CAJ | 학술논문

目的：总结肝衰竭合并肾功能不全患者行血浆置换联合日间连续性血液滤过治疗的护理。方法选取首都医科大学附属北京佑安医院人工肝中心2013年1月~2014年5月进行血浆置换联合日间连续性血液滤过治疗的肝衰竭合并肾功能不全患者187例为研究对象，比较治疗前后的肝肾功能及凝血象指标。治疗前与患者沟通，治疗中密切观察、正确处理不良反应和有效护理干预，治疗后回访及健康宣教。结果患者治疗后的丙氨酸氨基转移酶[(220.2±109.9)比(366.4±153.3)U/L]、天门冬酸氨基转移酶[(148.2±71.7)比(219.8±90.0)U/L]、总胆红素[(283.0±78.2)比(420.0±106.3)μmol/L]、直接胆红素[(141.5±38.1)比(206.7±52.4)μmol/L]、尿素[(25.0±5.8)比(28.8±5.6) mmol/L]、肌酐[(176.6±38.6)比(290.7±63.3)μmol/L]较治疗前明显降低，白蛋白[(28.1±3.0)比(26.6±3.1)g/L]和凝血酶原活动度[(32.3±7.1)%比(27.7±7.0)%]较治疗前明显升高，差异有高度统计学意义(P﹤0.01)。结论血浆置换联合日间连续性血液滤过治疗肝衰竭合并肾功能不全，为患者提供了新的治疗选择。治疗前、中、后的有效护理支持是保证治疗成功的关键。
목적：총결간쇠갈합병신공능불전환자행혈장치환연합일간련속성혈액려과치료적호리。방법선취수도의과대학부속북경우안의원인공간중심2013년1월~2014년5월진행혈장치환연합일간련속성혈액려과치료적간쇠갈합병신공능불전환자187례위연구대상，비교치료전후적간신공능급응혈상지표。치료전여환자구통，치료중밀절관찰、정학처리불량반응화유효호리간예，치료후회방급건강선교。결과환자치료후적병안산안기전이매[(220.2±109.9)비(366.4±153.3)U/L]、천문동산안기전이매[(148.2±71.7)비(219.8±90.0)U/L]、총담홍소[(283.0±78.2)비(420.0±106.3)μmol/L]、직접담홍소[(141.5±38.1)비(206.7±52.4)μmol/L]、뇨소[(25.0±5.8)비(28.8±5.6) mmol/L]、기항[(176.6±38.6)비(290.7±63.3)μmol/L]교치료전명현강저，백단백[(28.1±3.0)비(26.6±3.1)g/L]화응혈매원활동도[(32.3±7.1)%비(27.7±7.0)%]교치료전명현승고，차이유고도통계학의의(P﹤0.01)。결론혈장치환연합일간련속성혈액려과치료간쇠갈합병신공능불전，위환자제공료신적치료선택。치료전、중、후적유효호리지지시보증치료성공적관건。
Objective To summarize the nursing care of plasma exchange combined with daytime continuous venous-venous hemofiltration in liver failure patients accompanied with renal insufficiency. Methods 187 liver failure patients accompanied with renal insufficiency received plasma exchange combined with daytime continuous venous-venous hemofiltration in Artificial Liver Center, Beijing You'an Hospital Affiliated to Capital Medical University from January 2013 to May 2014 were selected as research objects. Liver and kidney function and blood coagulation indexes before and after treatment were compared. The nursing measures included the pretreatment conversation with patient, close observation, correct handling to adverse reactions with effective nursing intervention during treatment, health education and follow up after treatment. Results Alanine transaminase [(220.2±109.9) v s (366.4±153.3) U/L], aspartate transami-nase [(148.2±71.7) vs (219.8±90.0) U/L], total bilirubin [(283.0±78.2) vs (420.0±106.3)μmol/L], direct bilirubin [(141.5±38.1) vs (206.7±52.4)μmol/L], serum urea [(25.0±5.8) vs (28.8±5.6) mmol/L], creatinine [(176.6±38.6) vs (290.7±63.3)μmol/L] of patient after treatment was significantly lower than that before treatment respectively, albumin [(28.1±3.0) v s (26.6±3.1) g/L], prothrombin activity [(32.3±7.1)%v s (27.7±7.0)%] of patient after treatment was significantly higher than that before treatment respectively, with significantly statistical difference (P﹤ 0.01). Conclusion The combination of plas-ma exchange and daytime continuous venous-venous hemofiltration provides a good option for treatment of liver failure patients accompanied with renal insufficiency. Nurs-ing care support during the whole treatment proce-dures is the key of success.