无抗凝连续性肾脏替代治疗体外循环装置使用时间影响因素的研究

Study on factors influencing lifespan of the extracorporeal circuit device in continuous renal replacement therapy without anticoagulation

目的探讨影响无抗凝连续性肾脏替代治疗(CRRT)体外循环装置使用时间的主要影响因素,为合理的无抗凝CRRT护理风险评估提供依据。方法对2015年7月至2018年7月首次行无抗凝CRRT合并高危出血风险的257例急慢性肾衰竭患者进行回顾性分析。结果无抗凝CRRT治疗中体外循环装置发生衰竭125例(48.64%),CRRT体外循环装置使用时间为(248.51±87.56)min。多因素Cox比例风险回归模型分析显示,4个独立影响因素与体外循环装置使用时间显著相关,分别为:治疗中血流量不畅停泵次数(HR=1.572,95%CI=1.373~1.801),静脉壶栓塞容积比(HR=1.022,95%CI=1.014~1.030),红细胞压积(HR=1.037,95%CI=1.007~1.068),CRRT治疗剂量(HR=1.336,95%CI=1.007~1.772)。结论治疗中血流量不畅停泵次数、高静脉壶栓塞容积比、高红细胞压积、高CRRT剂量是影响无抗凝CRRT体外循环装置使用时间的独立危险因素;治疗中施行周期性生理盐水冲洗并不能有效延长体外循环装置的使用时间。临床工作者应针对相关危险因素有针对性地制定干预措施,进而最大限度地降低体外循环装置衰竭的发生率,延长装置使用时间,保障医疗护理安全。

Objective To investigate the main risk factors that influence lifespan of the extracorporeal circuit device in continuous renal replacement therapy (CRRT) without anticoagulation, to provide evidence for nursing risk assessment of non-anticoagulant CRRT. Methods A retrospective analysis was performed to enroll 257 patients with acute renal failure or chronic renal failure and at high risk of bleeding.The patients were admitted to hospital from July 2015 to July 2018, and underwent first time non-anticoagulant CRRT treatment. Results A total of 125(48.64%) experienced extracorporeal circuit device failure during non-anticoagulant CRRT and lifespan of extracorporeal circuit device averaged (248.51±87.56)min. Multivariate Cox proportional hazards regression model analysis showed that four independent factors were associated with extracorporeal circuit device lifespan significantly respectively: frequency of pump interruption due to poor blood flow ( HR =1.572,95% CI =1.373-1.801),the volume ratio of venous chamber embolism ( HR =1.022,95% CI =1.014-1.030), hematocrit ( HR =1.037, 95% CI =1.007-1.068), and the dose of CRRT ( HR =1.336,95% CI =1.007-1.772). Conclusion Such factors as frequent pump interruption due to poor blood flow, high volume ratio of venous chamber embolism, high hematocrit values, and high-dose CRRT were significantly associated with the lifespan of extracorporeal circuit device during non-anticoagulant CRRT.During the therapy, intermittent flushing with saline could not extend the lifespan of extracorporeal circuit device.Clinical workers should take interventions targeting the risk factors, so as to reduce the incidence of extracorporeal circuit device failure, extend lifespan of the device, and ensure the safety of treatment.