ICU患者持续性肾脏替代治疗非计划性下机相关因素的研究

Related factors of unplanned end of continuous renal replacement therapy for ICU patients

目的探讨ICU患者持续性肾脏替代治疗(CRRT)不同时段非计划性下机的相关影响因素,为临床CRRT患者的科学管理提供依据。方法采用便利抽样法,选取2015年6月至2016年6月行CRRT的107例患者,统计CRRT非计划性下机例次,并分析相关因素。结果107例患者共行CRRT 408例次,其中非计划性下机304例次,发生率74.51%,CRRT非计划性下机的时间为(24.41±11.50)h。其中24h内下机172例次(56.58%),其受血泵速度、PT值、血小板值影响;超过24h无明确诱因下机132例次(43.42%),其受血泵速度、APTT值、抗凝方式、PT值及血小板值影响。结论 CRRT非计划性下机多发生在24h内,24h内非计划性下机与血流速、PT值、血小板值有关,同时与医护人员的操作密切相关;超过24h非计划性下机与血流速、APTT值、抗凝方式、PT值、血小板值有关。ICU科室应加强相关制度制定及医护人员专科培训,提高CRRT相关操作能力与知识水平,排除和及时处理各种报警,避免体外循环凝血,保证中心静脉留置导管的通畅。

Objective To investigate the related factors of unplanned end of continuous renal replacement therapy （CRRT） in different stage for ICU patients, and to provide reference for scientific management for patients undergoing CRRT. Methods A total of 107 patients undergoing CRRT from June 2015 to June 2016 were recruited by convenience sampling, the case times of unplanned end of CRRT for the patients were recorded and related factors were analyzed. Results Totally 408 case times of CRRT were recorded for the 107 patients, and 304 case times of unplanned end were recorded, the rate of unplanned end was 74.51%. The average time of unplanned end of CRRT was 24.41± 11. 50 hours. One hundred and seventy two case times （56.58G） of the unplanned end happened within 24 hours of CRRT, which was influenced by the speed of blood pump, prothrombin time （PT） and platelet count, another 132 case times （43.42 G） without uncertain incentives happened over 24 hours of CRRT, which was affected by blood pump speed, activated partial thromboplastin time （APTT）, anticoagulation therapy, PT and platelet count. Conclusion Unplanned end of CRRT always happens in the first 24 hours, the unplanned end occurred within 24 hours has something to do with the speed of blood pump, PT, platelet count, and it also has close relationship with the operation of medical staff; while the unplanned end occurred over 24 hours is affected by speed of blood pump, APTT, antieoagulation therapy, PT and platelet count. ICU should draft relevant rules and regulations and strengthen specialized training for medical staff, so as to improve CRRT relevant skills and knowledge, exclude and deal with all kinds of alarm in time to avoid extraeorporeal circulation blood coagulation, and ensure the central venous indwelling catheter is unobstructed.