重症患者连续性肾脏替代治疗非计划下机的相关因素研究

Related factors of unexpected interruption of continuous renal replacement therapy in critical care patients

目的探讨连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)非计划下机的相关因素,为临床CRRT质量管理提供参考依据。方法采用方便抽样的方法进行前瞻性研究,2019年3月~2019年6月行CRRT治疗的159例重症患者,统计CRRT非计划下机的例次,并分析相关危险因素。结果346例次CRRT治疗中非计划下机50例次(14.45%),平均治疗时间(19.00±15.58)h。多因素回归分析提示静脉压、跨膜压(transmembrane pressure,TMP)、凝血酶原时间(prothrombin time,PT)、活化部分凝血活酶时间(activated partial thromboplastin time,APTT)、红细胞压积、抗凝方式、护士负责机器数量是CRRT治疗中非计划下机的危险因素(OR值分别为1.022,1.045,0.537,0.502,4.422,12.611,1.021;95%CI值分别为1.002~1.043,1.023~1.078,0.326~0.885,0.298~0.818,4.035~4.972,9.900~16.223,0.810~1.265;P值分别为0.043,0.014,0.016,0.019,0.027,0.043,0.001)。结论在实施CRRT治疗过程中,应注意观察压力监测值的变化及凝血指标、红细胞压积指标,选择合适的抗凝剂和剂量,管理者根据情况合理安排护士工作量,从而降低非计划下机的发生率。

Objective T o explore the related factors of unexpected interruption of continuous renal replacement therapy(CRRT),and to provide the information about clinical CRRT quality management.Methods This was a prospective study using the convenient sampling method.Atotal of 159 patients undergoingCRRTdue to severe illnesses from March 2019 to June 2019 were enrolled in this study.The number of unexpected interruptions of CRRT was recorded and the related factors were analyzed.Results In the 346 CRRT treatments,50 patientstimes of unplanned cessation of CRRT(14.45%)occurred,and the average treatment time was 19.00±15.58 hours.Multivariate regression analysis revealed that venous pressure(OR=1.022,95%CI=1.002~1.043,P=0.043),transmembrane pressure(TMP;OR=1.045,95%CI=1.023~1.078,P=0.014),prothrombin time(PT;OR=0.537,95%CI=0.326~0.885,P=0.016),activated partial thromboplastin time(APTT;OR=0.502,95%CI=0.298~0.818,P=0.019),hematocrit(OR=4.422,95%CI=4.035~4.972,P=0.027),anticoagulation method(OR=12.611,95%CI=9.900~16.223,P=0.043),and number of nurses responsible for the machine(OR=1.021,95%CI=0.810~1.265,P=0.001)were the risk factors for unplanned cessation of CRRT.Conclusion During the implementation of CRRT,changes of pressure value,coagulation indicators and hematocrit indicators must be carefully monitored,anticoagulants and their doses must be appropriately adjusted,and the workload of the nurses must be properly arranged to reduce the rate of unexpected interruption of CRRT.