局部枸橼酸钠抗凝-连续性血液净化治疗中血液透析管路采血代替血管采血的可行性研究

Feasibility study of blood collection by hemodialysis tube instead of blood vessel in regional citrate anticoagulation-continuous blood purification treatment

目的探讨局部枸橼酸钠抗凝-连续性血液净化(RCA-CBP)治疗过程中血透管路采血代替血管采血行电解质及血气监测的可行性,以减少危重症患者CBP过程中频繁采血带来的创伤和痛苦。方法选择2016年1月—2019年2月急诊重症监护室接受RCA-CBP治疗的89例患者为研究对象,采用自身对照法,经患者动脉和血液透析管路同时采集血标本,比较2处血标本电解质、血气检测结果的差异。结果采集血标本共400例,电解质及血气分析结果显示,2组血钙、血钠、血氯、血糖、pH值、乳酸、HCO 3-及碱剩余(BE)差异无统计学意义(P>0.05)。管路采血组的血钾和CO 2分压(PCO 2)高于动脉采血组[(3.91±0.34)mmol/L vs.(3.56±0.40)mmol/L,P<0.01;(44.95±9.40)mm Hg vs.(36.85±9.34)mm Hg,P<0.01]。结论RCA-CBP治疗时,正确的血液透析管路采血可以代替血管采血进行血钙、血钠、血钾、HCO 3-等指标的监测,但需注意动静脉血钾的差异。

Objective To explore the feasibility of blood collection by hemodialysis tube instead of blood vessel for electrolyte and blood gas monitoring during regional citrate anticoagulation-continuous blood purification(RCA-CBP)treatment,so as to reduce the trauma and pain caused by frequent blood collection during CBP treatment in critical patients.Methods Totally eighty-nine patients treated with CBP from January 2016 to February 2019 were selected as subjects in the self-control study.Blood samples were collected simultaneously through the patient's artery and hemodialysis tubes,and the differences in electrolyte and blood gas test results of the two blood samples were compared.Results Blood samples were collected in 400 cases.Electrolyte and blood gas results showed that there was no statistical significance in blood calcium,blood sodium,blood chlorine,and blood glucose,pH value,lactic acid,HCO 3-and base excess(BE)between the two groups(P>0.05).The serum potassium and partial pressure of carbon dioxide(PCO 2)in the hemodialysis tube blood collection group were significantly higher than those in the arterial blood collection group([3.91±0.34]mmol/L vs.[3.56±0.40]mmol/L,P<0.01;[44.95±9.40]mm Hg vs.[36.85±9.34]mm Hg,P<0.01).Conclusion The blood collection by hemodialysis tube can replace the arterial blood sample collection for blood calcium,blood sodium,blood potassium,bicarbonate and other monitoring while RCA-CBP treatment,but attention should be paid to the difference in blood potassium.