不同封管方式对急性重度中毒病患者血液灌流期间发生下肢深静脉事件的预防效果

Effects of Different Sealing Methods in Preventing Lower Extremity deep Venous Events in Patients with Acute Severe Poisoning during Hemoperfusion

目的不同封管方式对急性重度中毒病患者血液灌流期间发生下肢深静脉事件的预防效果。方法选取我院2011年5月至2015年5月119例急性重度中毒病行血液灌流患者为研究对象,将患者抽签随机分为改良封管组(67例)与常规封管组(52例)。改良封管组给予高浓度肝素盐水封管结合留置导管内输液,常规封管组采用普通静脉留置封管法,比较两组导管留置时间、昏迷时间、住院时间、住院费用,治疗前后血红蛋白浓度、白细胞计数、血小板计数;记录下肢深静脉血栓、出血情况、导管堵塞发生率。结果两组导管留置时间、昏迷时间比较无统计学意义(P>0.05);改良封管组住院时间、住院费用低于常规封管组(P<0.05)。两组治疗后血红蛋白浓度、白细胞计数、血小板计数均低于治疗前(P<0.05)。改良封管组下肢深静脉血栓发生率0.00%显著低于常规封管组25.00%(P<0.05)。改良封管组其他部位出血发生率4.48%低于常规封管组19.23%(P<0.05)结论高浓度肝素盐水封管结合留置导管内输液进行封管,可有效降低下肢深静脉血栓、非插管部位出血率,缩短住院时间,减少住院费用。

Objective To explore the effects of different sealing methods in preventing lower extremity deep venous events in patients with acute severe poisoning during hemoperfusion. Methods 119 patients with acute severe poisoning who underwent hemoperfusion in our hospital between May 2011 and May 2015 were selected as study subjects and were randomized into modified sealing group（ 67 cases）and conventional sealing group（52 cases）. The modified sealing group was treated with high-concentration heparin saline sealing combined with transfusion in indwelling catheter, while the conventional sealing group was treated with common venous indwelling sealing method. The catheter imtwelling time, duration of coma, length of hospital stay,hospitalization costs, concentrations of hemoglobin, white blood cell count and platelet count before and after treatment were compared between the two groups;The incidence rates of deep venous thrombosis, bleeding and catheter blockage were recorded. Results There were no significant differences in catheter indwelling time and duration of coma between the two groups （ P 〉 0. 05 ） ; The length of hospital stay and hospitalization costs in the modified sealing group were shorter and less than those in the conventional sealing group（ P 〈0. 05 ）. After treatment, concentrations of hemoglobin, white blood cell count and platelet count in both groups were lower than those before treatment（ P 〈 0.05 ）. The incidence of lower extremity deep venous thrombosis in the modified sealing group （0.00%）was significantly lower than that in the conventional sealing group（25.00% ） （ P 〈 0.05 ）. The incidence of bleeding at other sites in the modified sealing group was （4.48 % ） was lower than that in the conventional sealing group （ 19.23 % ） （ P 〈 0. 05 ）. Conclusion The application of high-concentration heparin saline sealed tube combined with transfusion in indwelling catheter can effectively reduce the incidence rates of deep vein thrombosis and bleeding at non intubation sites, shortenhospitalization time, reduce hospitalization costs.