连续性肾脏替代治疗中应用不同管腔容积的肝素溶液封管对患者凝血功能的影响  

The Effect of heparin solution sealing with different tube volumes on coagulation function in patients undergoing continuous renal replacement therapy

作　　者：马颖[1] 付丽[1] 李莹莹[1] 林瑾[1] 刘景峰[1] Ma Ying;Fu Li;Li Yingying;Lin Jin;Liu Jingfeng(Department of Intensive Care Unit,Bejing Friendship Hospital,Capital Medical University,Bejing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院重症医学科,北京100050

出　　处：《中国实用护理杂志》2024年第21期1628-1634,共7页Chinese Journal of Practical Nursing

基　　金：北京市属医院科研培育计划(PX2021003)。

摘　　要：目的探讨无隧道和涤纶套的透析导管(简称为非隧道式导管)不同容积肝素盐水封管对连续性肾脏替代治疗(CRRT)患者凝血功能影响。方法采用随机对照试验方法,便利抽样法于2021年3月至2022年12月选择首都医科大学附属北京友谊医院重症医学科行CRRT过程中需要封管的患者为研究对象,分为试验组和对照组,对照组采用100%管腔容积的肝素溶液封管,试验组采用80%管腔容积的肝素溶液封管,对比2组患者凝血功能活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、凝血酶原活动度(PTA)、纤维蛋白原(Fbg)、血红蛋白、血小板及封管不良预后事件(主要包括堵管、出血、出血倾向)。结果最终121例患者入选,试验组59例,对照组62例。对照组男39例,女23例,年龄(66.6±18.2)岁;试验组男29例,女30例,年龄(65.2±17.5)岁。封管后,试验组APTT、PT分别为(41.2±7.6)、(14.0±0.8)s,低于对照组的(48.1±14.7)、(16.2±4.0)s,差异均有统计学意义(t=4.32、4.08,均P<0.05);试验组PTA、血红蛋白、血小板分别为(77.9±12.5)s、(90.3±10.1)g/L、(151.3±89.4)×10^(9)/L,高于对照组的(65.3±17.2)s、(85.2±5.2)g/L、(110.0±21.6)×10^(9)/L,差异均有统计学意义(t=-4.59、-5.03、-5.59,均P<0.05);试验组出血发生率为1.7%(1/59),低于对照组的12.9%(8/62),差异有统计学意义(χ^(2)=0.12,P<0.05)。结论80%管腔容量肝素溶液封管改善凝血功能,降低出血风险,且不增加导管堵塞发生率。Objective To investigate the influence of various volumes of heparinized saline seal on coagulation function in patients undergoing Continuous Renal Replacement Therapy(CRRT)with non-tunneled hemodialysis catheters.Methods A randomized controlled trial was conducted on patients requiring catheter sealing during CRRT in the Department of intensive care unit,Beijing Friendship Hospital Affiliated to Capital Medical University from March 2021 to December 2022.Patients were randomly assigned to either the experimental group or the control group,The control group used 100%catheter volume of heparinized solution,while the experimental group used 80%catheter volume of heparinized solution.Compare the activated partial thromboplastin time(APTT),prothrombin time(PT),prothrombin activity(PTA),fibrinogen(Fbg),hemoglobin,platelets,and poor prognosis events(mainly including clotting,bleeding,bleeding inclination)between two groups of patients.Results A total of 121 patients were included in the study,with 59 in the experimental group and 62 in the control group.In the control group,there were 39 males and 23 females,with an average age of(66.6±18.2)years,while in the experimental group,there were 29 males and 30 females,with an average age of(65.2±17.5)years.After catheter sealing,APTT and PT in the experimental group were(41.2±7.6)s and(14.0±0.8)s,respectively,both lower than the corresponding values in the control group[(48.1±14.7)s and(16.2±4.0)s],with statistically significant differences(t=4.32,4.08,both P<0.05).In the experimental group,PTA,fibrinogen levels,and platelet were(77.9±12.5)s,(90.3±10.1)g/L,and(151.3±89.4)×10^(9)/L,respectively,higher than the corresponding values in the control group(65.3±17.2)s,(85.2±5.2)g/L,and(110.0±21.6)×10^(9)/L,with statistically significant differences(t=-4.59,-5.03,-5.59,all P<0.05).After the closure of the tube,the bleeding incidence rate in the experimental group was 1.7%(1/59),which was significantly lower than that in the control group at 12.9%(8/62),with statistic

关 键 词：连续性肾脏替代治疗 非隧道式导管 肝素封管 管腔容积 

分 类 号：R473[医药卫生—护理学]