蔡瑜玮　王亚平　屠益微　陈宏才

[摘要] 目的 探討肾病血液透析患者中心静脉置管血栓及纤维鞘形成护理干预方法及其效果。 方法 选择本院2014年10月～2015年10月间收治的65例中心静脉导管功能不良患者为研究对象，根据计算机随机分配原则分为两组，其中对照组32例（给予常规护理模式），研究组33例（给予针对性溶栓护理+健康教育模式），统计并对比两组Kt/V值以及血栓、纤维鞘形成情况和感染、出血、导管皮下隧道扭转及导管打折等的并发症发生率。 结果 研究组Kt/V值[（1.21±0.16）g/L]明显小于对照组[（1.31±0.11）g/L]，差异有统计学意义（P<0.05）；研究组一次及再次导管血栓、纤维鞘形成率均显著低于对照组，差异有统计学意义（P<0.05）；研究组感染、出血、导管皮下隧道扭转、导管打折的并发症发生率为15.15%，显著低于对照组的43.75%（P<0.05）。 结论 对肾病血液透析中心静脉导管患者予以针对性护理干预，给予口服华法林溶栓护理可有效降低肾病血液透析患者的血栓及纤维鞘形成率，适当健康教育还可有效降低并发症发生率，临床治疗效果显著，具有推广应用的价值。

[关键词] 血液透析；中心静脉置管；血栓形成；纤维鞘形成；护理措施

[中图分类号] R473.5 [文献标识码] B [文章编号] 1673-9701（2017）12-0153-04

[Abstract] Objective To explore the nursing intervention and effect of central venous catheter thrombosis and fibrous sheath formation in the patients with renal disease receiving hemodialysis. Methods A total of 65 patients with central venous catheter dysfunction who were collected from October 2014 to October 2015 in our hospital were included in the study subjects. According to the principle of computer randomization， the patients were divided into two groups， with 32 patients in the control group （conventional nursing model）， and 33 patients in the study group （targeted thrombolytic nursing care+health education model）. Kt/V value and thrombosis， fibrous sheath formation and the incidence rates of complications such as infection， bleeding， catheter subcutaneous tunnel torsion and snapped catheterization were statistically analyzed and compared. Results In the comparison of the Kt/V value， the study group （1.21±0.16） g/L was significantly lower than that of （1.31±0.11） g/L in the control group， and the difference between groups was significant（P<0.05）； the incidence rates of single and repeated catheter thrombosis and fibrous sheath formation in the study group were significantly lower than those in the control group， and the differences were statistically significant （P<0.05）. In terms of the incidence rate of complications， the incidence rate of complications such as infection， bleeding， catheter subcutaneous tunnel torsion and snapped catheterization was 15.15%， which was significantly lower than that of 43.75% in the control group（P<0.05）. Conclusion The targeted nursing intervention of oral administration of warfarin thrombolytic nursing for the patients with renal disease receiving hemodialysis by central venous catheter can effectively reduce the incidence rate of thrombosis and fibrous sheath formation. Appropriate health education can also reduce the complication rate， and the clinical efficacy is remarkable， which has the value of popularization and application.

[Key words] Hemodialysis； Central venous catheterization； Thrombosis； Fibrous sheath formation； Nursing measures

血液透析通過将患者体内血液引流至透析器，对肾病患者体内过多的水分及代谢“废物”进行清除，同时补充患者体内缺乏的钙、碳酸氢根等物质，从而代替肾脏行代谢功能。每次血液透析治疗时间通常为4～5 h，可将患者体内55%～75%的肌酐或尿素氮清除出体外，同时将体内多余的水分一并清除。据有关统计表明，2013年我国登记在册的慢性肾脏病患者超过1亿，其中尿毒症患者高达120万～210万，如果全部肾脏病患者都接受血液透析治疗，每年医疗费用可达1100亿。而目前我国肾脏病患者数量仍在持续增加，需要进行血液透析治疗的患者也会随之增加，血液透析治疗已经成为终末期肾病最主要的一种肾脏替代疗法。对于血液透析患者来说，血管通路就是其维持生存的根本。……