连续血液净化患者枸橼酸抗凝治疗时间的影响因素研究

Study on the influencing factors of citric acid anticoagulant treatment time in patients with continuous blood purification

目的探讨ICU床边连续性血液净化(CBP)患者行枸橼酸抗凝治疗时间的影响因素。方法选取2017年10月-2018年10月于我院ICU行CBP且抗凝方式为枸橼酸抗凝的26例患者,对影响治疗时间的相关因素进行分析。结果26例患者共行CBP 119例次,其中非计划性下机97例次,占总例次的81.5%;有明确诱因的17例次,包括因股静脉留置双腔导管功能不良、血流量不足引起血泵停转而下机9例次,静脉壶凝血6例次,患者躁动致输入端负压极值多次报警2例次;无明确诱因的80例次。Logistic回归分析显示,滤器后钙离子、滤器后血流速、滤过分数、脱水量是非计划性下机的影响因素。结论在实施枸橼酸抗凝的CBP治疗过程中,滤器后钙离子、滤器后血流速、滤过分数、脱水量是非计划性下机的影响因素,医护人员应熟练掌握枸橼酸抗凝原理及其影响因素,设置合理的CBP参数,提高滤器后血流速,降低滤过分数,密切监测各类相关指标,及时排除和处理各种报警,预防滤器凝血,保证CBP治疗的安全性和连续性。

Objective To investigate the influencing factors of citrate anticoagulant treatment time in patients with ICU undergoing bedside continuous blood purification(CBP).Methods From October 2017 to October 2018,26 patients with ICU treated with CBP and anticoagulant with citric acid anticoagulant were selected and the related factors of treatment time were analyzed.Results A total of 119 cases of CBP were performed in 26 patients,97 of them were unplanned,accounting for 81.5%,and 17 of them had definite inducements,including 9 cases of stopping of blood pump due to poor function of double lumen catheter and insufficient blood flow.There were 6 cases of coagulation in venous kettle,2 cases of negative pressure extreme value at the input end caused by restlessness,and 80 cases without definite inducement.Logistic regression analysis showed that calcium ion after filter and blood flow velocity after filter,filtration fraction and dehydration were the influencing factors of unplanned discharge.Conclusion In the course of CBP treatment with citric acid anticoagulant,calcium ion after filter,blood flow velocity after filter,filtration fraction and dewatering are the influencing factors of unplanned disengagement.Medical and nursing staff should master the anticoagulant principle of citric acid and its influencing factors skillfully,set reasonable CBP parameters,increase the blood flow rate after filter,reduce the filtration fraction,Monitor all kinds of related indexes,eliminate and deal with all kinds of alarm in time,prevent filter coagulation,and ensure the safety and continuity of CBP treatment.