Objective:To explore risk factors of skin pruritus in peritoneal dialysis patients and the effect of individualized care intervention, to provide guidance for clinical practice.Methods:The total of 87 patients with peritoneal dialysis who were followed-up with pruritus in the Beijing Anzhen Hospital from January 2017 to June 2020 were selected. The Visual Analogue Scale (VAS) was used to evaluate the degree of pruritus, and the patients were divided into two groups: mild-to-moderate skin pruritus group (VAS≤6 points) and severe skin pruritus group (VAS>6 points). The risk factors of severe skin pruritus were analyzed by single factor and multivariate Logistic regression. The improvement of skin pruritus after 3 months of individualized nursing intervention was observed.Results:Among the 87 patients, the mild-to-moderate skin pruritus group and the severe skin pruritus group accounted for 64.4%(56/87) and 35.6%(31/87), respectively. Single factor analysis showed that the age, prevalence of diabetes, serum albumin, serum phosphorus, intact parathyroid hormone and C-reactive protein levels were (61.8 ± 11.5) years old, 33.3%(19/56), (36.3 ± 5.3) g/L, (1.6 ± 0.5) mmol/L, 328.4(144.9, 494.5) ng/L, 2.8(0.6, 8.3) ng/L in the mild-to-moderate skin pruritus group, and (67.0 ± 9.2) years old, 61.1%(19/31), (33.9 ± 4.8) g/L, (1.9 ± 0.3) mmol/L, 397.0(300.0,758.6) ng/L, 7.2(2.6, 17.2) mg/L in the severe skin pruritus group, the differences were significant between the two groups ( t values were -2.17, 2.14, -2.32, Z values were -2.28, -2.90, χ 2 value was 6.07, P<0.05). Logistic multivariate regression analysis showed that low albumin, high blood phosphorus and high C-reactive protein were independent risk factors for severe skin pruritus in peritoneal dialysis patients ( P<0.05). After 3 months of individualized care,18.4% (16/87) patients had complete remission,19.5% (17/87) patients significantly relieved, 55.2% (48/87) relieved, 6.9% (6/87) were ineffective, and the total response rate was 93.1%(81/87). Conclusions:More than one-third of peritoneal dialysis patients with pruritus are severe. Lower serum albumin, higher serum phosphorus and higher C-reactive protein are independent risk factors for severe pruritus in peritoneal dialysis patients. Individualized care can effectively improve pruritus in peritoneal dialysis patients.

Objective:To evaluate the reliability of several formulae for estimating the quantity of glucose absorption of peritoneal dialysate (GA).Methods:Forty-four patients receiving continuous ambulatory peritoneal dialysis (CAPD) were enrolled in this study. The quantities of GA obtained from actual measurement and estimation were compared to judge whether there was statistical difference between them.Results:The GA quantities estimated by Grodstein formula, Bodnar formula, K/DOQI formula, empirical method A (based on 60% absorption rate) and empirical method B (based on 50% absorption rate in daytime and 80% absorption rate in night) were as follows: 81.3 (64.2, 118.0) g, (97.8±19.7) g, (94.1±25.8) g, 87.1 (76.2, 109.0) g and (89.5±16.0) g, respectively; the actually measured GA quantity was [94.2 (77.5, 111.6)] g. Wilcoxon signed rank test of paired samples showed that only the results of Bodnar formula and K/DOQI formula did not present statistical differences from actually measured result.Conclusion:It can be considered to use Bodnar formula and K/DOQI formula to roughly estimate the GA quantity of CAPD patients, but to accurately understand the individual GA value, actual measurement is still required.

Objective:To discuss the effect of experiential diet education on the compliance of low-protein diet in patients with chronic kidney disease(CKD), provide basis for improving the compliance of low protein diet in patients with CKD.Methods:A total of 119 patients with CKD stage 3 who were hospitalized from March 2018 to September 2019 in the Division of Nephrology of Beijing Anzhen Hospital, Capital Medical University were selected. They were divided into the following two groups according to the admission time: the control group (58 cases) from March to December 2018 received traditional education, and the observation group(61 cases) from January to September 2019 received systematic experiential diet education on the basis of the control group. At the time of discharge, the eating experience of the observation group was investigated. Three months after discharge, the LPD compliance of the patients in the two groups were investigated by questionnaire, and statistical analyses were performed. And the reason why the observation group could not continue to use CKD nutrition package was analyzed.Results:The score of compliance was (49.44±6.38) points in the observation group and (45.50±6.45) points in the control group, the difference was statistically significant ( t value was 2.68, P<0.05). At the time of discharge, the satisfaction of the observation group was more than 70%, but only 6 patients (9.8%,6/61) adhered to the nutritional package after 3 months. The main reasons why 55 patients could not insist were expensive cost and inconvenient production. Conclusions:Experiential diet education for patients with CKD is a brand-new education model combining routine education and diet experience practice. It can effectively improve the compliance of patients with LPD, which is worth being popularized.

Objective To sum up nursing experience of cerebrospinal fluid drainage in patients with aortic dissection with paraplegia after sun′s operation. Methods Retrospective analysis of 17 cases of clinical nursing care from January 2014 to December 2016, summing up related nursing experience includingintensive care of cerebrospinal fluid drainage, observation of limb movement and muscle strength, monitoring complications, maintain stable hemodynamics, strengthen the life nursing during hospitalization, in order to ensure the drainage of cerebrospinal fluid. Results 2 deaths, Recovery of different degrees of paraplegia or paresis in 12 and persistent paraplegia in 12 out of the other 15 patients, 9 patients recovered and discharged,6 cases transferred to rehabilitation hospital. Conclusions Careful nursing of cerebrospinal fluid drainage can improve paraplegia or lower extremity paresis caused by spinal cord ischemia,and promote patients′rehabilitation.

Objective:To explore the inducing factors of symptom onset in patients with symptomatic carotid artery stenosis, and to provide basis for preventive care.Methods:Totally 104 patients with symptomatic carotid artery stenosis hospitalized in Stroke Ward from September 2014 to December 2017 were selected by convenience sampling method. The clinical data of patients were analyzed retrospectively, and the possible inducing factors were analyzed.Results:there were 104 patients with symptomatic carotid artery stenosis, and 35 patients (33.7%) had obvious inducing factors before onset, but 69 patients (66.3%) had not. The inducing factors were classified into ten categories: posture, activity and fatigue, mood, blood pressure reduction, eating, drinking, noisy environment, hot bath, sweating and cold stimulation. There was no significant difference in gender, age, single and bilateral stenosis, comorbidities (hypertension, diabetes, coronary artery disease, hyperlipidemia) and smoking between the induced group and the non-induced group ( P>0.05). Among the 31 patients with a history of alcohol consumption, 15 had an inducement, accounting for 48.4%; among the 73 patients without a history of alcohol consumption, 20 had an inducement, accounting for 27.4%. The difference between the two groups was statistically significant ( χ 2=4.294, P<0.05).Three cases (8.6%) were directly caused by drinking alcohol. Conclusion:There are many inducing factors for symptomatic carotid artery stenosis, especially for drinking patients, health education should be given, and corresponding preventive measures should be taken to reduce the occurrence of symptoms.

Objective:To summarize the nursing experience of patients with traumatic aortic dissection.Methods:The clinical data of 72 patients with traumatic aortic dissection treated in our department from January 2009 to August 2020 were retrospectively analyzed. Maintain hemodynamic stability and prevent shock, accurate judgment and effective analgesia, safe transportation and avoid secondary damage, careful skin care during bed confinement, prevention of deep vein thrombosis, lung nursing after thoracic injury are included.Results:Totally 69 patients survived, the survival rate was 95.83%. 1 patient was critically ill before the operation and was treated with invasive ventilator at admission. After the above nursing, he could not maintain effective vital signs and died. 1 patient died of aortic dissection rupture before operation. 1 patient died of disseminated intravascular coagulation after stent implantation. 1 patient suffered from skin pressure injury during hospitalization. No aortic rupture or fracture site displacement occurred in tran sit. Among the 5 patients with atelectasis, 1 died of using invasive ventilator before operation, and the other 4 patients recovered well after treatment with noninvasive positive pressure ventilation. No DVT occurred in all patients during hospitalization, 1 patient was diagnosed as deep vein thrombosis and pulmonary embolism at admission. After treatment, the symptoms of pulmonary embolism improved.Conclusions:Pay attention to hemodynamic monitoring and maintenance of stability, accurate analgesia, safe transport, skin care, anticoagulation prevention of deep vein thrombosis and intraoperative bleeding, lung care after chest injury, can effectively reduce complications and promote the rehabilitation of patients.