CAJ | 학술논문

目的探讨4种不同抗凝方法用于高危出血患者血液透析中的安全性、可行性和护理特点.方法将有高危出血倾向的血液透析患者128例随机分成4组,A组采用30%枸橼酸钠局部体外抗凝(RCA)透析,B组采用鱼精蛋白中和肝素的局部肝素抗凝法,C组采用低分子肝素抗凝,D组采用无肝素透析.分别观察4组患者出血、体外循环的凝血情况、不良反应以及护理特点.结果 (1)A组透析68例次,均顺利完成透析;B组透析60例次中发生6例次出血或原有出血加剧;C组透析64例次中发生8例次出血或原有出血加剧;D组透析66例次中8例次因透析中出现体外循环Ⅲ级凝血而终止透析.(2)透析过程中A组有3例次、B组有2例次出现不良反应,经处理后症状缓解,可继续进行透析.C、D组均无不良反应出现.结论 RCA用于高危出血患者血液透析是安全可行的,护理方法也简便易于掌握.
목적 탐토4충불동항응방법용우고위출혈환자혈액투석중적안전성、가행성화호리특점.방법 장유고위출혈경향적혈액투석환자128례수궤분성4조,A조채용30%구연산납국부체외항응(RCA)투석,B조채용어정단백중화간소적국부간소항응법,C조채용저분자간소항응,D조채용무간소투석.분별관찰4조환자출혈、체외순배적응혈정황、불량반응이급호리특점.결과 (1)A조투석68례차,균순리완성투석;B조투석60례차중발생6례차출혈혹원유출혈가극;C조투석64례차중발생8례차출혈혹원유출혈가극;D조투석66례차중8례차인투석중출현체외순배Ⅲ급응혈이종지투석.(2)투석과정중A조유3례차、B조유2례차출현불량반응,경처리후증상완해,가계속진행투석.C、D조균무불량반응출현.결론 RCA용우고위출혈환자혈액투석시안전가행적,호리방법야간편역우장악.
Objective To observe the efficacy, safety and feasibility of the four kinds of anticoagulation method in hemodialysis patients with high risk of hemorrhage. Methods 128 patients with high risk of hemorrhage who had undergone hemodialysis were randomly divided into four groups. In group A, 68patients were resorted with 30% regional sodium citrate anticoagulation(RCA). In group B, 60 patients were treated with local heparin anticoagulation. In group C, 64 patients were treated with low molecular weight heparin (LMWH). In group D, 66 patients received no heparinization hemodialysis. The changes of bleeding, clotting function, adverse effect and nursing strategies were studied. Results All patients of group A completed regular hemodialysis with satisfactory indices, 6 cases with bleeding and primary bleeding aggravated in group B, 8 cases with bleeding and primary bleeding aggravated in group C, 8 cases occurred grade three coagulation and finished dialysis in group D. 3 cases in group A and 2 cases in group B occurred adverse reaction, but no adverse reaction was seen in group C and D. Conclusions RCA is safe,effective and can be easily handled in regular hemodialysis. It is an ideal dialysate for hemodialysis in patients with high risk of hemorrhage.