不同采血路径在体外枸橼酸抗凝连续性肾脏替代治疗患者中的应用效果研究

Difference of calcium monitoring in continuous renal replacement therapy patients treated with in vitro citrate anticoagulation by different blood collection routes

目的:探讨不同采血路径在体外枸橼酸抗凝连续性肾脏替代(CRRT)治疗患者中的应用效果。方法:选择南昌大学第一附属医院重症医学科2020年10月—2021年10月收治的行CRRT治疗的患者164例,以患者的住院号为分组依据,采用随机抽签法分为血滤管组和外周组,每组82例。患者入院后均进行体外枸橼酸抗凝的CRRT治疗,血滤管组患者在血滤前泵(滤器前)的采血端口采血,外周组患者直接从患者血管采血。比较两组患者的采血耗费时间、钙离子浓度、并发症发生率、护理满意度等指标。结果:血滤管组患者的采血前、采血中、采血后及总采血时间均低于外周组,差异有统计学意义(P<0.05);两组血液中钙离子浓度比较,差异无统计学意义(P>0.05);血滤管组并发症发生率(3.66%)低于外周组(14.63%),护理满意度(95.12%)高于外周组(80.49%),差异均有统计学意义(P<0.05)。结论:对行体外枸橼酸抗凝的CRRT患者在治疗期间通过血滤管引血端口采血可以替换外周静脉采血路径,能够缩短采血时间,降低患者的并发症发生率,且不影响患者的钙离子浓度,简化采血流程,从而减轻患者痛苦,减少护理人员工作量,提高患者及护理人员满意度。

Objective:To study the effect of different blood collection routes on patients undergoing continuous renal replacement(CRRT)therapy with in vitro citrate anticoagulation.Methods:A total of 164 patients treated with CRRT who were admitted to the department of critical care medicine in the first affiliated hospital of nanchang university from October 2020 to October 2021 were selected.Based on the patient's hospitalization number,they were randomly divided into a hemofiltration tube group and a peripheral group,82 cases in each group.After admission,all patients were treated with CRRT for in vitro citric acid anticoagulation.Patients in the hemofiltration tube group took blood from the blood leading end of the hemofiltration tube,and patients in the peripheral group took blood from peripheral vein.The blood collection time,calcium concentration,complication rate and nursing satisfaction of the two groups were statistically compared.Results:The time before blood collection,during blood collection,after blood collection and total blood collection time in the hemofiltration tube group were all lower than those in the peripheral group,and the differences were statistically significant(P<0.05).There was no significant difference in the calcium ion concentration in the blood between the two groups(P>0.05).The incidence of complications in the hemofiltration tube group(3.66%)was lower than that in the peripheral group(14.63%),and the nursing satisfaction(95.12%)was higher than that in the peripheral group(80.49%),and the difference was statistically significant(P<0.05).Conclusion:For CRRT patients undergoing extracorporeal citrate anticoagulation,blood collection through the blood filter can replace the peripheral venous blood collection path,shorten the blood collection time,reduce the incidence of complications,and do not affect the accuracy of calcium consistency.It can simplify the blood collection process,reduce the pain of patients and reduce the workload of nursing staff,improving the satisfaction of patients.