间歇式静脉壶冲洗法预防无肝素透析凝血的效果分析

Effect analysis of intermittent intravenous pot washing on prevention of coagulation during heparin-free hemodialysis

目的：探讨间歇式静脉壶冲洗法在无肝素透析过程中预防透析凝血的效果和安全性。方法选取新桥医院无肝素透析患者50例,均采用肝素预充管路,分别按2种盐水冲洗方法进行无肝素透析1次,按照冲洗方法分为对照组和实验组各50例。对照组每隔半小时使用150 ml 0.9%氯化钠溶液从泵前冲洗透析器和管路1次,实验组每隔半小时使用100 ml和50 ml 0.9%氯化钠溶液分别从泵前和静脉壶补液管冲洗透析器和管路1次,比较两组透析器和静脉壶凝血情况以及透析完成情况。结果实验组的静脉壶Ⅲ~Ⅳ级凝血6例,对照组18例,差异有统计学意义（Z=-2.667,P〈0.05）；实验组的透析器Ⅲ~Ⅳ级凝血10例,对照组14例,差异无统计学意义（Z=-0.785,P〉0.05）；对照组患者中6例因静脉壶凝血提前结束治疗,实验组只有1例,差异有统计学意义（χ2=3.841,P〈0.05）。结论在无肝素透析中,间歇式静脉壶冲洗法能够改善静脉壶凝血情况,提高无肝素透析的质量,值得临床推广。

Objective To explore the efficacy and safety while applying the intermittent intravenous pot irrigation method on preventing the clotting during the heparin-free dialysis. Methods To select 50 patients without using heparin during hemodialysis in Xinqiao Hospital, they were filled intravenous tube by heparin before hemodialysis and received hemodialysis. All patients were divided into control group and experimental group according to two different salt washing methods. The patients of control group underwent 150ml normal saline to wash hemodialysis machine every half hour and tube once from pump while all cases in the experimental group were given 100ml and 50 ml normal saline to wash hemodialysis machine and intravenous pot every half hour and wash tube once. The coagulation of hemodialysis machine and intravenous were compared as well as the completion status of hemodialysis. Results The intravenous pot of experimental group had 6 cases Ⅲ-Ⅳ grade coagulation while it was 18 cases in the control group （ Z = -2. 667, P 〈0. 05 ）; hemodialysis machine coagulation of experimental group had 10 cases Ⅲ-Ⅳ grade compared 14 cases in the control group （ Z =-0. 785,P〉0. 05）;6 cases had been finished treatment earlier because of intravenous pot coagulation in the control group while it was just on cases happened in the experimental group （χ2 = 3. 841,P 〈 0. 05）. Conclusions During the heparin-free hemodialysis, intermittent intravenous pot washing method can improve the situation of the coagulation in the intravenous pot and contribute the quality of heparin-free dialysis. It is worthy of promoting in the clinical.