无抗凝CRRT体外循环管路冲洗护理对病人凝血指标的影响研究

Influence research of extracorporeal circulation nursing with non-anticoagulant CRRT on the coagulation index of patients

[目的]探索生理盐水冲洗与免冲洗两种方法对有高危出血风险行无抗凝连续性肾脏替代治疗(CRRT)病人凝血指标的影响。[方法]将有高危出血风险行无抗凝CRRT治疗的48例病人随机分为对照组(采用生理盐水冲洗)和观察组(免冲洗),在上机时及上机后1h、3h、6h时将血流速度调至100mL/min后1min时从动脉端采集血标本,通过酶联免疫分析(ELISA)测定两组病人的凝血酶原片段1+2(PF1+2)和β-血小板球蛋白(β-TG)的变化。[结果]两组PF1+2和β-TG的变化值差异均无统计学意义(P>0.05),两组病人因压力高限报警下机时间均在5h以上,初步推断生理盐水冲洗与免冲洗在5h内均能顺利完成治疗,对体外循环管路凝血影响不大,但超过5h时,采用生理盐水冲洗的病人因压力高限报警下机例数明显少于免冲洗病人。[结论]采用生理盐水冲洗对于预防5h以上CRRT体外循环管路的凝血有一定的作用。

Objective： To explore the effect of two methods： physiological saline irrigation and no irrigation on the coagulation index of patients with high risk of bleeding with non anticoagulant continuous renal replacement therapy （CRRT）. Methods： A total of 48 patients at high risk of bleeding risk line with non anticoagulant CRRT treatment were randomly divided into control group （saline irrigation） and observation group （no irrigation）. Blood samples were collected from the arteries at the start of CRRT and 1 min after dispatch blood flow velocity to 100 mL/min in 1 h,3 h,and 6 h from the start. Determined the two groups′ prothrombin fragment （PF1＋2） and β thromboglobulin （β TG） changes through the enzyme linked immunoassay （ELISA）. Results： The differences between two groups′ PF1 ＋ 2 and β TG changes had no statistical significance （ P 〉0.05）.Patients of the two groups kept more than 5 h before the high pressure range alarm,which preliminary inference saline irrigation and no irrigation could complete treatment within 5 h,and had little influence on extracorporeal circulation blood coagulation.When the treatment lasted longer than 5 h,there were significantly fewer patients received the high pressure alarm in the saline irrigation group than the no irrigation group. Conclusion： Using physiological saline irrigation had a certain effect on preventing extracorporeal circulation blood coagulation of CRRT over 5 h.