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4种体位方式对腹膜透析术后早期导管移位的影响

杨君 李嵘 李会平 董凡凡 陈彤 王梦 李晓利   

  1. 第四军医大学西京医院肾脏内科
  • 出版日期:2015-11-25 发布日期:2015-11-25

Comparison of effects of four position ways on reduce the incidence of catheter displacement in early stage of peritoneal dialysis

  • Online:2015-11-25 Published:2015-11-25

摘要: 目的:探讨在腹膜透析患者置管术后运用4 种体位方式对患者进行腹腔冲洗,降低腹膜透析术后早期导管移位的发生率。方法:将120 例首次进行腹膜透析置管患者随机分为四组,均于24 小时内使用1.5% 乳酸盐腹膜透析液进行腹腔冲洗,冲洗方式均为利用重力作用方式,每日1 次,连续5 天。A 组(30 例)采用去枕平卧位方式冲洗腹腔;B 组(30 例)采用坐位方式冲洗腹腔;C 组(30 例)采用立位方式冲洗腹腔;D 组(30 例)采用半卧位方式冲洗腹腔。结果:通过对四组患者导管位置进行评分比较,所得结果的差异有统计学意义,C 组评分优于其他3 组(均P <0.05),四组患者在进行术后腹腔冲洗时的疼痛程度比较,差异有统计学意义,C 组优于其他3 组(均P <0.05)。四组患者均无伤口渗液、腹腔出血、相关感染以及疼痛使用药物等并发症的发生。但四组患者中平卧位和半卧位容易引起便秘的发生。结论:采用立位方式对患者术后进行腹腔冲洗可减少术后导管移位的发生,不会增加患者的便秘和疼痛感,在腹膜透析置管术后,没有任何禁忌证的情况下,腹透护士可将腹透液悬挂于输液架上,利用重力作用对患者采取立位的方式进行腹腔冲洗。

Abstract: Objective: To explore the effect of four position ways of peritoneal lavage on reducing the incidence of catheter displacement in early stage of peritoneal dialysis. Methods: The 120 new peritoneal dialysis patients receiving peritoneal lavage with 1.5% lactated peritoneal dialysis solution were randomly divided into four groups: group A (n=30), lying position lavage;group B (n=30), sitting position lavage; group C (n=30), standing position lavage and group D (n=30), semi-reclining position lavage. The gravity-assisted lavage was performed once a day for 5 consecutive days in the four groups. Results: There was statistical difference in both scores of the catheter tip position and the pain intensity scores during lavage among the four groups,with group C significantly lower than the other 3 groups (P<0.05 for al1). None of patients in the four groups developed wound effusion, peritoneal bleeding, infection and pain medication using. However, constipation was easily produced with lying and semi-reclining position lavage among the four groups. Conclusion: Standing position could reduce catheter displacement in early stage of peritoneal dialysis without increasing subjective pain intensity and constipation, which is recommended for patients without contraindications. The peritoneal dialysis nurses could hang the peritoneal dialysis solution on the infusion rack and use the gravity-assisted lavage in standing position.