An observation on application of modified perfusion device pre-flushing method in double plasma molecular adsorption system treatment and nursing care effect on patients with liver failure / 中国中西医结合急救杂志

ABSTRACT

Objective To observe the application of modified perfusion device pre-flushing method in double plasma molecular adsorption system (DPMAS) treatment and nursing care effect on patients with liver failure. Methods A retrospective analysis was conducted; 56 patients with liver failure who were consistent with the enrolled standard and admitted to the Surgical Intensive Care Unit (SICU) of Beijing Chaoyang Hospital fromJune 2014 to December 2016 were the objects of the study and their clinical data were collected. Ten patients involving the results of 17 case times from June 2014 to April 2015 were selected as the control group by using the traditional method of pre-flushing, and 46 patients involving the results of 68 case times from May 2015 to December 2016 were chosen as the observation group by using the modified perfusion device pre-flushing method. Both groups adopted effective nursing care cooperation such as closely observe the changes of symptoms and signs of patients during the peri-treatment period, strengthen psychological care, maintain pipeline properly, and carry out the preventive management of anticoagulation and potential complications. The changes of symptoms and signs in the patients of two groups were observed, the DPMAS pre-flushing time and single time effective treatment time of the two groups were compared, before and 3 days after DPMAS treatment, the changes of serum total bilirubin (TBil), total bile acid (TBA) and its clearance rate, the changes of electrolytes, liver and kidney functions, blood routine and blood coagulation function were observed and compared between the two groups to evaluate and analyze the therapeutic effect of DPMAS.Results In the two groups, there were 56 patients involving 85 case times of DPMAS treatment all successfully completed, and the patients' symptoms and signs were improved significantly. The pre-flushing time of the observation group was obviously shorter than that in the control group (minutes 29.5±13.1 vs. 38.9±14.7), and the single effective treatment time was obviously longer than that in the control group (minutes 6.7±1.1 vs. 3.4±0.9,P 0.05), and urea nitrogen (BUN), creatinine (Cr), hemoglobin (Hb), platelet count (PLT), Na+ and K+ had no significant changes compared with those before treatment (allP > 0.05). The TBil clearance rate [(42.5±15.5)% vs. (32.9±13)%] and TBA clearance rate [(27±8.9)% vs. (17.1±5.8)%] in the observation group were significantly higher than those in the control group (allP < 0.05). There were no adverse events such as electrolyte disturbance, errhysis or bleeding found in the two groups during the treatment. In the study, there were 8 case times with self feeling of skin itching, 8 case times of skin rash, 6 case times of nausea and vomiting, 6 case times of chest tightness, 5 case times of blood pressure dropping phenomena and 4 case times of fever symptoms, and after the symptomatic treatments and nursing intervention, all the above symptoms were relieved or disappeared.Conclusion The modified perfusion device pre-flushing method can effectively elevate the pre-flushing effect and therapeutic effect, it is simple, time-saving, can reduce the economic burden of the patients, thus it is worthy to be used widely in clinic, during the therapeutic process, reasonable and effective nursing measures are practiced, that is the key to guarantee the successful treatment of patients.