肝素冲洗对ICU动脉置管患者凝血功能的影响及护理  

Effect of Heparin Irrigation on Coagulation Function in Patients with Arterial Intubation in ICU and Nursing Cooperation

作　　者：吕伟涛[1] 卢婉娴[1] 

机构地区：[1]暨南大学附属第一医院ICU,广州510630

出　　处：《血栓与止血学》2017年第2期324-326,共3页Chinese Journal of Thrombosis and Hemostasis

摘　　要：目的探衬肝素冲洗对ICU动脉置管患者凝血功能的影响及护理。方法选取我院2015年5月至2016年4月75例ICU动脉置管患者为研究对象,随机分为A、B、C三组,每组25例。A组给予0.5 U/ml肝素冲洗液干预,B组给予1.0 U/ml肝素冲洗液干预,C组给予3 U/ml肝素冲洗液干预,比较三组导管堵塞、动脉穿刺点渗血发生率,活化部分凝血活酶时间(aPTT)、国际标准化率(INR)、凝血酶时间(TT)、纤维蛋白原(Fbg)、凝血酶原时间(PT)等凝血功能指标及血小板计数(PLT),并采取护理配合。结果三组导管堵塞发生率比较无统计学意义(P>0.05);C组动脉穿刺点渗血发生率48.00%高于A组4.00%、B组20.00%,有统计学意义(P<0.05)。三组aPTT、INR、TT、PT等凝血功能指标及PLT比较无统计学意义(P>0.05)。分析发现,从保持测压管道需通畅、防止测压管的堵塞脱出,严格执行无菌操作及注意防止导管血栓、气栓形成几个方面进行护理,有利于及时、准确、连续监测动脉血压。结论不同浓度肝素冲洗对ICU动脉置管患者凝血功能无影响,且均能维持动脉测压管的通畅,但3 U/ml的肝素冲洗会增加患者出血风险,需谨慎使用;同时,护理配合对患者病情评估具有重要意义。Objective To analyze the effect of heparin irrigation on coagulation function in patients with arterial intubation in ICU and nursing cooperation. Methods 75 patients with arterial intubation in ICU who were admitted between May 2015 and April 2016 were randomized into group A,group B and group C ,25 cases in each. Group A was intervened with 0. 5 U/ml heparin irrigation while group B was intervened with 1.0 U/ml heparin irrigation and group C group was intervened with 3 U/ml heparin irrigation. The incidence rates of catheter obstruction and bleeding at arterial puncture point, activated partial thromboplastin time （aPTY）, international normalized ratio （ INR ）, thrombin time （ TT）, fibrinogen （ Fbg）, prothrombin time （FF） and other coagulation function indexes and platelet count（PLT） were compared between the three groups. The nursing cooperation methods were analyzed. Results There was no significant difference in the incidence of catheter obstruction between the three groups （P 〉 0. 05 ） ; The incidence of bleeding at arterial puncture point in group C （48.00%） was higher than that in group A （4. 00% ） and group B （ 20.00% ） （ P 〈 0. 05 ）. There ! were no significant differences in aFFF, INR, TT, PT and other coagulation function indexes and PLT between the three groups （ P 〉 0. 05 ）. Analysis found that to apply nursing from the perspectives of keeping piezometer tube unobstructed, preventing blockage prolapse of piezometer tube, strict implementation of aseptic operation and paying attention to prevention of catheter thrombosis and aeroembolism is conducive to timely, accurate and continuous monitoring of arterial blood pressure. Conclusion There is no effect of different concentrations of heparin irrigation on coagulation function in patients with arterial intubation in ICU. Besides, it can keep arterial pressure tube unobstructed. However, 3 U/ml heparin irrigation will increase the risk of bleeding, so it should be used with caution; Meanwhile, the n

关 键 词：肝素冲洗 动脉置管 凝血功能 护理 

分 类 号：R473[医药卫生—护理学]