无抗凝剂连续性肾脏替代治疗高危出血患者中适时再次肝素冲洗的护理体会

Nursing Experience of No Anticoagulant Continuous Renal Replacement Therapy in Patients at High Risk of Bleeding Timely Again Heparin Flushing

目的探讨适时再次肝素冲洗法在高危出血患者行无抗凝剂连续性肾脏替代治疗中的护理效果。方法选择我院2013-03∽2015-03间收治的96例行无抗凝剂连续性肾脏替代治疗的高危出血患者作为研究对象,按照随机数字表法分为观察组和对照组各48例,两组患者均采取肝素冲洗管路和滤器,观察组在治疗过程中发现患者有凝血倾向,立即采用肝素再次冲洗。对比分析两组患者的全身活动性出血状况、单次管路和滤器使用时间、血小板的数值及凝血4项。结果治疗前后两组患者血小板数值及凝血4项无明显变化（P〉0.05）;观察组滤器及管路单次使用时间均显著高于对照组（P〈0.05）;观察组活动出血率显著低于对照组（P〈0.05）。结论无抗凝剂连续性肾脏替代治疗高危出血患者中,予以适时再次肝素冲洗,可延长管路和滤器的使用时间,并减少患者全身活动性出血。

Objective To discuss nursing effect of timely irrigation heparin in patients at high risk of bleeding again without anticoagulant continuous renal replacement therapy. Methods 96 patients at high risk of bleeding timely again heparin flushing under no anticoagulant continuous renal replacement therapy from March,2013 to March,2015 were randomly divided into observation group and control group,with 48 cases in each group. Patients of two groups received heparin flushing pipeline and filter. In the observation group,in the process of treatment,when patients were prone to clotting,heparin was used to make immediately rinse again. Systemic active bleeding condition,single line and the filter using time,the value of platelet and coagulation of the two groups were compared. Results Before and after treatment,platelet value and coagulation had no significant change（ P〈0. 05）; in the observation group,filter and pipeline single using time were significantly higher than those in control group（ P〈0. 05）; in the observation group,bleeding rate was significantly lower than the control group（ P〈0. 05）. Conclusion Patients at high risk of bleeding under no anticoagulant continuous renal replacement therapy should get duly heparin flushing again. In this way,it can prolong the life time of the pipeline and filter,and reduce the active bleeding of patients.