双机换管法对连续性肾脏替代治疗患者上机血流动力学的影响

Effect of Dual Tube Replacement on the Hemodynamics in Patients Undergoing Continuous Renal Replacement Therapy

目的观察双机换管法对连续性肾脏替代治疗(CRRT)患者上机血流动力学的影响.方法选择2015年2月至2015年11月行CRRT且需要使用去甲肾上腺素维持血压的患者43例,当前CRRT机治疗结束开始回血收机时,使用另外一台CRRT机同时开始引血,采用自身对照法比较患者结束当前治疗时、引血完毕开始下次治疗时以及开始治疗后5 min平均动脉压、心率和中心静脉压以及去甲肾上腺素的用量.结果 43例患者共纳入CRRT 115例次,患者开始回血时、结束引血时以及开始治疗后5 min后血流动力学和去甲肾上腺素用量变化,差异无统计学意义(P>0.05).结论对于血流动力学不稳定的患者行进行CRRT换管时采用双机换管法更换管路和滤器可以减少上机对患者血流动力学的影响,减少治疗中断时间,保持患者生命体征平稳.

Objective To investigate the effect of double tube replacement method on the hemodynamics for patients undergoing continuous renal replacement therapy（CRRT）. Method 43 patients with norepinephrine and CRRT were surveyed retrospectively from February 2015 to November 2015. At the end of the current treatment, double machine operation was used to start blood pump and return the blood to the patient at the same time. The mean arterial pressure,heart rate,central venous pressure and norepinephrine dosage were analyzed at the end of the current treatment and at the beginning and five minutes of next CRRT with self contrast method. Results 43 patients with 115 filters were enrolled in the study.There was no significant change in the hemodynamics and norepinephrine dosage of the patients at the end of the current treatment and at the beginning and five minutes of the next CRRT.Conclusion For patients with homodynamic instability,we can use double tube replacement method to start blood pump and return the blood at the same time during changing tube and filter,which may reduce the impact on the patient’s hemodynamics and interruption of treatment time to maintain a stable life signs.