生理盐水冲管频率对无肝素CRRT治疗患者血流感染的影响分析

Influence of frequency of flushing of in vitro pipelines with normal saline on bloodstream infection in patients undergoing heparin-free CRRT

目的探讨生理盐水冲管频率对无肝素连续肾脏替代治疗(CRRT)患者血流感染的影响。方法选取2015年1月-2016年12月于医院进行CRRT治疗患者384例,采用随机数字表法将患者分为试验组和对照组,每组192例;两组患者均接受无肝素CRRT治疗,治疗过程中,试验组和对照组采用生理盐水冲洗体外管路的频率分别为100ml/6h和100ml/h,记录两组患者滤器使用当日的凝血功能指标,比较两组患者使用滤器平均治疗时间、平均滤器使用时间和平均管路使用时间,记录两组患者血流感染的发生率。结果滤器使用当日,两组患者纤维蛋白原降解产物、纤维蛋白原、凝血酶时间、凝血酶原时间、国际标准化比值和活化部分凝血酶时间比较差异均无统计学意义;试验组和对照组分别完成连续性静脉-静脉血液滤过(CVVH)治疗396次和404次;两组平均治疗时间、平均滤器使用时间和平均管路使用时间比较差异均无统计学意义;试验组和对照组分别发生2例和12例血流感染病例,感染率分别为1.04%和6.25%,两组感染率比较差异有统计学意义(P<0.05)。结论高频率生理盐水冲洗可能无助于改善患者凝血功能,而且可能会增加血流感染的风险,其在临床应用中的必要性值得商榷。

OBJECTIVE To explore the influence of frequency of flushing of in vitro pipelines with normal saline on bloodstream infections in patients undergoing heparin-free continuous renal replacement therapy （GRRT）. METHODS A total of 384 patients who received the CRRT in the hospital from Jan 2015 to Dec 2016 were enrolled in the study and randomly divided into the observation group and the control group, with 192 cases in each group. Both groups of patients were treated with heparin-free CRRT; the frequency of flushing of in vitro pipelines with normal saline was 100 m1/6 h in the observation group, 100 ml/h in the control group; the blood coagulation func- tion indexes of the two groups of patients were recorded on the day of use of filters; the average time of use of ters for treatment, average time of use of filters and average time of use of pipelines were compared between the two groups of patients, and the incidence of bloodstream infections of the two groups of patients was recorded. RESULTS There was no significant difference in the fibrinogen degradation products, fibrinogen, thrombin time, prothrombin time, international normalized ratio or activated partial thrombin time between the two groups of pa- tients on the days of use of filters.The continuous veno-venous hemofiltration （CVVH） therapy was completed for 396 times in the observation group, 404 times in the control group.There was no significant difference in the aver- age treatment time, average time of use of filters or average time of use of pipelines between the two groups.To- tally 2 patients had bloodstreamtions rate was 1.04% in the observation group, 6.25 % in the control group, and there was significant difference in the infection rate between the two groups （P〈0.05）.CONCLUSION The high frequency of flushing with normal saline may not improve the blood coagulation function but lead to the increase of risk of bloodstream infections, and the necessity of its clinical application is worthy to be discussed.