由设备因素导致血液透析治疗肝素用量偏差的原因分析与研究

Study on Deviation of Heparin Dosage in Hemodialysis Caused by Equipment Factors

目的从透析设备和注射器方面判断和分析导致血液透析治疗肝素用量偏差的原因。方法将透析机肝素泵速度分别设置为1、2、5、10ml/h。注射器种类不变,测量不同运转时间的透析机肝素泵注入流量;测量同一台透析机的肝素泵分别应用6种品牌20ml医用一次性注射器后的注入流量。结果①不同运转时间的透析机肝素泵流量误差均小于±5%。B组(运转时间在20000~35000h,n=6)透析机肝素泵检测流量在不同速度测量点均低于设定值,与A组(运转时间在10000~20000h,n=6)透析机测量结果的差异具有统计学意义(1ml/h:t=2.857,P=0.021;2ml/h:t=2.32,P=0.042;5ml/h:t=3.295,P=0.007)。②6种品牌注射器在不同设定速度的测量点检测结果之间的差异具有统计学意义(1ml/h:H=16.685,P=0.005;2ml/h:H=18.675,P=0.002;5ml/h:H=21.654,P=0.001;10ml/h:H=19.773,P=0.001)。结论为了保证肝素泵能够精准稳定的工作,日常保养与维护工作非常重要。在更换注射器品牌时应详细了解注射器的内径等重要参数,如较之前有所不同应及时更改透析机内设定参数。

Objective To judge and analyze the causes of heparin dosage deviation in hemodialysis from the aspects of dialysis equipment and syringe.Method The speed of heparin pump in dialyzer was set as 1 ml/h,2 ml/h,5 ml/h,and 10ml/h,respectively.①The injection flow of heparin pump in dialyzer with different operatingtime was measured without changing the type of syringes.②The injection flow of heparin pump was measured in the same dialysis machine after applying 6 brands of 20ml disposable medical syringes.Results①The flow errors of heparin pump in dialyzer with different operating time were all less than±5%.The measured flow of heparin pump in the dialyzer of group B(running time of 20000h to 35000h,n=6)was lower than the set value at different speed measurement points,which was significantly different from that of group A(running time of 10,000h to 20,000 h,n=6)(1ml/h:t=2.857,P=0.021;2ml/h:t=2.32,P=0.042;5ml/h:t=3.295,P=0.007).②There were significant differences in the detection results of the 6 brands of syringes at the measuring points with different set speeds.(1ml/h:H=16.685,P=0.005;2ml/h:H=18.675,P=0.002,P=0.042;5ml/h:H=21.654,P=0.001;10ml/h:H=19.773,P=0.001).Conclusion In order to ensure accurate and stable operation of heparin pump,daily maintenance and maintenance are very important.When replacing the brand of the syringe,important parameters such as the inner diameter of the syringe should be understood in detail,and the setting parameters in the dialysis machine should be changed in time if they are different from those before.