血液透析患者紧急脱机方法研究

Emergent off-machine method in patients by hemodialysis

目的探讨血液透析患者在紧急状况下快速脱机的适宜方法。方法选择90例血液透析患者作为研究对象,分为常规回血脱机组(A组)、拔针脱机组(B组)和夹管脱机组(C组)各30例,比较3种方法脱机操作所用时间、安全性及不同血管通路对脱机时间的影响。结果3种脱机方法完成操作所用时间为:A组(391±85)秒,B组(68±12)秒,C组(30±9)秒,B、C两组与A组比较,差异均有统计学意义(P<0.05);安全性方面,B、C组患者均有约300ml血液丢失,C组患者血管通路未及时处理,有发生出血的可能。结论回血脱机法脱机用时最长,但最安全;拔针脱机、夹管脱机两种方法用时短,但存在血液丢失和/或血管通路出血危险的弊端,适用于非常危急状况下患者的脱机。

Objective To explore a rapid off-machine method for hemodialysis patients in emergency. Methods We selected 90 cases of hemodialysis patients as research objects which were randomly divided into 3 groups：the blood returning off-machine group （group A）,the needle withdrawing off-machine group （group B） and the tube clipping off-machine group （group C）. The operation time and safety of the 3 off-machine methods were compared. Results The operation time by three off-machine methods was 391±85″ in group A,68±12″ in group B and 30±9″ in group C respectively. There was significant difference between group A and group B （P 〈 0.001）. There was significant difference between group A and group C （P〈0.001）. In terms of safety,patients in group B and group C lost about 300ml of blood. Patients in group C bore risk of bleeding for untimely dealing of vascular access. Conclusion The blood returning off-machine method is the safest,but takes the longest time. Needle withdrawing off-machine method and tube clipping off-machine method take shorter time but bear risk of blood loss or bleeding in vascular access,which are suggested to use in critical conditions.