Predictive nursing intervention of hemodialysis combined with plasma exchange in the treatment of hematological diseases
血液透析联合血浆置换治疗血液系统疾病预见性的护理干预

摘要

目的 血液透析（HD）是利用透析器将体内的血液向体外引流，透析器由空心纤维组成，血液透析的过程是将透析液（及血液与机体浓度相似的电解质容易）经空心纤维进行物质交换的过程。通过血液透析能够将体内的代谢废物清除掉，同时去除体内多余的水分，可维持机体水电解质与酸碱平衡。血浆置换（PE）指的是以离心或者膜式血浆分离的方法分离细胞与血浆，清除有毒或致病血浆，将其引出体外循环，再将新的血浆或者血浆替代品输回到体内，通过血浆置换能够净化血液中大分子物质。血液透析与血浆置换均是临床治疗肾脏疾病、血液疾病等常用的治疗手段。血液透析联合血浆置换术均属于侵入性治疗，操作流程相对复杂、影响因素较多，因此，血浆置换常出现不良反应，在其治疗期间开展预见性全程护理干预能够最大限度降低过敏反应、血管穿刺渗漏、枸盐酸盐中毒、低钙血症、高钾血症等不良事件的产生，采取针对性护理措施，保证血浆置换顺利进行，提高护理质量的一种护理模式。

Abstract

Objective: Hemodialysis (HD) is a process that uses a dialyzer to drain blood from the body to the outside. The dialyzer is composed of hollow fibers. The process of hemodialysis is to disperse, ultrafiltration, adsorption and convection the dialysate (and electrolytes with similar blood concentration to the body) through hollow fibers, forming a process of material exchange. Through hemodialysis, the metabolic wastes in the body can be removed, and the excess water in the body can be removed at the same time, which can maintain the balance of water electrolyte and acid base in the body. Plasma exchange (PE) refers to the separation of cells and plasma by centrifugation or membrane plasma separation, the elimination of toxic or pathogenic plasma, the introduction of it to cardiopulmonary bypass, and the transfusion of new plasma or plasma substitutes back to the body. Plasma exchange can purify large amounts of substances in the blood. Hemodialysis and plasma exchange are commonly used in clinical treatment of kidney diseases, blood diseases, metabolic diseases and immune system diseases. Hemodialysis combined with plasma exchange is an invasive treatment, with relatively complex operation process and many influencing factors. Therefore, adverse reactions often occur in plasma exchange. During the treatment period, predictive whole course nursing intervention can minimize the occurrence of adverse events such as anaphylaxis, vascular puncture leakage, lycium chloride poisoning, hypocalcemia, hyperkalemia, and take targeted nursing measures to ensure the smooth progress of plasma exchange, A nursing mode to improve the quality of nursing.