血浆吸附治疗严重多发伤并发重度淤胆型肝炎的护理干预措施研究
[摘要]目的 探讨血浆吸附治疗严重多发伤并发重度淤胆型肝炎的护理干预措施。方法 选取2012年5月～2017年5月我院收治的严重多发伤并发重度淤胆型肝炎患者12例，随机分为两组，对照组应用保肝、降低胆红素等基础治疗并结合常规护理，研究组应用基础治疗基础上联合经血浆吸附治疗并加强护理干预，比较总胆红素（DB）和直接胆红素（TB）水平，不同阶段谷丙转氨酶（ALT）。结果 干预前两组患者DB、TB水平无明显差异（P>0.05）；干预后研究组DB、TB水平低于对照组（P<0.05），干预前两组无明显差异（P>0.05），干预后研究组ALT水平低于对照组（P<0.05）。结论 严重多发伤并发重度淤胆型肝炎患者的治疗过程中，血浆吸附的治疗效果理想，加强护理干预后，患者总胆红素及直接胆红素水平明显降低，患者病情得到明显改善，临床上应当进一步推广应用。
[关键词] 血浆吸附；严重多发伤；并发；重度淤胆型肝炎；护理
[中图分类号] R473.6 [文献标识码] B [文章编号] 1673-9701（2018）08-0150-03
Nursing intervention measures of plasma adsorption therapy in treating severe multiple injury combined with severe cholestatic hepatitis
GAO Hong
Department of Liver Diseases and Oncology， Shenyang Sixth People"s Hospital， Shenyang 110000，China
[Abstract] Objective To investigate the nursing interventions of plasma adsorption in the treatment of severe multiple injury combined with severe cholestatic hepatitis. Methods 12 patients with severe multiple injury complicated with severe cholestatic hepatitis treated in our hospital from May 2012 to May 2017 were randomly divided into two groups. The control group was treated with basic therapy such as hepatoprotective and bilirubin reduction combined with routine nursing. The study group was treated with plasma adsorption therapy and strengthened nursing intervention based on the basic treatment. The levels of DB （total bilirubin）， TB （direct bilirubin） and ALT （alanine aminotransferase） of different stages were compared. Results There was no significant difference in the levels of DB and TB in the two groups before intervention（P>0.05）. After intervention， the levels of DB and TB in the study group were lower than those in the control group （P<0.05）. There was no significant difference between the two groups before intervention（P>0.05）. The level of ALT in the study group was lower than that in the control group after intervention （P<0.05）. Conclusions Plasma adsorption has a satisfactory treatment effect in the patients with severe multiple traumatic injury complicated with severe cholestatic hepatitis. After strengthening nursing intervention， the patients" total bilirubin and direct bilirubin levels are significantly reduced， and the patient"s condition is significantly improved. The application of nursing interventions should be further promoted clinically.
[Key words] Plasma adsorption； Severe multiple injuries； Complicating； Severe cholestatic hepatitis； Nursing
严重多发伤一般是指在事故发生之后，因为同一个致伤原因使人体两个以上的脏器或者是解剖部位发生情况严重的损伤[1]。严重多发伤患者在早期对损伤进行控制和外科处理与治疗复苏后，仍有一定几率发生气管功能性障碍而发生死亡[2]。严重多发伤之后患者肝胆在没有直接发生损伤或是胆道梗阻情况下，会发生氨基转移酶升高为主要特征的肝细胞性黄疸，但是并发重度淤胆型肝炎的情况较为少見，并且药物临床治疗效果和患者预后情况并不理想[3]。血浆吸附治疗是通过对血浆分离及特异性吸附仪器，将血浆或是全血当中的特定物质进行吸附的情况。我院在严重多发伤并发重度淤胆型肝炎患者临床治疗中应用血浆吸附方法进行治疗并加强护理干预措施，效果理想，现报道如下。