难治性心力衰竭患者连续血液净化治疗回血方法的研究  

Study on blood return of continuous blood purification therapy for patients with heart failure

作　　者：李艳霞[1] 杨荣利[2] 赵琳[1] 颜燕[3] 周军[3] 刘俊[1] 王明杰 于晓宝 Li Yanxia;Yang Rongli;Zhao Lin;Yan Yan;Zhou Jun;Liu Jun;Wang Mingjie;Yu Xiaobao(Intensive Care Unit of Dalian Central Hospital,Dalian 116033,China;Department of Cardiology,Dalian Central Hospital,Dalian 116033,China;Nursing Department,Dalian Central Hospital,Dalian 116033,China)

机构地区：[1]大连市中心医院重症医学科,116033 [2]大连市中心医院心内科,116033 [3]大连市中心医院护理部,116033

出　　处：《中国实用护理杂志》2019年第33期2571-2574,共4页Chinese Journal of Practical Nursing

摘　　要：目的探讨适合难治性心力衰竭患者连续血液净化治疗的回血方法.方法选取2017年1月至2018年1月入住大连市中心医院重症医学科行连续血液净化(CBP)治疗的难治性心力衰竭患者69例为研究对象.按照随机数字表法分为试验组35例和对照组34例.最终完成研究试验组32例和对照组31例.试验组采用血袋回血法,对照组采用机器回血法.对2组患者第一次CBP治疗回血时的生命体征、临床表现及血流动力学指标进行比较和分析.结果第一次CBP治疗回血后对照组纽约心功能分级(NYHA)心功能加重率、SpO2、CVP、心率分别为33.27%(11/31)、0.91±0.06、(12.44±1.43)cmH2O(1 cmH2O=0.098 kPa)、(118.17±3.27)次/min,试验组分别为6.25%(2/32)、0.96±0.04、(8.98±1.36)cmH2O、(90.45±3.35)次/min,2组比较差异有统计学意义(χ^2=3.786,t=2.861、-7.565、3.792,P<0.05).2组CBP治疗小于24 h回血后NYHA心功能加重率、SpO2、CVP、心率分别为76.92%(10/13)、0.86±0.01、(12.92±1.12)cmH2O、(111.38±2.96)次/min,试验组分别为8.33%(1/12)、0.94±0.01、(8.11±0.74)cmH2O、(90.34±1.32)次/min,2组比较差异有统计学意义(χ^2=9.345,t=-14.101、2.894、7.648,P<0.05);对于CBP治疗24 h以上的患者,回血后2组NYHA心功能加重率、SpO2、CVP、心率比较差异无统计学意义(P>0.05).结论行CBP治疗的心力衰竭患者,尤其是对于CBP治疗开始24 h之内的心力衰竭患者,血袋回血法有助于避免心力衰竭患者病情加重.Objective To explore the method of the blood return of continuous blood purification therapy for patients with heart failure.Methods A total of 69 patients with heart failure treated by continuous blood purification therapy in our ICU from January 2017 to January 2018 were randomly divided into experimental group(blood return with blood bag,35 patients)and the control group(blood return with machine,34 patients).The vital signs,clinical manifestations and hemodynamic indicators of each patient were collected during the blood return of the first CBP therapy,and the data were analyzed between the two groups.Results After blood return of the first CBP therapy,the exacerbation of New York Heart Association(NYHA)heart function grade,SpO2,CVP,HR of patients in the control group were 33.27%(11/31),0.91±0.06,(12.44±1.43)cmH2O(1cmH2O=0.098 kPa),(118.17±3.27)times per minute and those in the experimental group were 6.25%(2/32),0.96±0.04,(8.98±1.36)cmH2O,(90.45±3.35)times per minute,respectively.The difference was statistically significant between the two groups(χ^2=3.786,t=2.861,-7.565,3.792,P<0.05).Subgroup analysis showed that for patients within 24 hours of CBP treatment,the exacerbation of NYHA heart function grade,SpO2,CVP,HR of the control group and the experimental group were respectively 76.92%(10/13),0.86±0.01,(12.92±1.12)cmH2O,(111.38±2.96)times per minute and 8.33%(1/12),0.94±0.01,(8.11±0.74)cmH2O,(90.34±1.32)times per minute,the difference was statistically significant(χ^2=9.345,t=-14.101,2.894,7.648,P<0.05).For patients treated with CBP therapy over 24 hours,the difference of the exacerbation of NYHA heart function grade,SpO2,CVP,HR of the control group and the experimental group was not statistically significant(P>0.05).Conclusions In patients with heart failure treated with CBP,especially in those treated with CBP therapy within 24 hours,blood return with blood bag may avoid the recurrence of heart failure.

关 键 词：难治性心力衰竭 连续血液净化 回血 

分 类 号：R54[医药卫生—心血管疾病]