无肝素CRRT患者体外循环凝血的危险因素及护理干预对策

Risk factors of coagulation during cardiopulmonary bypass in patients received heparin free CRRT and nursing intervention countermeasures

目的探讨无肝素CRRT患者体外循环凝血的危险因素,制定护理干预对策。方法回顾性分析2018年3月—2019年3月在本院行无肝素CRRT治疗的238例患者的临床资料,按照是否发生体外循环凝血分为凝血组(118例)和非凝血组(120例)。对可能造成患者体外循环凝血的因素进行单因素及多因素分析。结果单因素分析显示,凝血组和非凝血组在γ-谷酰胺转肽酶、谷草转氨酶、谷丙转氨酶、碱性磷酸酶、肌酐、白细胞计数、血钾、血氯、红细胞压积、血小板计数、国际标准化比值、间断生理盐水冲洗方面的差异有统计学意义(P<0.05)。多因素Logistic回归分析发现,高血小板计数、高红细胞压积、间断生理盐水冲洗是无肝素CRRT患者的独立危险因素(P<0.05)。结论血小板计数、红细胞压积、间断生理盐水冲洗是无肝素CRRT患者的独立危险因素,应针对危险因素,制定护理对策,以预防凝血的发生。

Objective To explore the risk factors of coagulation during cardiopulmonary bypass in patients receivedheparin free CRRT, and to formulate nursing intervention strategies.Methods The clinical data of 238 patients who received heparin free CRRT from March 2018 to March 2019 in our hospital were analyzed retrospectively. According to whether coagulation occurred during cardiopulmonary bypass, they were divided into coagulation group(118 cases) and non coagulation group(120 cases). Single factor and multi factor analysis were made on the factors that may cause coagulation in patients with cardiopulmonary bypass.Results Single factor analysis showed that there were significant differences in γ-glutamine transpeptidase, glutamic oxaloacetylase, glutamic pyruvic transaminase, alkaline phosphatase, creatinine, leukocyte count, blood potassium, blood chlorine, hematocrit, platelet count, international standardized ratio and intermittent physiological salt water washing between coagulation group and non coagulation group(P<0.05). Multivariate logistic regression analysis showed that high platelet count, high hematocrit and intermittent normal saline irrigation were independent risk factors for non heparin CRRT(P<0.05).Conclusions Platelet count, hematocrit and intermittent normal saline irrigation were independent risk factors for patients with heparin free CRRT.To prevent the occurrence of coagulation, nursing countermeasures should be made in view of the risk factors.