自拟慢泡快冲改良预充法在无肝素血液透析中的临床观察

Clinical observation on the modified pre-flushing method of soaking slowly and rushing fast in heparinfree hemodialysis

目的探讨自拟慢泡快冲改良预充法在无肝素抗凝血液透析(hemodialysis,HD)中的临床应用价值。方法选择2018年1月~2019年3月间桐乡市第一人民医院血液净化中心行无肝素抗凝的血液透析患者38例,随机分为2组。A组:采用传统方法进行透析器及管路预充;B组:采用慢泡快冲改良法进行预冲。每组19例,每例患者观察周期4例次。记录透析过程中透析器及管路凝血评级、生理盐水冲洗次数、透析时间等,并于第4例次HD时测定eKt/V。结果相比采用传统方法,B组患者在透析器、透析管路凝血0级、II级、III级的比较差异均有统计学意义(t值分别为7.851,3.437,8.774;P值分别为0.013,0.009,<0.001);生理盐水冲洗次数比较中,0次、1次、3次、≥4次经比较差异具有统计学意义(t值分别为7.602,8.959,5.848,8.192;P值分别为0.031,0.006,0.024,0.018);2组HD时间≥3h的百分率分别为87.2%、97.4%,经比较差异具有统计学意义(t=6.752,P=0.011);2组eKt/V达标率比较差异具有统计学意义(t=8.039,P=0.023)。结论自拟慢泡快冲改良预充法在无肝素抗凝HD治疗中,应用简单、经济、安全,且不影响透析充分性。

Objective To discuss clinical application value of the modified pre-flushing method by soaking slowly and rushing fast in heparin-free hemodialysis. Methods A total of 38 patients of heparin-free dialysis in the Blood Purification Center of Tongxiang First People’s Hospital from Jan. 2018 to Mar. 2019 were enrolled in this study. They were randomly divided into two groups. The traditional pre-flushing method of dialyzer and pipeline was used in the group A(n=19), and the modified method of soaking slowly and rushing fast was used in the group B(n=19). The observation period was 4 dialysis sessions for every patient. Blood clotting grade in dialyzer and pipeline, the number of flushing by normal saline, and actual dialysis time were recorded. eKt/V was estimated at the fourth hemodialysis session for every patient. Results Blood clotting in dialyzer and pipeline at 0、II and III grades were better in group B than in group A(t=7.851, 3.437 and8.774 respectively;P=0.013, 0.009 and <0.001 respectively). Normal saline flushing for 0, 1, 3 and ≥ 4 times were statistically different between group A and B(t=7.602, 8.959, 5.848 and 8.192 respectively;P=0.031,0.006, 0.024 and 0.018 respectively). The percentage of hemodialysis time greater than or equal to 3 h was87.2% and 97.4% in group A and B respectively(t=6.752, P=0.011). The rate of eKt/V compliant with the standard was 82.1% in group A and 94.8% in group B(t=8.039, P=0.023). Conclusion The modified preflushing method of soaking slowly and rushing fast in heparin-free hemodialysis was simple, inexpensive and safe and did not affect the adequacy of hemodialysis. This method is worthy to be used clinically.