不同冲洗管路方法对无肝素连续肾脏替代治疗中滤器使用时限的影响

Effect of different pipe flush methods on the life of the filter used in CRRT without heparin

目的探讨无肝素连续肾脏替代治疗（CRRT）期间，不同冲洗管路方法对滤器使用时限的影响。方法将108例行无肝素CRRT患者随机分为实验组56例和对照组52例，对照组给予常规每小时100m10．9％氯化钠溶液冲洗滤器及管路1次；实验组每6小时暂停治疗并以肝素盐水（50mg／L）冲洗管路后用0．9％氯化钠溶液冲洗再继续治疗。比较两组治疗过程中使用滤器数及滤器平均使用时间。结果继发肾衰竭、妊娠合并MODS、重症胰腺炎、中毒、流行性出血热和脑血管意外并发肺炎的实验组患者更换滤器数分别为68，26，39，28，21，26个，均高于对照组的71，35，55，36，24，30个，差异均有统计学差异（X2分别为28．34，15．61，18．08，19．31，18．50，16．72；P〈0．05）；实验组患者滤器使用平均时限为（11．60±1．51）h，高于对照组的（9．48±1．29）h，差异有统计学意义（t=2．79，P〈0．05）。结论无肝素CRRT治疗中，间断使用肝素盐水加0．9％氯化钠溶液冲洗法可减少滤器凝血情况，延长滤器使用时限，降低患者治疗费用。

Objective To investigate the effect of different pipe flush methods on the life of the filter used in CRRT without heparin. Methods 108 patients of CRRT without heparin were randomly divided into observation group （56 cases） and control group （52 cases）. The control group used conventional 100 ml 0.9% sodium chloride solution to flush the filter and pipe once for an hour, while the observation group stopped the treatment every 6 hours, first used heparin saline （50 mg/L）, second 0.9% sodium chloride solution to flush, and then continued the treatment. The number of filter and its average service time were compared during the process. Results The number of filter used to treat patients with secondary renal failure, MODS, severe pancreatitis, poisoning, epidemic hemorrhagic fever and cerebrovascular accident complicated by pneumonia in the observation group was respectively 68,26,39,28,21 and 26, all of which were higher than that of the control group （71,35,55,36,24,30, respectively）, and the differences were not statistically significant （ X2 = 28.34, 15.61,18.08,19.31,18.50, respectively ; P 〈 0.05 ）. The service time of the filter in the observation group was （i 1.60 ± 1.51 ）h, higher than that of the control group which was （9.48 ± 1.29）h, and the difference was statistically significant （t = 2.79,P 〈 0.05 ）. Conclusions In the CRRT without heparin treatment, the method of intermittent saline with heparin and 0.9% sodium chloride solution can reduce the clotting of the filter, extend its life and cut patients＇ treatment cost.