超纯透析中逆超滤冲洗用于无肝素血液透析患者效果观察  

Effect of backflushing with ultrapure dialysis fluid in patients on heparin-free hemodialysis

作　　者：吕锦旭[1] 牛洪艳[1] 胡璐璐[1] 薛丽娜[1] 刘金凤[1] 梁聪 LüJinxu;Niu Hongyan;Hu Lulu;Xue Lina;Liu Jinfeng;Liang Cong(Blood Purification Center,Changzhou First People′s Hospital,Changzhou 213000,China)

机构地区：[1]常州市第一人民医院血液净化中心,江苏常州213000

出　　处：《护理学杂志》2024年第11期42-45,共4页Journal of Nursing Science

基　　金：2021年度常州市第一人民医院科技计划资助项目(yy2021002)。

摘　　要：目的探讨超纯透析中逆超滤冲洗在无肝素血液透析中的应用效果。方法将便利选取的45例有出血风险的无肝素血液透析患者分为对照组26例、干预组19例;血液透析过程中对照组采用常规生理盐水冲洗法,干预组采用逆超滤冲洗法;比较两组治疗完成情况、凝血指标及护理操作便捷性。结果两组均行91例次血液透析;干预组提前下机与更换管路后完成血液透析率、透析器和静脉壶凝血发生率显著低于对照组,每例次血液透析时间及护理操作频次显著少于对照组(均P<0.05)。干预组血液透析前后相关凝血指标差异无统计学意义(均P>0.05);对照组凝血酶原时间、活化部分凝血酶时间显著延长,纤维蛋白原含量显著减少(均P<0.05)。结论超纯透析中逆超滤冲洗可有效减少无肝素血液透析患者体外管路凝血,提高血液透析效率与安全性。Objective To explore the effect of backflushing with ultrapure dialysis fluid in patients on heparin-free hemodialysis.Methods A convenience sample of 45 patients at risk for bleeding receiving heparin-free hemodialysis were divided into a control group(n=26)and an intervention group(n=19).During hemodialysis,the control group used normal saline for flushing,while the intervention group received intermittent backflushing with ultrapure dialysis fluid.The completion of treatment,coagulation parameters and convenience of nursing operation were compared between the two groups.Results Both groups received 91 sessions of hemodialysis.The rate of completion of the treatment after early termination of hemodialysis sessions or replacement of the tubing system,and the rate of clotting at the dialyzer and venous drip chamber were significantly lower in the intervention group than those in the control group(all P<0.05).The intervention group also had significantly shorter duration of each dialysis session and fewer nursing operations compared with the control group(both P<0.05).There were no statistically significant differences in coagulation parameters pre-and post-dialysis in the intervention group(all P>0.05).However,in the control group,the prothrombin time and activated partial thromboplastin time were significantly prolonged,and the fibrinogen level was significantly reduced(all P<0.05).Conclusion Backflushing with ultrapure dialysis fluid can effectively reduce extracorporeal circuit clotting in patients receiving heparin-free hemodialysis,thereby improving hemodialysis efficiency and safety.

关 键 词：血液透析 出血风险 超纯透析液 生理盐水 管路冲洗 凝血 逆超滤 

分 类 号：R473.5[医药卫生—护理学] R459.5[医药卫生—临床医学]