连续性肾脏替代疗法在重症医学科中的合理应用评价  

The Evaluation of Reasonable Application of CRRT in ICU

作　　者：杨文超[1] 刘馨侠 王岩[1] 范特[1] 胡萨萨[1] 王茂义[1] 董亚琳[1] 

机构地区：[1]西安交通大学第一附属医院,西安710061

出　　处：《中国药学杂志》2016年第11期935-941,共7页Chinese Pharmaceutical Journal

摘　　要：目的评价连续性肾脏替代疗法(continuous renal replacement therapy,CRRT)在重症医学科(intensive care unit,ICU)患者中的应用现状。方法回顾性分析2014年1~12月西安交通大学第一附属医院ICU的CRRT适应证患者171例的临床资料,分为行CRRT组(n=148)和未行CRRT组(n=23),其中CRRT组分为两个亚组:连续静脉-静脉血液滤过(continuous veno-venous hemofiltration,CVVH)组(n=66)和非CVVH组(n=82)。行CRRT治疗的148例患者按治疗效果分为好转组(n=83)、无好转组(n=46)及死亡组(n=19);行CVVH治疗的66例患者按治疗效果分好转组(n=39)和无好转组(n=27)。对171例患者的适应证及行CRRT的148例患者的首选抗凝方案、置管方案、置换液、CRRT管路冲洗的5个指标进行统计评估,并对患者临床数据与CRRT治疗模式和患者治疗效果(好转、无好转及死亡)之间的相关性进行统计学分析。结果 171例患者的适应证及行CRRT的148例患者的首选抗凝方案、置管方案、置换液、CRRT管路冲洗这5个方面指标的合理率分别为86.55%、84.76%、66.89%、100%、100%。单因素分析显示,在3种治疗模式下(CVVH组、非CVVH组、未行CRRT组),171例患者的尿素氮基线(P=0.035)、肌酐基线(P=0.007)、治疗前3天每日尿量中d2(P=0.004)、d3(P=0.034),差异有统计学意义;CRRT组中首选置管方案与患者存活率(P=0.01)间差异有统计学意义、首选置管方案与存活患者预后之间(P=0.007)差异有统计学意义。多因素分析显示,CVVH组中ICU入住时长[P=0.005,OR:0.734,95%CI(0.592,0.910)]、首选置管方案[P=0.016,OR:5.302,95%CI(1.369,20.527)],与患者预后呈显著相关性。结论本研究中,171例患者的适应证及行CRRT的148例患者的首选抗凝方案、置管方案这3个指标存在不合理性,其不合理率分别为13.45%、15.24%、33.11%。临床药师应该结合患者的病理生理基础特征,考虑到ICU患者用药的复杂性,对患者行CRRT过程中的整体化用药,进行重点追�OBJECTIVE To evaluate the status of application of continuous renal replacement therapy （CRRT） in patients in the intensive care unit （ICU）. METHODS The clinical data of 171 ICU patients who had indications for CI^RT in the First Affiliated Hospital of Xi＇an Jiaotong University from January to December 2014 were retrospective analyzed. The patients were divided into non- CRRT group （n = 23） and CRRT group （ n = 148） which was composed of continuous veno-venous hemofiltration （CVVH） group （n =66） and non-CVVH group （n = 82）. Among the 148 CRRT patients, 83 had improvement, 46 had no improvement, and 19 died. Among the 66 CVVH patients, 39 had improvement, and 27 had no improvement. The indications of the 171 patients and several aspects of the CRRT group including anticoagulation regimen, catheterization program, replacement fluid, and CRRT pipe flushing were statistically analyzed. And the correlations between the clinical data, CRRT mode, and efficacy were evaluated. RESULTS The rate of rational indications of 171 patients was 86. 55%, meanwhile the rates of the reasonability of anticoagulation method, catheteriza- tion program, replacement fluid, and CRRT pipe flushing of the CRRT group were 84. 76%, 66. 89%, 100%, and 100%, respec- tively. Single factor analysis showed that the levels of BUN （P = 0. 035） and creatinine （P = 0. 007） at baseline and the urine output on the third day （P = 0. 034） had statistically significant difference among the CVVH group, non-CVVH group, and non-CRRT group. There were also significant differences in the survival rate （P = 0.01 ） and prognosis of survivals （P =0. 007 ） in CRRT group among different catheterization programs. Multivariate analysis indicated that there was significant correlation between the lengh of stay in ICU [P =0. 005, OR：0. 734, 95% CI（0. 592,0. 910） ], catheterization program [P =0. 016, OR：5. 302,95%CI（1. 369,20. 527） ] and prognosis. CONCLUSION The indications, anticoagulation method, and cathe

关 键 词：连续性肾脏替代疗法 重症医学科 连续静脉-静脉血液滤过 

分 类 号：R969.3[医药卫生—药理学]