血液透析机的使用与维护

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                    <p style=""><span style="margin: 0px; padding: 0px; max-width: 100%; font-size: 14px; font-family: 宋体; box-sizing: border-box !important; word-wrap: break-word !important;">血液透析机是用于治疗急、慢性肾功能衰竭的主要体外循环设备，在使用中可能出现各种不良事件，最常见的是出现机器报警。血液透析机的报警主要有以下几种情况。</span></p><p style=""><span style="margin: 0px; padding: 0px; max-width: 100%; font-size: 14px; font-family: 宋体; box-sizing: border-box !important; word-wrap: break-word !important;">　　<strong style="margin: 0px; padding: 0px; max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;">一是静脉压高报警。</strong>当静脉压高报警时首先要保持管路畅通，隔离器进血或进水及时给予更换，超滤过高可适当延长透析时间，无肝素透析引起的透析器凝血、阻力大，血液无法回到体内，此时不可将血凝块回输患者体内。如果管路全部凝血，停泵后重新更换透析器及管道，用生理盐水冲洗静脉管路，辨别凝血阻塞的部位。</span></p><p style=""><span style="margin: 0px; padding: 0px; max-width: 100%; font-size: 14px; font-family: 宋体; box-sizing: border-box !important; word-wrap: break-word !important;">　　<strong style="margin: 0px; padding: 0px; max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;">二是静脉压低报警。</strong>此时，应检查静脉管路各接口和连接处有无漏洞、静脉压是否正确、滤网有无堵塞，检查静脉压报警限值，高超滤偶可引起静脉压降低。</span></p><p style=""><span style="margin: 0px; padding: 0px; max-width: 100%; font-size: 14px; font-family: 宋体; box-sizing: border-box !important; word-wrap: break-word !important;">　　<strong style="margin: 0px; padding: 0px; max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;">三是动脉压低报警。</strong>此时，应检查动脉管路有无空气进入，管路是否受压；如减少血流量后动脉压还是没有继续下降，说明动脉血流不足，多为动脉狭窄或动脉针位置不当，患者血压下降时动脉血流也会减小，因此应常规监测血压。</span></p><p style=""><span style="margin: 0px; padding: 0px; max-width: 100%; font-size: 14px; font-family: 宋体; box-sizing: border-box !important; word-wrap: break-word !important;">　　<strong style="margin: 0px; padding: 0px; max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;">四是空气报警。</strong>当空气报警时，应检查机器内是否有大量空气进入血路。动脉压低产生气泡，透析液气泡进入血中，静脉管路会出现老化；如血中未见气泡，重新安装静脉壶和管路，改变探测部位，使静脉壶和管路与空气探测器探头妥贴。也可用少许水或乳膏、霜剂填满管壁与探头之间的空隙。检查管道连接处是否紧密、输液端的夹子是否夹紧、管子是否破损和漏气，如有破损立即更换。输血、灌盐水时不要输入过多空气，一旦透析系统出现严重真空现象，尤其是静脉壶里的血液也流空时，切勿尝试在透析继续运行的情况下抽出气泡或把血液输回患者体内。</span></p><p style=""><span style="margin: 0px; padding: 0px; max-width: 100%; font-size: 14px; font-family: 宋体; box-sizing: border-box !important; word-wrap: break-word !important;">　<strong style="margin: 0px; padding: 0px; max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;">　五是电导度报警。</strong>此时，应检查浓缩是否正确，提起浓缩液吸管，观察浓缩液是否吸入，若吸入则检查透析液流量是否正确，不吸入则检查浓缩液管有无扭曲打结，滤网是否堵塞，接头是否漏气。</span></p><p style=""><span style="margin: 0px; padding: 0px; max-width: 100%; font-size: 14px; font-family: 宋体; box-sizing: border-box !important; word-wrap: break-word !important;">　　<strong style="margin: 0px; padding: 0px; max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;">六是漏血报警。</strong>漏血报警时应首先检查透析器是否破膜，空气大量进入透析液，漏血探测有脏物沉积，探测器故障。处理措施是观察透析液颜色，必要时从透析出口取样测定。如破膜，通常在超滤率过大、透析液管与透析器接头较松的情况下发生，透析液除气不良也会产生大量气泡。若无漏血也未见空气或气泡，则应暂停透析，冲洗机器，必要时将漏血探测器卸下清洗后再使用。</span></p><p style=""><span style="margin: 0px; padding: 0px; max-width: 100%; font-size: 14px; font-family: 宋体; box-sizing: border-box !important; word-wrap: break-word !important;">　　因此，预防血液透析机不良事件，一定要规范透析液的配置、透析用水以及浓缩液的配置。</span></p><p style=""><span style="margin: 0px; padding: 0px; max-width: 100%; font-size: 14px; box-sizing: border-box !important; word-wrap: break-word !important;"><span style="margin: 0px; padding: 0px; max-width: 100%; font-size: 12px; box-sizing: border-box !important; word-wrap: break-word !important;"> <span lang="EN-US" style="margin: 0px; padding: 0px; max-width: 100%; font-size: 10.5pt; font-family: Arial; box-sizing: border-box !important; word-wrap: break-word !important;">  <span class="apple-converted-space" style="margin: 0px; padding: 0px; max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"> </span></span><span style="margin: 0px; padding: 0px; max-width: 100%; font-size: 10.5pt; font-family: 宋体; box-sizing: border-box !important; word-wrap: break-word !important;">血液透析机不同于其他常用电子仪器，在透析过程中，各个单元稍有问题就会造成停机，影响治疗工作的正常进行。因此，要确保机器正常运转，进行严格细致的维护保养及定期的检测与维修管理非常重要。透析机日常维护和保养应结合该机器说明书操作，并在关机状态下进行。机器表面应保持清洁，无灰尘、液体痕迹、血迹。要用清水湿布，必要时用柔性清洁剂清洁机壳，消毒静脉夹及光学传感器，血液监测、气泡监测、空气监测处应保持清洁明亮，以免误报警。如果有污染现象，使用半湿的棉签反复擦洗探头部位，然后用干棉签擦净，保持清洁干燥。仪器红、蓝接头插座上不要滴上透析液，以免形成结晶，堵塞开关弹起。如果发生这种情况，要用注射器在开关的缝隙处滴上冰醋酸，反复按动直到润滑为止；一次效果不好，可重复上面的操作次数。</span></span></span></p><p style=""><img src="http://mmbiz.qpic.cn/mmbiz/rz7R73cuHRrv6jdOCoJeZmYwvEAIoHpY0a7yJL2egiaEokLTpwkIsIRTzTFUic09aEThKHS4hrEcSqU0lAS3tu5g/0" data-ratio="0.14784394250513347" data-w="487" width="auto" width="auto" src="http://mmbiz.qpic.cn/mmbiz/rz7R73cuHRrv6jdOCoJeZmYwvEAIoHpY0a7yJL2egiaEokLTpwkIsIRTzTFUic09aEThKHS4hrEcSqU0lAS3tu5g/0?tp=webp" style="margin: 0px; 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