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目的探讨采用无肝素血浆置换(PE)治疗肝功能衰竭患者的护理及安全性。方法采用血浆置换对72例肝功能衰竭患者进行治疗,随机分为2组,治疗组40例进行无肝素血浆置换治疗,共116人次,持续用注射泵进行生理盐水冲洗分离器及管路,对照组32例常规加用肝素进行血浆置换治疗,共90人次,观察2组患者治疗中及治疗后出凝血相关不良反应及并发症的发生情况。结果治疗组除PE治疗中常见的不良反应外,无1人次出现血浆分离器及管路凝血以及术中和术后出血等并发症,对照组发生出凝血相关性不良反应15人次,2组对照出凝血相关性不良反应发生情况差异有显著统计学意义(P<0.01),护理干预后出凝血相关并发症情况差异无统计学意义(P>0.05)。结论采用无肝素人工肝血浆置换(PE)治疗肝功能衰竭,出血及凝管的发生率低,操作简单,安全性较高,同时,做好术前心理护理、术中密切观察患者的生命体征并配合医生及时处理并发症,是无肝素血浆置换治疗顺利完成的基础。
Objective To investigate the nursing and safety of hepatic failure patients treated with heparin-free plasma exchange (PE). Methods Seventy-two patients with liver failure were treated by plasma exchange. They were randomly divided into two groups. Forty-five patients in the treatment group were treated with heparin-free plasma exchange, 116 times in total. A total of 32 patients were treated with plasma exchange with heparin for a total of 90 patients. The adverse reactions and complications of coagulation were observed during and after treatment in both groups. Results In addition to the common side effects of PE treatment, none of the patients presented with plasma separator, coagulation of blood vessels, complications such as intraoperative and postoperative bleeding, and 15 patients with coagulation-related adverse reactions in the control group. There were significant differences in the incidence of coagulation-related adverse reactions (P <0.01). There was no significant difference in coagulation-related complications after nursing intervention (P> 0.05). Conclusion The treatment of hepatic failure with heparin-free artificial liver plasma exchange (PE) has a low incidence of hemorrhage and coagulation. It is simple and safe to operate. At the same time, preoperative psychological nursing is performed and the vital signs And with the doctor in a timely manner to deal with complications, is the basis for the successful completion of heparin-free plasmapheresis.