摘要
目的：探讨在重症腹膜炎患者术后脉波轮廓温度稀释连续心排血量监测（PICCO）指导下的连续性肾脏替代治疗（CRRT）三级水平精细化容量管理方案及护理措施。方法：选取2012年1月~2015年12月重症腹膜炎患者术后入住ICU的患者60例为研究对象,确诊病例均采取CRRT治疗,以达到特定的血流动力学特性,提高患者CRRT治疗的耐受性为目标,将病例随机等分为试验组和对照组。试验组根据出入量及PICCO监测参数制定出三级水平精细化容量管理方案,对照组根据一般临床监测和CVP监测采用三级水平容量管理护理方案。对比两组患者行CRRT治疗的平均每次治疗时间、被动下机次数、去甲肾上腺素的使用量及心率、单小时尿量。结果：试验组患者CRRT被动下机率明显少于对照组,平均每次CRRT治疗时间长于对照组（P〈0.05）。试验组患者治疗72 h内去甲肾上腺数用量、APACHEⅡ评分、心率均低于对照组,CVP、单小时尿量均高于对照组（P〈0.05）。结论：PICCO指导下的CRRT三级水平精细化容量管理,能够精确调整患者的容量状况,有利于重症腹膜炎患者的救治,能达到最佳的治疗效果。
Objective：To explore tertiary level fine capacity management and nursing measures of continuous renal replacement therapy（CRRT） for severe peritonitis patients under the guidance of postoperative thermodilution pulse- induced contour cardiac output（PICCO）. Methods： Selected 60 severe peritonitis patients from January 2012 to December 2015 who stayed in ICU after operations as study objects and divided them into experimental group and control group at random. All patients accepted CRRT treatment to reach specific hemodynamic characters and in the pursuit of raising CRRT treatment tolerance of patients. A tertiary level fine capacity management scheme should be formulated for experimental group according to their intake and output records and PICOO monitoring parameters. A tertiary levelcapacity management scheme should be adopted for control group according to general clinical monitor and CVP monitor. When accepting CRRT treatment,patients of two groups were compared in terms of average time of therapy every time,passive therapy-stopping frequency,noradrenaline dosage,heart rate and urine volume per hour. Results： Experimental group patients had lower of CRRT passive therapy-stopping frequency,shorter CRRT therapy time every time than control group patients（P〈 0. 05）. With in 72 hours affer freatment experimental group patients were lower in noradrenaline dosage,APACHE Ⅱscore and heart rate and higher in CVP and urine volume per hour than control group（ P〈 0. 05）.Conclusions： CRRT tertiary level fine capacity management under the guidance of PICCO can precisely adjust capacity status of patients,facilitate treatment on severe peritonitis patients and help to realize best cure effects.
出处
《护理实践与研究》
2016年第8期6-8,共3页
Nursing Practice and Research
基金
广东省云浮市医药卫生科研立项课题(2014B56)
作者简介
陈玉叶,女，本科，主管护师。
