连续性肾脏替代治疗的低体温发生率及相关因素分析  

Analysis of the incidence and related factors of hypothermia in patients with continuous renal replacement therapy

作　　者：张鹏[1] 江海娇[1] 叶小铭 方可 汪君[1] 袁莉萍[1] 张陆雨 鲁卫华[1] 陶秀彬[1] 姜小敢[1] Zhang Peng;Jiang Haijiao;Ye Xiaoming;Fang Ke;Wang Jun;Yuan Liping;Zhang Luyu;Lu Weihua;Tao Xiubin;Jiang Xiaogan(Department of Critical Care Medicine,the First Affiliated Hospital of Wannan Medical College(Yijishan Hospital),Anhui Provincial Clinical Research Center for Critical Respiratory Disease,Wuhu 241000,Anhui,China)

机构地区：[1]皖南医学院弋矶山医院重症医学科,安徽省危重症呼吸疾病临床医学研究中心,安徽芜湖241000

出　　处：《中华危重病急救医学》2023年第4期387-392,共6页Chinese Critical Care Medicine

基　　金：安徽省医疗卫生重点专科建设项目(2021-273);弋矶山医院科技创新团队"攀峰"培育计划(PF2019014)。

摘　　要：目的探讨急性肾损伤(AKI)患者接受连续性肾脏替代治疗(CRRT)期间低体温的发生率及发生低体温的影响因素,并比较不同加温方式对CRRT患者低体温发生率的影响。方法采用前瞻性研究方法,选择2020年1月至2022年12月皖南医学院弋矶山医院重症医学科收治的行CRRT的AKI患者作为研究对象。按照随机数字表法将患者分为透析液加热组和回输管路加热组。两组均由床位医生根据患者具体病情提供合理的治疗模式和参数设置。透析液加热组使用AsahiKASEI血透机加热板直接对透析液进行加热,加热温度设置为37℃;回输管路加热组使用Prismaflex CRRT系统自带的Barkey血液加热器对回输管路进行加热,加热管路温度设置为41℃。持续监测患者体温,将体温低于36℃或较基础体温下降超过1℃定义为低体温。比较两组患者低体温的发生率及发生时间;采用二元多因素Logistic回归分析探讨AKI患者CRRT期间发生低体温的影响因素。结果最终共纳入73例行CRRT治疗的AKI患者,其中透析液加热组37例,回输管路加热组36例。与回输管路加热组比较,透析液加热组患者低体温发生率明显降低〔40.5%(15/37)比69.4%(25/36),P<0.05〕,且透析液加热组低体温的发生时间晚于回输管路加热组(h:5.40±0.92比3.35±0.92,P<0.01)。将患者按照是否发生低体温分为低体温组和非低体温组,对所有指标进行单因素分析,结果显示,与非低体温组(n=33)比较,低体温组(n=40)患者平均动脉压(MAP)明显降低〔mmHg(1 mmHg≈0.133 kPa):77.45±12.47比94.42±14.51,P<0.01〕,休克、使用中大剂量血管活性药物比例(中等剂量:0.2~0.5μg·kg^(-1)·min^(-1),大剂量:>0.5μg·kg^(-1)·min^(-1))及CRRT治疗剂量均明显升高〔休克:45.0%(18/40)比6.1%(2/33),使用中大剂量血管活性药物:82.5%(33/40)比18.2%(6/33),CRRT治疗剂量(mL·kg^(-1)·h^(-1)):51.50±9.38比38.42±10.97,均P<0.01〕,且两组CRRT加热类型亦存�Objective To investigate the incidence and risk factors of hypothermia in patients with acute renal injury(AKI)receiving continuous renal replacement therapy(CRRT),and to compare the effects of different heating methods on the incidence of hypothermia in patients with CRRT.Methods A prospective study was conducted.AKI patients with CRRT who were admitted to the department of critical care medicine of the First Affiliated Hospital of Wannan Medical College(Yijishan Hospital)from January 2020 to December 2022 were enrolled as the study subjects.Patients were divided into dialysate heating group and reverse-piped heating group according to randomized numerical table method.Both groups were provided with reasonable treatment mode and parameter setting by the bedside physician according to the patient's specific condition.The dialysis heating group used the AsahiKASEI dialysis machine heating panel to heat the dialysis solution at 37℃.The reverse-piped heating group used the Barkey blood heater from the Prismaflex CRRT system to heat the dialysis solution,and the heating line temperature was set at 41℃.The patient's temperature was then continuously monitored.Hypothermia was defined as a temperature lower than 36℃or a drop of more than 1℃from the basal body temperature.The incidence and duration of hypothermia were compared between the two groups.Binary multivariate Logistic regression analysis was used to explore the influencing factors of hypothermia during CRRT in AKI patients.Results A total of 73 patients with AKI treated with CRRT were eventually enrolled,including 37 in the dialysate heating group and 36 in the reverse-piped heating group.The incidence of hypothermia in the dialysis heating group was significantly lower than that in the reverse-piped heating group[40.5%(15/37)vs.69.4%(25/36),P<0.05],and the hypothermia occurred later than that in the reverse-piped heating group(hours:5.40±0.92 vs.3.35±0.92,P<0.01).Patients were divided into hypothermic and non-hypothermic groups based on the presence

关 键 词：连续性肾脏替代治疗 低体温 危险因素 加温方式 

分 类 号：R692.5[医药卫生—泌尿科学]