生理盐水冲洗与免冲洗在高危出血风险患者中的应用效果比较

Application effect comparison of saline irrigation and non-irrigation in patients with high risk of bleeding

目的探讨生理盐水冲洗与免冲洗对高危出血风险患者行无抗凝连续性肾脏替代治疗(CRRT)时循环的影响。方法选取2017年1月3日~2018年7月8日于我院高危出血风险行无抗凝CRRT治疗的84例患者,按照是否采用生理盐水冲洗分为对照组(生理盐水冲洗,40例)和观察组(免冲洗,44例)。记录两组患者上机时(T0)、上机后1h(T1)、2h(T2)、3h(T3)、4h(T4)、5h(T5)、下机前(T6)的心率、平均动脉压、脉压;比较两组患者的正常下机情况。结果T0时,两组患者的心率、平均动脉压和脉压比较,差异均无统计学意义(P>0.05);T1、T2、T3、T4、T5、T6时,观察组的心率高于对照组,脉压均显著低于对照组,差异有统计学意义(P<0.05)。两组所有时间点的平均动脉压比较,差异无统计学意义(P>0.05)。两组的正常下机率比较,差异无统计学意义(P>0.05)。结论对于高危出血风险行CRRT治疗组患者,采用免冲洗可以显著改善患者的心率和脉压,维持其生命体征稳定,可在临床中进行推广。

Objective To investigate the effect of saline irrigation and non-irrigation on circulation in patients with high risk of bleeding who were undergoing no-anticoagulation continuous renal replacement therapy (CRRT). Methods All of 84 patients at high risk of bleeding undergoing no-anticoagulation CRRT in our hospital from January 3, 2017 to July 8, 2018 were selected and they were divided into the control group (40 cases) and observation group (44 cases) according to whether saline irrigation was used or not. Heart rate (HR), mean arterial pressure (MAP) and pulse pressure difference at 7 time points (T0), 1 h (T1), 2 h (T2), 3 h (T3), 4 h (T4), 5 h (T5) and the end of treating (T6) were recorded respectively. The normal disengagement of patients between the two groups was compared. Results At T0, there was no significant difference in HR, MAP and pulse pressure between the two groups (P>0.05). At T1, T2, T3, T4, T5 and T6, HR in the observation was higher than those in the control group, pulse pressure in the observation group was significantly lower than that of the control group, and the differences were statistically significant (P<0.05). There was no significant difference in MAP between the two groups at all time points (P>0.05). There was no significant difference in the normal disengagement rate between the two groups (P>0.05). Conclusion For no-anticoagulation CRRT in patients with high risk of bleeding, the application of no-irrigation can significantly improve the heart rate and pulse pressure, maintain the stability of patients′ vital signs, and it can be promoted in clinic.