增加预冲周期对重症中毒病人血液灌流后血小板下降的影响  

Effect of increasing pre-flushing cycle on thrombocytopenia after hemoperfusion in patients with severe poisoning

作　　者：秦玉菊 杨霞 刘家红 朴美萤 张海钢 徐红波 QIN Yuju;YANG Xia;LIU Jiahong;PIAO Meiying;ZHANG Haigang;XU Hongbo(Huazhong University of Science and Technology Union Shenzhen Hospital,Guangdong 518052 China)

机构地区：[1]华中科技大学协和深圳医院,广东518052 [2]华中科技大学同济医学院附属协和医院

出　　处：《护理研究》2020年第16期2868-2872,共5页Chinese Nursing Research

基　　金：深圳市卫生计生系统科研项目,编号:SZFZ2018030。

摘　　要：[目的]探讨增加预冲周期对重症中毒病人血液灌流后血小板计数和凝血功能的影响。[方法]抽取2017年1月—2019年11月在深圳市某医院重症监护病房(ICU)行血液灌流的重症中毒病人116例,随机分为观察组和对照组,每组58例。观察组采用100mg/L的肝素生理盐水预冲2个周期;对照组采用100 mg/L的肝素生理盐水预冲1个周期,并静置30 min。比较两组血液灌流前后血小板计数、部分凝血活酶时间(APTT)、凝血酶原时间(PT)、纤维蛋白原(Fib)的变化情况;观察并比较两种方法的预冲所需时间及两组的出血情况、滤器凝血情况。[结果]血液灌流后,观察组血小板计数、APTT分别为161(127,228)×10^9/L、36.6(33.9,46.8)s,对照组血小板计数、APTT分别为156(109,187)×10^9/L、39.7(35.7,47.1)s,两组差值比较均有统计学意义(P<0.05);观察组预冲所需时间为26.0(25.0,27.0)min;对照组预冲所需时间为46.5(45.0,47.0)min,两组比较差异有统计学意义(P<0.001);两组均未发生Ⅲ级灌流器凝血及皮肤黏膜、消化道、口腔、鼻腔、泌尿系、颅脑等脏器出血。[结论]增加预冲周期可改善血液灌流后血小板计数下降,节约预冲所需时间,为重症病人赢得抢救时机。Objective:To probe into the effect of increasing the pre-flushing cycle on blood platelet counts(BPC)and coagulation function after hemoperfusion in patients with severe poisoning.Methods:A total of 116 patients with severe poisoning,who received hemoperfusion in the intensive care unit(ICU)in a hospital in Shenzhen from January 2017 to November 2019,were enrolled and randomly divided into the intervention group and the control group,with 58 cases in each group. The intervention group used 100 mg/L heparin saline to pre-flush for 2 cycles. While and the control group used 100 mg/L heparin saline to pre-flush for 1 cycle and was aside for 30 minutes. BPC,activated partial thromboplastin time(APTT),prothrombin time(PT),and fibrinogen level were compared between the two groups before and after the hemoperfusion. Additionally,the required flushing time,bleed status,and filter coagulation status between the two groups were recorded and compared.Results:After hemoperfusion,the BPC and APTT of the observation group were 161(127,228)×10^9/L and 36. 6(33. 9,46. 8)s,respectively. The BPC and APTT of the control group were 156(109,187)×10^9/L and 39. 7(35. 7,47. 1)s,respectively. Differences between the two groups were statistically significant(P<0. 05). The required time for pre-flushing in the intervention group was 26. 0(25. 0,27. 0)min,while that was 46. 5(45. 0,47. 0)min in the control group. Differences between the two groups was statistically significant(P<0. 001). There was no report on Grade Ⅲ filter coagulation and hemorrhage of organs such as skin and mucous membranes,gastrointestinal tract,oral cavity,nasal cavity,urinary system,cranial brain,and other organs in both groups.Conclusions:Increasing the pre-flushing cycle could significantly prevent thrombocytopenia after hemoperfusion,save the required time for pre-flushing,thus to grasp the rescue opportunity for critically ill patients.

关 键 词：血液灌流 血浆吸附 血小板 凝血功能 预冲时间 出血 

分 类 号：R472[医药卫生—护理学]