护联体内血液透析通路标准护理流程的建立及实践

doi:10.3761/j.issn.0254-1769.2022.07.004

摘要/Abstract

摘要：

目的探讨护联体内血液透析通路标准护理流程对维持性血液透析（maintained hemodialysis,MHD）患者动静脉内瘘的实施效果。方法 2020年5月—2021年5月,以江苏省某三级甲等医院护联体内10所基层血液透析中心为试点,采用随机数字表法选取5所血液透析中心作为试验组,其余5所作为对照组。试验组实施构建的血液透析通路标准护理流程,对动静脉内瘘进行建立、评估、监测、维护等一体化的规范护理。对照组实施常规动静脉内瘘护理。比较实施前和实施后3、6、12个月,两组患者透析充分性、动静脉内瘘并发症发生情况和自体动静脉内瘘自我管理水平等指标。结果试验组143例,对照组155例完成研究。实施后的3、6、12个月,试验组的尿素清除指数高于对照组（P<0.05）;实施后的6、12个月,试验组的血流量、尿素下降率和自体动静脉内瘘自我管理水平高于对照组（P<0.05）;实施后的12个月,试验组的血肿和狭窄发生率低于对照组（P<0.05）。结论护联体内血液透析通路标准护理流程的建立,有效提高了MHD患者的透析充分性,提升了患者动静脉内瘘自我管理水平,并减少了动静脉内瘘并发症发生情况。

关键词: 肾功能衰竭, 慢性, 血液透析, 动静脉内瘘, 血管通路护理, 护联体

Abstract:

Objective To explore the nursing effect of the establishment of standard nursing procedures of hemodialysis vascular access in the nursing consortium on arteriovenous fistula in patients with maintained hemodialysis（MHD）. Methods In this study,10 primary hemodialysis centers in the nursing consortium of our hospital were used as pilots from May 2020 to May 2021,and 5 hemodialysis centers were selected as the experimental group by the random number table method,and the remaining 5 were the control group. The experimental group was implemented with the standard nursing process of hemodialysis access established in this study,and the control group received routine arteriovenous fistula nursing. The dialysis adequacy,arteriovenous fistula complications,the self-management ability and other indicators of the 2 groups were compared before the implementation and 3 months,6 months,and 12 months after the implementation. Results 143 cases in the experimental group and 155 cases in the control group completed the study. 3 months,6 months and 12 months after implementation,the kt/V value of the experimental group was significantly higher than that of the control group（P<0.05）;6 months and 12 months after implementation,the QA,URR and self-management ability of the experimental group were significantly higher than those of the control group（P<0.05）. 12 months after the implementation,the incidence of hematoma and stenosis in the experimental group was significantly lower than that in the control group（P<0.05）. Conclusion The establishment of the standard nursing process of hemodialysis access in the nursing consortium can effectively improve the dialysis adequacy of MHD patients,improve the self-management ability of patients with arteriovenous fistula,and reduce the complications of arteriovenous fistula.

Key words: Kidney Failure, Chronic, Hemodialysis, Arteriovenous Fistula, Nursing Care of Hemodialysis Vascular Access, Nursing Consortium

潘文静, 何文霞, 刘同强, 唐羽裳, 徐宇红, 杭琤, 韩惠芳, 丁钟琴, 陈成. 护联体内血液透析通路标准护理流程的建立及实践[J]. 中华护理杂志, 2022, 57(7): 791-797.

PAN Wenjing, HE Wenxia, LIU Tongqiang, TANG Yushang, XU Yuhong, HANG Zheng, HAN Huifang, DING Zhongqin, CHEN Cheng. Establishment and practice of standard nursing procedures of hemodialysis vascular access in nursing consortium[J]. Chinese Journal of Nursing, 2022, 57(7): 791-797.

图/表 4

表1 两组一般资料比较

Table 1 Comparison of baseline data in the two groups

表2 两组实施前后透析充分性相关指标的比较（$\bar{x} \pm s$）

Table 2 Comparison of dialysis adequacy between the two groups before and after implementation（$\bar{x} \pm s$）

表3 两组实施前后动静脉内瘘并发症发生情况的比较[例（百分比,%）]

Table 3 Comparison of arteriovenous fistula complications between the two groups before and after implementation [cases（percentage,%）]

表4 两组实施前后自体动静脉内瘘自我管理水平的比较（分,$\bar{x} \pm s$）

Table 4 Comparison of the ability of self-management of internal fistula between the two groups before and after implementation（cases,$\bar{x} \pm s$）

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