from January to December 2011 before applying CQI measures and 72 cases from January and December 2012 after applying CQI measures in West China Hospital. Then we studied the episodes, cause and pathogenic bacteria species of peritonitis in peritoneal dialysis patients. We implemented the process of reducing the episodes of peritonitis by applying PDCA four-step design: plan-do-check-act. ResultsThe episodes of peritonitis were reduced from per 60.8 patient-months (0.197/patient-years) to per 66.6 patient-months (0.180/patient-years) after applying CQI measures. The positive rate of pathogenic bacteria culture was both 50.0% before and after applying CQI measures, in which 66.7% were gram-positive cocci. The curing rate of peritonitis was increased from 57 case/times (76.3%) to 87 case/times (79.2%). Switching to hemodialysis rate was reduced from 17 cases/times (14.9%) to 10 cases/times (13.9%). Death cases was reduced from 9 cases/times (7.9%) to 5 cases/times (6.9%). ConclusionThese results show that the incidence of peritoneal dialysis related peritonitis decreases and the curing rate increases through CQI measures.

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  • 保赫曼妙贴预防腹透导管出口处感染效果观察

    【摘要】 目的 观察腹膜透析患者使用保赫曼妙贴覆盖腹透导管出口处其感染预防的临床效果。 方法 选择2008年10月-2009年3月首次行腹膜透析置管手术患者60例,按行腹膜透析置管手术单双日分为两组,观察组:腹透导管出口处使用保赫曼妙贴(8 cm×10 cm);对照组:使用传统敷料(6 cm×7 cm 的12层无菌纱布),并用纸胶布固定。观察两组患者术后腹透导管出口处敷料固定情况及感染发生率。 结果 术后7 d,观察组腹透导管出口处敷料固定良好,优于对照组(Plt;0.05);术后6周内,观察组腹透导管出口处感染率低于对照组(Plt;0.05),差异有统计学意义。 结论 保赫曼妙贴能有效预防腹透导管出口处感染,使用简便,值得推广。

    Release date:2016-08-26 02:18 Export PDF Favorites Scan
  • A Clinical Analysis of the Disorders of Calcium and Phosphorus Metabolism Peritoneal Dialysis Patients

    【摘要】 目的 探讨生理钙透析液对持续性不卧床腹膜透析(CAPD)患者钙磷代谢的影响。 方法 回顾性分析2008年1月-2009年12月腹膜透析患者的钙磷指标,资料齐全的患者中使用钙浓度为1.25 mmol/L的腹膜透析液(生理钙组)的患者有30例,使用钙浓度为1.75 mmol/L的透析液(标准钙组)患者30例。对两组患者钙磷代谢指标进行比较。 结果 治疗前后两组的血磷、钙磷乘积和全段甲状旁腺素差异均无统计学意义(Pgt;0.05);治疗后标准钙组血钙较前升高,差异有统计学意义(Plt;0.05),而生理钙组治疗前后血钙差异无统计学意义(Pgt;0.05)。 结论 不同含钙浓度腹膜透析液对机体钙磷代谢的影响是不同的,在高钙、高磷、低转运骨病的腹膜透析患者中使用钙浓度为1.25 mmol/L的生理钙透析液减轻了钙负荷,为临床医生使用含钙磷结合剂提供了治疗空间。【Abstract】 Objective To investigate the effects of physiological calcium dialysate on the calcium and phosphorus metabolism in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). Methods We retrospectively analyzed the clinical data of 60 patients having undergone CAPD in West China Hospital of Sichuan University between January 2008 and December 2009. The patients were divided into two groups with 30 in each by calcium concentration of the dialysate: the physiological calcium dialysate group (1.25 mmol/L) and the standard calcium dialysate group (1.75 mmol/L). The metabolism indexes of calcium and phosphorus for the two group of patients were compared. Results Levels of Serum phosphate, calcium-phosphate product and immoreactive parathyroid hormone (iPTH) of all the patients in both groups before and after treatment showed no significant differences (Pgt;0.05). Serum calcium increased significantly in patients treated with standard calcium dialysate (Plt;0.05), while it did not change significantly in patients treated with physiological calcium dialysate (Pgt;0.05). Conclusions Dialysate with different concentrations of calcium provides different influence on the metabolism of calcium and phosphorus. Changing calcium concentration to 1.25 mmol/L in the dialysate can lower the calcium load for patients with hypercalcium and/or hyperphosphate with low bone turnover, providing treatment space for clinical doctors to use binders containing both calcium and phosphorus.

    Release date:2016-09-08 09:24 Export PDF Favorites Scan
  • 老年腹膜透析患者相关营养指标比较及教育对策

    目的 分析比较老年腹膜透析患者营养状况,提出针对性的营养教育对策。 方法 回顾分析2010 年12月-2011年11月328例维持性腹膜透析患者的临床及随访资料,并通过两组不同年龄段患者(≥60岁和<60岁)的血浆白蛋白(ALB)、前白蛋白(PAB)、铁蛋白(FER)、血清铁(FE)、总铁结合力(TIBC)、血红蛋白(HGB)、标准化每日蛋白质分解率(nPCR)、尿素清除指数(Kt/V)、肌酐清除率(Ccr)、24 h尿、腹透液漏出蛋白和体质量指数(BMI)、改良定量主观整体评估(MQSGA)等指标,比较其营养状况。 结果 老年组腹膜透析患者营养不良的发生率(72.79%)高于中青年组(28.65%)(P<0.05)。两组患者ALB分别为(32.64 ± 4.78) g/L和(34.99 ± 5.42) g/L(P<0.05),PAB分别为(303.00 ± 72.47)mg/L和(372.53 ± 88.09)mg/L(P<0.05),HGB分别为(102.58 ± 21.05)g/L和(91.63 ± 19.37)g/L(P<0.05);老年组ALB和PAB水平均低于中青年组,而HGB水平高于中青年组(P<0.05)。两组患者BMI、FE、TIBC、FER、nPCR、Kt/V、Ccr、每日蛋白漏出总量差异无统计学意义(P>0.05)。 结论 老年腹膜透析患者比中青年患者更容易出现低蛋白血症,导致蛋白营养不良。故而在制定腹膜透析患者的营养教育方案时,应针对老年患者的临床特征,加强蛋白质营养方面的指导。

    Release date:2016-09-07 02:38 Export PDF Favorites Scan
  • The perioperative effect of non-peros time on elective general anesthesia patients in China: a systematic review

    ObjectiveTo systematically review the efficacy and safety of different non-peros (NPO) times [( trial group: preoperative solid fast, 6 hours; fluid fast 2–3 hours) vs. (control group: preoperative solid fast, 12 hours; fluid fast 4–6 hours)] in elective general anesthesia patients in China.MethodsRandomized controlled trials (RCTs) and quasi-RCT of NPO time in elective general anesthesia patients were searched and retrieved through online databases (PubMed, Cumulative Index to Nursing and Allied Health, Embase, Cochrane Library, China Biology Medicine database, China National Knowledge Internet, VIP, WanFang, SUMsearch, and Google search engine) and related literatures were reviewed up to April 25th, 2018. Two investigators independently screened literatures, extracted data, and evaluated the risk of bias assessment tools for RCT using the Version 5.1.0 of Cochrane Handbook for Systematic Reviews of Interventions. Then, Meta-analysis was performed using RevMan 5.3 software.ResultsA total of 16 RCTs involving 2 722 elective general anesthesia patients (1 372 in the trial group and 1 350 in the control group) were included. The Meta-analysis showed that: the preoperative residual gastric volume [mean difference (MD)=–1.45 mL, 95% confidence interval (CI) (–2.88, –0.01) mL, P=0.05], the incidence of preoperative hypoglycemia [odds ratio (OR)=0.12, 95%CI (0.05, 0.28), P<0.000 01, the incidence of preoperative thirst [OR=0.15, 95%CI (0.11, 0.21), P<0.000 01], the incidence of preoperative hunger [OR=0.13, 95%CI (0.10, 0.18), P<0.000 01], the incidence of preoperative flustered tiredness [OR=0.11, 95%CI (0.07, 0.17), P<0.000 01], and the incidence of preoperative anxiety [OR=0.21, 95%CI (0.12, 0.37), P<0.000 1] in the trial group were significantly lower than those in the control group. There was no statistically significant difference in the intra-operative residual gastric volume between the two groups (P>0.05), and no intra-operative vomiting or aspiration took place in either group. The recovery time of exhaust and defecate of anus [MD=–8.71 hours, 95%CI (–11.43, –6.00) hours, P<0.000 01] in the trial group was significantly shorter than control group, and there was no statistically significant differences in the incidence of postoperative pneumonia, postoperative nausea, postoperative vomiting, or the postoperative thirsty and hungry between the two groups (P>0.05).ConclusionsCurrent evidence shows that, compared with the control group, the trial group could decrease the incidences of preoperative hypoglycemia, thirst, hunger, flustered tiredness and anxiety, and shorten the recovery time of exhaust and defecate of anus for postoperative patients, without increasing incidences of intraoperative or postoperative adverse reactions. Due to the limited quantity and quality of the included studies, the above conclusions still need to be verified by carrying out more large-scale samples and high-quality RCTs studies.

    Release date:2018-08-20 02:24 Export PDF Favorites Scan
  • Comparison between the Effects of Two Different Care Methods for the Exit of Peritoneal Dialysis Catheter

    目的 比较两种不同方法护理腹膜透析患者导管出口处的效果。 方法 选取2008年7月-2009年12月51例患者作为试验组,直接采用聚维酮碘溶液擦洗导管出口处,2007年1月-2008年7月45例患者作为对照组,先用生理盐水清洗遂道口,再用聚维酮碘溶液擦洗导管出口处。比较两组导管出口处感染的情况及操作所需时间。 结果 试验组出口评分系统(ESS)<2分15例,2~3分34例,≥4分7例;对照组<2分10例,2~3分24例,≥4分16例;两组差异有统计学意义(P<0.05)。试验组护士操作时间为(3.0 ± 1.0)min,患者操作时间为(5.0 ± 1.5)min;对照组护士操作时间为(8.0 ± 2.0)min,患者操作时间为(10.0 ± 2.0)min;两组差异有统计学意义(P<0.05)。 结论 聚维酮碘溶液直接清洗、消毒导管出口处降低了感染的发生率,减少了操作环节和所需物品,缩短了操作时间。

    Release date:2016-09-07 02:38 Export PDF Favorites Scan
  • Evaluation of the Relationship between Age and Nutrition Status in Continuous Ambulatory Peritoneal Dialysis Patients

    【摘要】 目的 探索持续非卧床腹膜透析(CAPD)患者年龄与营养状况的关系,为营养教育提供指导。 方法 对2007年8月-2010年1月腹膜透析177例患者的临床资料进行回顾性分析,包括血红蛋白(HGB)、血清白蛋白(ALB)、年龄、体重指数(BMI)、腹膜平衡试验(PET)、尿素清除指数(Kt/V)、24 h尿蛋白、腹透液漏出蛋白、标准化每日蛋白质分解率(nPCR)等,分析年龄与营养状况的关系。 结果 老年组(≥60岁)和中青年组(lt;60岁)ALB分别为(31.54±5.91)、(33.24±4.75)g/L,老年组ALB较低(Plt;0.05);老年组Kt/V值1.95±0.63和HGB水平(95.25±22.89) g/L均高于青年组(Plt;0.05)。两组患者营养不良与BMI、PET、每日蛋白漏出总量、nPCR无关。 结论 CAPD老年患者(≥60岁)更容易发生营养不良,且老年组低蛋白血症与透析充分性无明显关系。故应加强老年CAPD患者的饮食营养管理指导,设计合理的饮食。【Abstract】 Objective To investigate the relationship between age and nutrition status of the patients undergoing continuous ambulatory peritoneal dialysis (CAPD), and provide instructions for nutrition education. Methods We retrospectively analyzed the clinical data of 177 patients having undergone CAPD in the Department of Nephrology of West China Hospital between April 2007 and January 2010. Clinical parameters collected included hemoglobin (HGB), serum albumin (ALB), age, body mass index (BMI), results of the peritoneal equilibrium test (PET), urea clearance index (Kt/V), 24-hour urinary protein, protein loss in the peritoneal dialysate, normalized protein catabolic rate (nPCR). Relationship between age and nutrition status in these patients were analyzed. Results Plasma albumin was (31.54±5.91) g/L and (33.24±4.75) g/L respectively in patients of or older than 60 years old (the elderly group) and in patients younger than 60 years old (the younger group). Compared with the younger group, patients in the elderly group had lower ALB (Plt;0.05), but higher Kt/V 1.95±0.63 and hemoglobin level (95.25±22.89) g/L (Plt;0.05). In addition, malnutrition in both groups was not associated with BMI, PET results, daily protein loss in the peritoneal dialysate or nPCR. Conclusions Patients of or older than 60 years old undergoing CAPD are more likely to develop malnutrition, indicating that hypoalbuminemia is not associated with dialysis inadequacy. We advocate enhancing diet nutrition education in elderly CAPD patients and providing them with balanced diet regime.

    Release date:2016-09-08 09:24 Export PDF Favorites Scan
  • Application of Continuous Quality Improvement in Laparoscopic Peritoneal Dialysis Catheter Input

    ObjectiveTo reduce the incidence of peritoneal dialysis (PD) catheter complications through a continuous quality improvement (CQI) process. MethodsTwenty-nine patients with catheters inserted (from January 2011 to March 2011) before CQI, and another 41 patients with catheters inserted (between April 2011 and January 2012) after CQI were observed and analyzed. The possible causes of complications of catheter were summarized, and then on the basis of that, a PDCA four-step (plan-do-check-act) method was designed with a view to reducing the incidence of postoperative complications. ResultsPD catheter dysfunction decreased from 6.90% to 2.44%. The incidence of leakage decreased from 44.83% to 9.76%. ConclusionCQI is a useful method to reduce the incidence of postoperative complications of PD catheter in peritoneal dialysis.

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