规范化开展床旁间歇性肾脏替代治疗前评估的效果分析

Effect analysis of standardized pre-evaluation of bedside intermittent renal replacement therapy

目的探讨开展规范化床旁间歇性肾脏替代治疗(Intermittent Renal Replacement Therapy,IRRT)前评估的效果。方法筛选2019年6-8月收入首都医科大学附属北京友谊医院急诊行床旁IRRT治疗的患者。选择其中两次进行观察,采用自身前后对照进行配对对比分析,每位患者均一次按照常规方法进行评估(常规组),另一次按照《规范化开展床旁IRRT治疗前评估单》进行评估(评估组),并根据评估的结果给予积极的干预措施,分别统计两次操作中不良事件(管路透析器凝血、治疗中的低血压、治疗中体温降低、治疗中寒战、治疗中发热、出血、死亡、非计划性下机、其他不适)发生的情况。结果共入组患者69例,平均行床旁IRRT 4.41次。评估组通过采用规范化的床旁IRRT操作评估单进行评估后,管路透析器凝血、治疗中低血压、治疗中寒战、治疗中发热、非计划性下机等不良事件的发生率较常规组降低,差异无统计学意义(P>0.05),但发生例数较常规组有明显减少,具有临床意义。结论规范化评估后床旁IRRT的不良事件发生率明显下降。在床旁IRRT前进行规范化评估,可以更全面地评估患者的危险因素,有针对性的进行预防,从而减少不良事件的发生。

Objective To study the effect of standardized evaluation before intermittent renal replacement therapy(IRRT).Methods The patients who accepted IRRT more than two times during June 1st,and August 31st 2019 were enrolled in this study.Two of them were observed and matched before and after self-control.Each patient was evaluated once according to routine method(routine group),the other was assessed according to the standardized bedside IRRT pre-treatment assessment sheet(the assessment group),and positive interventions were given based on the results of the assessment,the incidence of adverse events during the two operations,such as blood coagulation by a catheter dialyzer,hypotension during treatment,hypothermia during treatment,chills during treatment,fever during treatment,hemorrhage,death,unplanned disconnection,and other discomfort,were analyzed.Results 69 patients were enrolled in this study,the mean times of IRRT were 4.41.After assessment by the evaluation team using the standardized bedside IRRT operational evaluation sheet,the incidence of adverse events such as blood coagulation,hypotension,chills,fever and unplanned disconnection in the treatment group was significantly lower than that in the control group(P>0.05),however,the number of cases was significantly reduced compared with the routine group,which has clinical significance.Conclusion The incidence of adverse events in bedside IRRT was significantly decreased after standardized assessment.Standardized assessment before bedside IRRT allows a more comprehensive assessment of patients'risk factors,targeted prevention,and thus reduces the incidence of adverse events.