中国血液净化

中国血液净化 ›› 2020, Vol. 19 ›› Issue (01): 3-6.doi: 10.3969/j.issn.1671-4091.2020.01.002

• 临床研究 • 上一篇    下一篇

延长间断肾脏替代治疗非计划性下机相关因素分析

李雪洁1, 郑茜子1,于重燕1,金其庄1   

  1. 1. 北京大学第一医院肾内科，北京大学肾脏病研究所卫生部肾脏疾病重点实验室
  • 收稿日期:2019-06-24 修回日期:2019-11-11 出版日期:2020-01-20 发布日期:2019-12-30
  • 通讯作者: 金其庄 jinqizhuang@bjmu.edu.cn E-mail:jinqizhuang@bjmu.edu.cn
  • 基金资助:
    北京大学第一医院科研种子基金(2019SF72)

Related factors of unscheduled interruption during prolonged intermittent renal replacement therapy

Xue-Jie LI,Xi-zi ZHENG,Chong-yan YU,Qi-zhuang JIN   

  1.  1Department of Nephrology, Peking University First Hospital; Institute of Nephrology, Peking University; Key Laboratory of Renal Disease, China Ministry of Health; Key Laboratory of Chronic Kidney Disease Prevention and Treatment, China Ministry of Education,
    Beijing 100034, China
  • Received:2019-06-24 Revised:2019-11-11 Online:2020-01-20 Published:2019-12-30
  • Contact: Qi-zhuang JIN E-mail:jinqizhuang@bjmu.edu.cn

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摘要： 【摘要】目的探讨笔者中心实施延长间断肾脏替代治疗(prolonged intermittent renal replacement therapy,PIRRT)非计划性下机的相关因素，对后续质量改进提供依据。方法以2017 年1 月1 日～12 月31 日由北京大学第一医院肾内科行PIRRT 治疗的住院患者及其治疗例次作为研究对象，回顾性采集数据进行分析。结果82 例患者接受的898 例次治疗最终纳入本研究，非计划性下机共259 例
次(28.8%)。管路及滤器凝血共212 例次，占非计划下机比例81.9%。与计划性下机组相比，非计划性下机组无肝素抗凝比例更高(34.7% 比13.3% ，χ2=71.941，P＜0.001)，股静脉导管使用率(68.3% 比59.8%，χ2=5.745，P=0.010)及最高滤过分数[(31.7 ± 5.3)% 比(31.0±4.6)%，t=-1.985，P=0.047]均更高。2 组间护士学历(62.9%比64.9% ，χ2=0.304，P=0.318)、护士工作年限[(3.3±2.0)比(3.6±2.1)，t=-1.833，P=0.064]及患护比无显著差异[(1.8±0.7)比(1.9±0.8)，t=-0.971，P=0.360]。结论抗凝方式选择不当、滤过分数设置过高及导管功能不良等导致循环管路及滤器凝血是笔者中心非计划性下机的主要原因。在经过规范化培训和考核后，护士学历及工作年限对非计划性下机发生无显著影响。

关键词: 肾脏替代治疗, 抗凝, 滤过分数, 回路寿命

Abstract: 【Abstract】Objective To explore the related factors of unscheduled interruption during prolonged intermittent renal replacement therapy (PIRRT). Method The medical records of all patients received PIRRT in the Renal Department of Peking University First Hospital from January 2017 to December 2017 were retrospectively reviewed. Circuit and patient data were collected and analyzed. Result A total of 82 patients with 898 circuits were finally included in this study, in which 259 circuits (28.8%) were considered as unscheduled interruption. Circuit clotting was observed in 212 cases of the unscheduled interruption (81.9%). Compared to the scheduled group, the unscheduled group was more likely not to receive anticoagulation (34.7% vs. 13.3%,
χ2=71.941, P<0.001), to use femoral vein catheters (68.3% vs. 59.8%, χ2=5.745, P=0.010), and to have higher level of the highest filtration fraction (31.7±5.3% vs. 31.0±4.6%, t=-1.985, P=0.047). There were no significant differences in the education degree of nurses (62.9% vs. 64.9%, χ2=0.304, P=0.318), working years of nurses (3.3 ± 2.0 vs. 3.6 ± 2.1, t=- 0.971, P=0.064), and patient- nurse ratio (1.8 ± 0.7 vs. 1.9 ± 0.8, t=- 1.833, P=0.360) between the two groups. Conclusion The main reason for unscheduled interruption during PIRRT in our dialysis center was circuit clotting caused by inappropriate use of anticoagulation, higher filtration fraction and catheter malfunction. After regular and standardized training, the education degree and working years of nurses had no significant impact on unscheduled interruption.

Key words: Renal replacement therapy, Anticoagulation, Filtration fraction, Circuit life

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