刘建红+黄冬梅

摘 要 目的：探讨综合护理在预防尿毒症患者血液透析期间合并心力衰竭的效果。方法：将2012年8月—2015年3月因尿毒症行血液透析患者90例纳入研究，随机分为试验组和对照组各45例。对照组给予常规血液透析护理，试验组给予综合护理，包括心理护理、预防心血管病并发症的护理等。观察患者干预前后血压、心率、左室射血分数（LVEF）、左室内径缩短率（FS）、Zung抑郁自评量表（SDS）评分、6 min步行距离变化情况。结果：干预后，试验组收缩压、舒张压、心率均低于干预前和对照组（P<0.05），LVEF和FS均高于干预前和对照组（P<0.05），SDS评分低于干预前和对照组，6 min步行距离高于干预前和对照组（P<0.05）。结论：综合护理在预防尿毒症患者血液透析期间合并心力衰竭中的效果较好，可改善患者收缩压、舒张压、心率情况，提高LVEF和FS水平，降低SDS评分，延长6 min步行距离，临床应用价值较高。

关键词 尿毒症 综合护理 血液透析 心力衰竭

中图分类号：R459.5 文献标志码：A 文章编号：1006-1533（2016）18-0036-03

Effect of comprehensive nursing in the prevention of heart failure occurring in hemodialysis patients with uremia

LIU Jianhong， HUANG Dongmei

（Hemodialysis Room of Peoples Hospital， Yichun City， Jiangxi 336000， China）

ABSTRACT Objective： To explore the effect of comprehensive nursing in the prevention of heart failure during hemodialysis in uremic patients. Methods： From August 2012-March 2015， 90 cases of uremic hemodialysis were enrolled in this study， and randomly divided into an experiment group and a control group with 45 cases each. The control group was cared by regular hemodialysis nursing， and the experiment group was cared by the comprehensive nursing， including psychological nursing， and cardiovascular disease complication prevention nursing and others. The blood pressure， heart rate， scores of left ventricular ejection fraction（LVEF）， left ventricular diameter shortening rate（LVDS）， Zung self-rating depression scale（SDS）， and 6 min walking distance were observed before and after intervention. Results： The systolic blood pressure， diastolic blood pressure， heart rate of the experiment group were lower than those before intervention and of the control group（P<0.05）. The scores of LVEF， and LVDS of the experiment group were higher than those before intervention and of the control group（P<0.05）. The SDS score of the experiment group was lower than that before intervention and of the control group（P<0.05）， and the 6 min walking distance of the experiment group was longer than that before intervention and of the control group（P<0.05）. Conclusion： The comprehensive nursing has good effect in the prevention of heart failure during hemodialysis in uremic patients， and can improve the systolic and diastolic blood pressures， heart rate， increase the levels of LVEF and LVDS， reduce the SDS score， and prolong 6 min walking distance， which has high value in clinical application.

KEY WORDS uremia； comprehensive nursing； hemodialysis； heart failure

尿毒症是各种晚期肾脏病的共有临床综合征，是慢性肾功能衰竭进入终末阶段表现的综合征。尿毒症主要通过血液透析治疗，而血液透析是引发心血管并发症的主要原因，如心力衰竭（心衰）等[1]。对患者进行综合护理干预，在预防尿毒症患者血液透析期间合并心衰的发生中有重要临床意义。

1 资料与方法

1.1 一般资料

收集2012年8月-2015年3月我院收治的尿毒症行血液透析患者90例，按入院顺序抽签后随机分为试验组和对照组各45例。试验组中，男28例，女17例，年龄26～75岁，平均（59.44±6.85）岁；慢性肾小球肾炎30例，糖尿病肾病8例，高血压肾病7例。对照组男29例，女16例，年龄27～74岁，平均（60.33±7.12）岁；慢性肾小球肾炎29例，糖尿病肾病9例，高血压肾病7例。两组患者的一般资料相比差异无统计学意义（P>0.05）。

1.2 方法

两组患者行血液透析每周3次，每次4 h，透析机为Fresenius 4008和GAMBRO-AK-95，透析液为标准碳酸氢盐低糖透析液。……