术后危重患者血滤导管封管液与出血相关并发症的研究

The Association between Hemorrhage-related Complications and Different Locking Solutions for Central Venous Catheter in Critically Ill Hemofiltration Patients after Operation

目的 研究4%枸橼酸钠、4 000 U/mL肝素钠、6 250 U/mL肝素钠三种封管液对进行血滤治疗的外科术后危重患者的影响,分析封管液配方与出血相关并发症的关系。方法 纳入北京大学第一医院外科重症病房2014~2016年29个月行床旁血滤患者116例,进行回顾性队列研究。比较使用4%枸橼酸钠、4 000 U/mL肝素钠、6 250 U/mL肝素钠对血滤导管封管的影响。观察的结果包括外科术后3 d和10 d失血指数、术后显性失血量、导管通畅性、封管后凝血功能和导管感染率。结果 在研究期间,共有116名患者接受了439次血滤后封管。使用6 250 U/mL肝素钠封管后3 d和10 d失血指数和显性失血量均明显高于4%枸橼酸组(P<0.001)和4 000 U/mL肝素钠组(P<0.001)。三组封管液封管后PT均无显著变化,P=0.833。APTT在4%枸橼酸组和6 250 U/mL肝素钠组有显著性差异,P=0.023。4%枸橼酸盐组的导管功能障碍比两个浓度的肝素钠组高6.91%vs4.92%vs2.98%,P>0.05,但无统计学意义。三组封管液对于导管相关感染无差异,P>0.05。结论 4%枸橼酸钠和4 000 U/mL肝素钠对于外科手术相关出血并发症和全身凝血的影响小于6 250 U/mL肝素钠;三组封管液在维持血滤患者的导管通畅性方面有效性类似。三种封管液在导管相关感染方面安全性相似。

Objective To investigate the effects of 4%sodium citrate,4000U/mL heparin sodium and 6250 U/mL heparin sodium on the critically ill hemofiltration patients after operation,and to analyze the relationship between the different locking solutions and the hemorrhage-related complications.Methods During our study period,116 postoperation patients underwent bedside hemofiltration who were admitted to the intensive care unit(ICU)of Peking University First Hospital from February 2014 to July 2016,were analyzed.We conducted a retrospective cohort study.Compare the effectiveness and safety of use of 4%sodium citrate,4000 U/mL heparin sodium,6250 U/mL heparin on catheters locking.The results of the observation included blood loss index,postoperative blood loss,catheter patency,clotting function,and catheter infection rate 3 days and 10 days after surgery.Results A total of 116 patients received 439 post-hemofiltration closures during the study period.The blood loss index and significant blood loss at 3 and 10 days after sealing with 6250 U/mL heparin sodium were significantly higher than those in the 4%citric acid group(P<0.001)and the 4000 U/mL heparin sodium group(P<0.001).The result of PT test had no significantly different between the three groups of locking solutions,P=0.833.APTT was significantly different between the 4%citrate group and the 6250 U/mL heparin group,P=0.023.The 4%citrate group had a higher rate of catheter dysfunction than the two heparin group by 6.91%vs4.92%vs2.98%,P>0.05,but not statistically significant.There was no difference in the rate of catheter related blood stream infection among the three groups of locking solutions,P>0.05.Conclusion 4%citrate and 4000 U/mL heparin,6250 U/mL heparin locking solutions are equally effective in maintaining catheter patency in patients with hemofiltration.6250 U/mL heparin group had a higher risk of hemorrhage-related complications after surgery.4%citrate group had a lower risk for systemic anticoagulation than 6250 U/mL heparin group.The three locking solutions are similarly in catheter related blood stream infections.