Objective To summarize the experience of open heart operation on neonates with critical and complex congenital heart diseases and evaluate the methods of perioperative management. Methods From May 2001 to January 2003, 12 patients of neonates with congenital heart diseases underwent emergency operation. Their operating ages ranged from 6 to 30 days, the body weights were 2.8 to 4.5 kg. Their diagnoses included D-transposition of the great arteries in 4 cases, ventricular septal defect with atrial septal defect in 5 cases, complete atrioventricular septal defect, obstructed supracardiac total anomalous pulmonary venous drainage and cardiac rhabdomyomas in 1 case respectively. 12 cases were operated under moderate or deep hypothermic cardiopulmonary bypass. Results All cases were observed in ICU for 2-11 days and discharged 7-19 days after operation. The postoperative complications included low cardiac output, mediastinal infection, respiratory distress syndrome, systemic capillary leak syndrome and acute renal failure. All cases were cured and the follow-up (from 6 months to 2 years) showed satisfactory outcome. Conclusion A particular cardiopulmonary bypass and proper perioperative management is very important to ensure the successful outcome. Peritoneal dialysis is an effective and safe method for treating acute renal failure after cardiac operation in neonates.
目的:调查我院腹膜透析患者死亡和转HD治疗的原因及相关影响因素。方法: 收集腹膜透析患者在我院死亡14例,转HD治疗 2 6例;查阅40例患者在我院的完整病历资料,调查其死亡及转HD治疗的原因及感染病原菌、营养等指标。结果: 14例腹膜透析死亡患者主要原因为肺部感染合并心脑血管疾病及消化道出血,均占(29%,4/14)。643%(9 / 14)的死亡患者HBlt;90 g/L,ALBlt;30 g/l;71.4%(10 / 14)的腹膜透析死亡患者合并钙磷失调。 26例腹膜透析患者转HD的首要原因和次要原因分别为腹透相关性腹膜炎(50%,13/26)和透析液引流不畅(42%,11/26)。72.7%透析液引流不畅的腹透患者经影像学诊断漂管,27.3%患者为拔管手术证实网膜堵塞管口。结论: 1.肺部感染性疾病合并合并心脑血管系统及消化系统,为腹膜透析患者死亡的主要原因,与全身营养状况不良,钙磷失调有关。 2. 腹膜透析相关性腹膜炎仍为腹膜透析患者退出转HD治疗的主要原因。 3.因透析液引流不畅而拔管为转HD治疗的第二位原因,漂管和网膜阻塞管口为透析液引流不畅的原因。
ObjectiveTo investigate the influence of evidence-based nursing intervention on the treatment effect and quality of life in patients with peritoneal dialysis. MethodSixty-four patients who underwent peritoneal dialysis between January 2013 and December 2014 in our hospital were randomly divided into control group (n=32) and intervention group (n=32) . The control group received routine nursing and the intervention group received evidencebased nursing intervention. Urea clearance index (KT/V), serum albumin and hemoglobin levels were detected for both groups of patients before and after nursing intervention. Generic Quality of Life Inventory (GQOLI)-74 scale was used to assess patients' quality of life. ResultsAfter nursing intervention, KT/V, serum albumin and hemoglobin levels in the intervention group were significantly higher than those in the control group (P<0.05) . The scores of such items as physical function, psychological function, social function and overall evaluation in the GQOLI-74 scale in the intervention group were significantly higher than those in the control group (P<0.05) . ConclusionsEvidence-based nursing intervention can effectively improve the treatment effect and quality of life in patients with peritoneal dialysis, which is worthy of clinical popularization and application.
ObjectiveTo explore the impact of continuous quality improvement on the quality of life and complications in end-stage hemodialysis patients. MethodWe reviewed the clinical data of 128 end-stage renal disease patients undergoing hemodialysis from January 2013 to January 2014. The patients were divided into observation group and control group randomly with 64 patients in each. Patients in the control group received routine nursing only during hemodialysis, while those in the observation group received extra continuous quality improvement nursing on the basis of routine one. Quality of life of the two groups of patients was evaluated by World Health Organization Quality of Life Scale-brief before and after intervention. Adverse reactions during hemodialysis were also observed in these two groups. ResultsThe incidences of hypotension, malnutrition, thrombosis, infection and arrhythmia in the observation group were significantly lower than those in the control group (P<0.05). Psychological dimension, social dimension, physiological adaptability and total scales of quality of life in the observation group were significantly better than those in the control group (P<0.05). ConclusionsContinuous quality improvement of nursing reduces the rates of complications and improves patients' quality of life.
In the management of diabetic nephropathy patients with hemodialysis, diabetes link nurse (DLN) can realize the continuity of nursing management, simplify the communication between multiple disciplines, and play multiple roles such as relieving patients’ psychology, participating in scientific research and clinical management. In this paper, by introducing the origin and development status of DLN in foreign countries, and summarizing the function and clinical contribution of DLN in the management of diabetic nephropathy hemodialysis patients. This article combines the current development status of DLN in China, to arouse the attention of clinical nursing colleagues, and provide some reference for the management of diabetic nephropathy patients with hemodialysis and the training of DLN in China.
Maintenance hemodialysis patients face great risk and challenges in the current coronavirus disease 2019 (COVID-19) epidemic, and adequate and reasonable nutrition is an important weapon in the prevention and treatment of COVID-19. Therefore, the Chinese Society of Parenteral and Enteral Nutrition proposed Dietary Expert Advice on Prevention and Treatment of COVID-19 in Hemodialysis Patients for hemodialysis patients. In this paper, the nine pieces of advice on hemodialysis patients’ staple food, intake of high-quality protein, vegetables and fruits, food types and combinations, prevention of virus transmission, fluid intake, nutritional supplements, regular rest and adequate sleep, as well as supplement of anti-inflammatory and antioxidant preparations are interpreted in detail.
ObjectiveTo summarize and improve the nursing skills of medication for hemodialysis patients. MethodsWe observed and took nursing measures for adverse medication events in 280 hemodialysis patients treated in our dialysis center from July 2013 to December 2013, and actively prevented all kinds of complications caused by medications. ResultsIn this group of patients, 26 had adverse drug events. Five patients with bleeding after central venous catheter indwelling were cured by changing the dressings. One patient had heparin induced thrombocytopenia, and the complication disappeared after the use of non-heparin hemodialysis. One patient had urokinase allergic reaction, and the complication disappeared by cardio-pulmonary resuscitation. One patient had EPO associated pure red cell aplastic anemia, and the patient did not suffer from it any more by changing the EPO. Two patients with high blood pressure recovered to normal by reducing the use of blood for rHuePO. One had allergic reaction for Iron Dextran Injection and was successfully treated by ICU. Six patients with severe reactive hypoglycemia were corrected quickly by intravenous injection of 50% glucose injection. One patient with adverse reaction to levocarnitine was cured by lowering the frequency of medication to one time per week. Two patients had flu-like symptoms after the use of biological agents were cured by stoppage of the medicine. ConclusionAdverse drug effect should be carefully observed, and patients' education and nursing skills of medical workers should be improved to ensure the medication safety of hemodialysis patients.
Central venous stenosis is a common complication following long-term dialysis catheter placement in dialysis patients. Generally, percutaneous angioplasty is the treatment of choice, and venous stent implantation should be considered in different situations. However, the venous stent migrating into right atrium is a rare but fatal complication. We presented a patient whose superior vena cava stents migrated into right atrium, resulting in acute tamponade, and exploratory thoracotomy was proceeded.