1例罗通定中毒患者行集成血液净化治疗的护理体会
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摘要
本院收治1例服用过量罗通定致急性药物中毒、急性肾功能衰竭的患者,给予早期积极的连续血液净化联合间断血液吸附治疗,针对患者的锥体外系反应对症给予安定治疗和个性化的早期活动,针对患者的心境障碍给予奥氮平和拉莫三嗪联合用药及心理护理,集成血液净化治疗过程中配合良好的管路护理、抗凝护理和监测护理,做好导管相关性血流感染,给予良好的营养支持,此外住院期间注意安全防护。
This paper reported a case of acute drug poisoning and acute renal failure induced by administration of overdose Rotundine.The patients received the combined therapies of intermittent hemoperfusion and continuous blood purification.The neuroleptic treatment and individualized early activities were carried out to address the extrapyramidal side effects.The drug administration of olanzapine and lamotrigine,in combination of psychological interventions were used in treatment of mood disorders.During the combined therapies of hemoperfusion and blood purification,comprehensive nursing measures were implemented including high-quality maintenance of pipeline,prevention of catheter-related blood stream infection,nutritional support and safety management.
This paper reported a case of acute drug poisoning and acute renal failure induced by administration of overdose Rotundine.The patients received the combined therapies of intermittent hemoperfusion and continuous blood purification.The neuroleptic treatment and individualized early activities were carried out to address the extrapyramidal side effects.The drug administration of olanzapine and lamotrigine,in combination of psychological interventions were used in treatment of mood disorders.During the combined therapies of hemoperfusion and blood purification,comprehensive nursing measures were implemented including high-quality maintenance of pipeline,prevention of catheter-related blood stream infection,nutritional support and safety management.
引文
[1]杜远东,赵玉珍.罗通定的药理作用和临床应用研究进展[J].西北药学杂志,2012,27(1):91-94.
[2]杨荣利,陈秀凯,王小亭,等.重症血液净化:从连续肾脏替代治疗到集成技术[J].中华医学杂志,2013,93(35):2769-2771.
[3]李建祥,宋玉果,栗建林.血液毒理学[M].北京:北京大学医学出版社,2011:278.
[4]贾公孚,谢惠民.药物联用禁忌手册[M].北京:中国协和医科大学出版社,2001:243.
[5]HERMANS G,DE JONGHE B,BRUYNINCKX F,et al.Clinical review:critical illness polyneuropathy and myopathy[J].Crit Care,2008,12(6):238.
[6]陈伟荣.双相心境障碍的药物治疗进展[J].中国实用医药,2017,12(22):197-198.
[7]STEVENS P E,LEVIN A.Evaluation and management of chronic kidney disease:synopsis of the kidney disease:improving global outcomes 2012 clinical practice guideline[J].Ann Intern Med,2013,158(11):825-830.
[8]NURMOHAMED S A,JALLAH B P,Vervloet M G,et al.Continuous venovenous haemofiltration with citrate-buffered replacement solution is safe and efficacious in patients with a bleeding tendency:a prospective observational study[J].BMC Nephrol,2013,14:89.
[9]张桂芝,李寒,张庆来.持续质量改进在预防血液灌流联合血液透析中凝血的应用[J].护理研究,2011,25(7B):1814-1815.
[10]葛学顺,陈维开,蒋福云,等.集束化干预策略在预防ICU中心静脉导管相关血流感染中的应用[J].中国感染控制杂志,2012,11(6):422-424.
[11]HAN Z,LIANG S Y,MARSCHALL J.Current Strategies for the Prevention and Management of Central Line-Associated Bloodstream Infections[J].Infect Drug Resist,2010,3(10):147-163.
[12]孙晋洁,孙永强.导管相关性血流感染的国外预防研究进展[J].护理学报,2015,22(10):26-30.
[13]MCCLAVE S A,TAYLOR B E,MARTINDALE R G,et al.Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient:Society of Critical Care Medicine(SCCM)and American Society for Parenteral and Enteral Nutrition(ASPEN)[J].JPEN,2016,40(2):159-211.
[14]王新颖.2016年成人危重症病人营养支持治疗实施与评价指南解读[J].肠外与肠内营养,2016,23(5):263-268.
[15]李桦.我国毒物代谢和毒代动力学研究三十年回顾[J].中国药理学与毒理学杂志,2016,30(12):1333-1342.
[2]杨荣利,陈秀凯,王小亭,等.重症血液净化:从连续肾脏替代治疗到集成技术[J].中华医学杂志,2013,93(35):2769-2771.
[3]李建祥,宋玉果,栗建林.血液毒理学[M].北京:北京大学医学出版社,2011:278.
[4]贾公孚,谢惠民.药物联用禁忌手册[M].北京:中国协和医科大学出版社,2001:243.
[5]HERMANS G,DE JONGHE B,BRUYNINCKX F,et al.Clinical review:critical illness polyneuropathy and myopathy[J].Crit Care,2008,12(6):238.
[6]陈伟荣.双相心境障碍的药物治疗进展[J].中国实用医药,2017,12(22):197-198.
[7]STEVENS P E,LEVIN A.Evaluation and management of chronic kidney disease:synopsis of the kidney disease:improving global outcomes 2012 clinical practice guideline[J].Ann Intern Med,2013,158(11):825-830.
[8]NURMOHAMED S A,JALLAH B P,Vervloet M G,et al.Continuous venovenous haemofiltration with citrate-buffered replacement solution is safe and efficacious in patients with a bleeding tendency:a prospective observational study[J].BMC Nephrol,2013,14:89.
[9]张桂芝,李寒,张庆来.持续质量改进在预防血液灌流联合血液透析中凝血的应用[J].护理研究,2011,25(7B):1814-1815.
[10]葛学顺,陈维开,蒋福云,等.集束化干预策略在预防ICU中心静脉导管相关血流感染中的应用[J].中国感染控制杂志,2012,11(6):422-424.
[11]HAN Z,LIANG S Y,MARSCHALL J.Current Strategies for the Prevention and Management of Central Line-Associated Bloodstream Infections[J].Infect Drug Resist,2010,3(10):147-163.
[12]孙晋洁,孙永强.导管相关性血流感染的国外预防研究进展[J].护理学报,2015,22(10):26-30.
[13]MCCLAVE S A,TAYLOR B E,MARTINDALE R G,et al.Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient:Society of Critical Care Medicine(SCCM)and American Society for Parenteral and Enteral Nutrition(ASPEN)[J].JPEN,2016,40(2):159-211.
[14]王新颖.2016年成人危重症病人营养支持治疗实施与评价指南解读[J].肠外与肠内营养,2016,23(5):263-268.
[15]李桦.我国毒物代谢和毒代动力学研究三十年回顾[J].中国药理学与毒理学杂志,2016,30(12):1333-1342.