CRRT管路预冲完成后不同时间的肝素液浸泡对滤器寿命的影响

The effect of heparin solution immersion at different times after CRRT pipeline pre-rinsing on the life of the filter

目的:探讨连续性肾脏替代治疗(CRRT)管路预冲完成后不同时间的肝素液浸泡对滤器寿命的影响。方法:选取2021年10月—2023年4月宁波大学附属第一医院收治的23例行CRRT治疗且使用肝素全身抗凝的患者为研究对象,共行CRRT 45例次,采用随机数字表法将其分为A组、B组和C组各15例次。A组预冲完成立即上机治疗,B组预冲完成滤器予以肝素液继续浸泡30 min后上机治疗,C组预冲完成滤器予以肝素液继续浸泡60 min后上机治疗,比较三组凝血指标、CRRT相关参数及非计划性下机(目标治疗时间为24 h)、出血并发症发生情况,分析滤器寿命终止的原因。结果:CRRT前后,三组活化部分凝血活酶时间、凝血酶原时间和血小板计数比较,差异均无统计学意义(P>0.05);三组滤器寿命、凝血达Ⅱ级时间、非计划性下机概率、维持肝素剂量及CRRT开始、结束滤器压、跨膜压比较,差异均无统计学意义(P>0.05)。三组治疗过程中均未发生出血并发症。在23例患者使用的45个滤器中,有27个滤器(60.0%)使用时间超过了目标治疗时间24 h;7个滤器(15.6%)因凝血以外的原因而终止使用,其中3个滤器因需更换治疗方案而终止使用,2个滤器因完成治疗目标而终止使用,1个滤器因患者需要转运(非计划性)而终止使用,1个滤器因患者血压下降而终止使用;其余11个滤器(24.4%)均因滤器凝血而终止使用。结论:使用肝素全身抗凝行CRRT患者管路预冲完成后不同时间的肝素液浸泡并不显著影响凝血功能、滤器寿命、凝血达Ⅱ级时间、非计划性下机概率、维持肝素剂量、出血并发症及CRRT开始、结束滤器压、跨膜压。

Objective To investigate the effect of heparin solution immersion at different time after continuous renal replacement therapy(CRRT)pipeline pre-rinsing on filter life.Methods From October 2021 to April 2023,23 patients treated with CRRT and heparin systemic anticoagulation in the First Affiliated Hospital of Ningbo University were selected as the research objects.A total of 45 case-times of CRRT were performed.They were divided into group A,group B and group C by random number table method,with 15 case-times in each group.Group A was treated immediately after pre-rinsing,group B was treated with heparin solution for 30 min after pre-rinsing,and group C was treated with heparin solution for 60 min after pre-rinsing.The coagulation indexes,CRRT related parameters,unplanned off-line(target treatment time was 24 h)and bleeding complications were compared among the three groups,and the causes of filter life termination were analyzed.Results Before and after CRRT,there were no significant differences in activated partial thromboplastin time,prothrombin time and platelet count among the three groups(P>0.05).There were no significant differences in filter life,time of coagulation reaching gradeⅡ,unplanned off-line rate,maintenance of heparin dose,filter pressure and transmembrane pressure at the beginning and end of CRRT among the three groups(P>0.05).No bleeding complications occurred during the treatment in the three groups.Of the 45 filters used in 23 patients,27 filters(60.0%)exceeded the target treatment time by 24 hours.7 filters(15.6%)were discontinued for reasons other than coagulation,of which 3 filters were discontinued due to the need to change the treatment regimen,2 filters were discontinued due to the completion of the treatment goal,one filter was discontinued due to the patient's need for transport(unplanned),and one filter was discontinued due to the patient's blood pressure drop;the remaining 11 filters(24.4%)were discontinued due to coagulation.Conclusions Heparin immersion at different times after the completion of pipeline preflushing in patients undergoing CRRT with heparin systemic anticoagulation did not significantly affect the coagulation function,filter life,coagulation gradeⅡtime,unplanned off-line rate,maintenance heparin dose,bleeding complications and CRRT start,end filter pressure,transmembrane pressure.