跨膜压与废液压趋势变化在连续性肾脏替代治疗滤器凝血的预测价值研究  

Study on the predictive value of the dynamic trends of transmembrane pressure and waste hydraulic pressure in coagulation of continuous renal replacement therapy filter coagulation

作　　者：庄耀宁 陈一媛 林敏[1] 林丹丹 黄美春[2] 林群英[1] ZHUANG Yaoning;CHEN Yiyuan;LIN Min;LIN Dandan;HUANG Meichun;LIN Qunying(Department of Respiratory and Critical Care Medicine,the Affiliated Hospital of Putian University,Putian 351100,Fujian,China;Department of Nursing,the Affiliated Hospital of Putian University,Putian 351100,Fujian,China)

机构地区：[1]莆田学院附属医院呼吸与危重症医学科监护室,福建莆田351100 [2]莆田学院附属医院护理部,福建莆田351100

出　　处：《护士进修杂志》2022年第15期1357-1362,共6页Journal of Nurses Training

基　　金：福建省莆田市科技计划项目(编号:2018S3F016)。

摘　　要：目的探讨跨膜压(TMP)、废液压趋势变化与连续性肾脏替代治疗(CRRT)滤器凝血运行时间的相关性,量化凝血风险水平以探究该曲线变化在CRRT滤器凝血中的预测价值。方法采用目的抽样,选取2018年1月-2020年12月我院重症医学科行CRRT治疗的患者214例,观察记录压力指标的趋势变化,测量TMP与废液压角度变化,将角度大小与CRRT滤器凝血运行时间的相关性分析、绘制滤器凝血在曲线图上的分布情况,并分析角度大小的相关影响因素及ROC曲线分析。结果TMP与废液压动态趋势变化具有一定的临床特征:两曲线在运行早期相对平行走向,随着滤器配套的凝血程度的增加,开始出现拐点,出现角度;角度大小与出现拐角之后滤器运行的时间及总的运行时间,两者之间存在线性关系,呈负相关,R~2分别为0.933及0.898,相关系数分别为-0.834及-1.112,差异具有统计学意义(P<0.01)。在拐角出现前,多集中在0~Ⅰ级;拐角出现后,滤器凝血程度多集中Ⅱ~Ⅲ级。单因素与多元线性回归分析结果显示,导管通畅、血流速度及APTT是曲线角度压大小的保护因素,滤过分数、预冲方式、血小板及红细胞压积是危险因素。以曲线角度大小为检测变量非计划下机指标进行ROC曲线分析。ROC曲线下面积为0.679(P<0.01),约登指数为0.497,最佳截距的角度为34.3,说明曲线图在非计划下机具有一定的预测价值。结论TMP与废液压动态趋势变化图在CRRT滤器凝血预测上具有一定的研究价值,可以作为临床CRRT的管理提供一定的科学依据。Objective To explore the correlation between the trend changes of transmembrane pressure(TMP) and waste liquid pressure and the clotting time of continuous renal replacement therapy(CRRT) filter, and to quantify the risk level of clotting to explore the predictive value of the curve changes in the coagulation of CRRT filter.Method Objective sampling was used to select 214 patients who received CRRT treatment in the intensive care department of our hospital from January 2018 to December 2020, observe and record the trend change of pressure indicators, measure the angle change of TMP and waste liquid pressure, analyze the correlation between the angle and the coagulation running time of CRRT filter, and plot the distribution of filter coagulation on the curve. The relative influencing factors of angle size and ROC curve analysis were analyzed. Results The dynamic trend changes of TMP and waste liquid pressure had certain clinical characteristics: the two curves were relatively parallel in the early stage of operation, and the inflection point and angle began to appear with the increase of coagulation degree of the filter;there was a linear and negative correlation between the angle and the running time and total running time of the filter after the corner, R~2 were 0.933 and 0.898, correlation coefficients were-0.834 and-1.112, the difference was statistically significant(P<0.01). Before the corner appears, the coagulation degree of filter mainly concentrated on the 0-Ⅰlevel;after the corner appeared, it mostly concentrated in Ⅱ-Ⅲ. Univariate and multiple linear regression analysis showed that patency of catheter, flow velocity, and APTT were the protective factors of curve angle pressure, while filtration fraction, preflush mode, platelet, and hematocrit were the risk factors. ROC curve was analyzed by taking the curve angle as the detection variable and unplanned disembarking index. The area under the ROC curve was 0.679(P<0.01), Youden index was 0.497, and the angle of the optimal intercept was 34.3, indic

关 键 词：连续性肾脏替代治疗 压力监测 滤器凝血 预测价值 

分 类 号：R459.5[医药卫生—治疗学] R472.9[医药卫生—临床医学]