延长间断肾脏替代治疗非计划性下机相关因素分析

Related factors of unscheduled interruption during prolonged intermittent renal replacement therapy

目的探讨笔者中心实施延长间断肾脏替代治疗(prolonged intermittent renal replacement therapy,PIRRT)非计划性下机的相关因素,对后续质量改进提供依据。方法以2017年1月1日~12月31日由北京大学第一医院肾内科行PIRRT治疗的住院患者及其治疗例次作为研究对象,回顾性采集数据进行分析。结果82例患者接受的898例次治疗最终纳入本研究,非计划性下机共259例次(28.8%)。管路及滤器凝血共212例次,占非计划下机比例81.9%。与计划性下机组相比,非计划性下机组无肝素抗凝比例更高(34.7%比13.3%,χ~2=71.941,P<0.001),股静脉导管使用率(68.3%比59.8%,χ~2=5.745,P=0.010)及最高滤过分数[(31.7±5.3)%比(31.0±4.6)%,t=-1.985,P=0.047]均更高。2组间护士学历(62.9%比64.9%,χ~2=0.304,P=0.318)、护士工作年限[(3.3±2.0)比(3.6±2.1),t=-1.833,P=0.064]及患护比无显著差异[(1.8±0.7)比(1.9±0.8),t=-0.971,P=0.360]。结论抗凝方式选择不当、滤过分数设置过高及导管功能不良等导致循环管路及滤器凝血是笔者中心非计划性下机的主要原因。在经过规范化培训和考核后,护士学历及工作年限对非计划性下机发生无显著影响。

Objective To explore the related factors of unscheduled interruption during prolonged intermittent renal replacement therapy(PIRRT).Method The medical records of all patients received PIRRT in the Renal Department of Peking University First Hospital from January 2017 to December 2017 were retrospectively reviewed.Circuit and patient data were collected and analyzed.Result A total of 82 patients with898 circuits were finally included in this study,in which 259 circuits(28.8%)were considered as unscheduled interruption.Circuit clotting was observed in 212 cases of the unscheduled interruption(81.9%).Compared to the scheduled group,the unscheduled group was more likely not to receive anticoagulation(34.7%vs.13.3%,χ~2=71.941,P<0.001),to use femoral vein catheters(68.3%vs.59.8%,χ~2=5.745,P=0.010),and to have higher level of the highest filtration fraction(31.7±5.3%vs.31.0±4.6%,t=-1.985,P=0.047).There were no significant differences in the education degree of nurses(62.9%vs.64.9%,χ~2=0.304,P=0.318),working years of nurses(3.3±2.0 vs.3.6±2.1,t=-0.971,P=0.064),and patient-nurse ratio(1.8±0.7 vs.1.9±0.8,t=-1.833,P=0.360)between the two groups.Conclusion The main reason for unscheduled interruption during PIRRT in our dialysis center was circuit clotting caused by inappropriate use of anticoagulation,higher filtration fraction and catheter malfunction.After regular and standardized training,the education degree and working years of nurses had no significant impact on unscheduled interruption.