无抗凝日间肾脏替代治疗凝血堵管相关因素分析

Analysis on related factors of anticoagulant-free daytime renal replacement therapy

目的:分析无抗凝日间肾脏替代治疗(RRT)凝血堵管的相关因素。方法:选择行无抗凝日间RRT的患者239例,记录患者一般人口学资料、治疗时间、机型、滤过膜面积、滤过膜材料、血管通路、治疗方式、是否输注血制品、是否间断生理盐水冲洗,治疗前实验室检查(包括血常规、血生化及凝血功能),是否发生体外循环凝血堵管。应用t检验、秩和检验、卡方检验、非条件Logistic回归分析无抗凝日间RRT体外循环的危险因素。结果:体外循环发生凝血堵塞118例(49.4%),平均使用时间(252.4±4.1)min。高红细胞压积(HR:1.077,95%CI:1.030~1.126,P=0.001)、高血小板计数(HR:1.007,95%CI:1.002~1.012,P=0.004)、间断生理盐水冲洗(HR:2.699,95%CI:1.096~6.650,P=0.031)是无抗凝日间RRT凝血堵管的独立危险因素。结论:高血小板计数,高红细胞压积,间断生理盐水冲洗均是无抗凝日间RRT凝血堵管的危险因素,但可能需要更大样本的前瞻性研究以确定持续生理盐水冲洗是否相对于间断生理盐水冲洗更有利于降低凝血堵管的发生。

Objective： To identify the related factors of anticoagulant-free daytime renal replacement therapy.Methods 239 patients with anticoagulant-free daytime renal replacement therapy were enrolled in our study. We obtained information on demographic data,treatment time,models,area and material of filtration membrane,vascular access,treatment methods,using blood products or not,using albumin or not,intermittent saline flushing or not,laboratory examination,including complete blood count,blood chemistry and coagulation function before anticoagulant-free daytime renal replacement therapy,whether coagulation happened in extracorporeal circulation. We analyzed the effects of each factor on circuit life of anticoagulant-free daytime renal replacement therapy with T test,Rank test,Chi-square tests and Logistic regression analysis. Results： The obstruction occurred in 118 patients（ 49. 4%） because of coagulation. The mean circuit life was（ 252. 4 ± 4. 1） min. The mean age of patients was（ 48. 4 ± 4. 1） years old and there were 168males（ 70. 3%）. It was found that higher Hct,higher PLT and intermittent saline flushing were independent risk factors of anticoagulant-free daytime renal replacement therapy. Conclusion： Higher Hct（ HR： 1. 077,95% CI： 1. 030-1. 126,P = 0. 001）,higher PLT（ HR： 1. 007,95% CI： 1. 002-1. 012,P = 0. 004） and intermittent saline flushing（ HR： 2. 699,95% CI： 1. 096-6. 650,P = 0. 031） are all independent risk factors to coagulation of anticoagulant-free daytime renal replacement therapy. We may need further survey to confirm whether continuous saline infusion is more effective than intermittent saline flushing to protect clotting.