精准调钠小程序在高钠血症患者连续性肾脏替代治疗中的应用  

Precision sodium adjustment mini-program in continuous renal replacement therapy for hypernatremia patients

作　　者：邓凤英[1] 任萌 罗湘俊[1] 谭心怡 刘朝晖 傅凯 DENG Fengying;REN Meng;LUO Xiangjun;TAN Xinyi;LIU Zhaohui;FU Kai(Nanhua Hospital Affiliated to University of South China,Hengyang 421002,China;School of Nursing,University of South China,Hengyang 421001,China;Science Training Service Department,National Olympic Sports Center,Beijing 100020,China;School of Computer Science,University of South China,Hengyang 421001,China)

机构地区：[1]南华大学附属南华医院肾内科,衡阳421002 [2]南华大学护理学院 [3]国家奥林匹克体育中心科学训练服务处 [4]南华大学计算机学院

出　　处：《肾脏病与透析肾移植杂志》2024年第6期514-520,共7页Chinese Journal of Nephrology,Dialysis & Transplantation

基　　金：2022年度湖南省卫生健康委科研立项课题(202214014748);2020年度湖南省社会科学成果评审委员会课题(XSP20YBC037)。

摘　　要：目的:构建置换液精准调钠小程序,评估其在连续性肾脏替代治疗(CRRT)联合枸橼酸钠抗凝治疗高钠血症患者的有效性和安全性。方法:选取2021年1月至2024年6月CRRT联合枸橼酸钠抗凝治疗的高钠血症患者36例,随机分为试错组和精准调钠组。试错组由医师经验法调整置换液,精准调钠组使用小程序自动计算置换液成分。比较两组患者治疗前后的心率、平均动脉压、外周血游离钙离子、pH值、HCO_(3)^(-)、剩余碱(BE)、血清氯离子、治疗后14 d的临床疗效、降钠效果、医务人员工作效率及满意度。结果:治疗8 h后,精准调钠组心率和平均动脉压显著降低(P<0.05),优于试错组。外周血游离钙浓度、血清氯离子及治疗后14 d疗效两组无显著差异(P>0.05)。治疗后两组pH值、HCO_(3)^(-)、BE、血清钠离子均改善(P<0.05),但组间无显著差异。两组患者2 h、4 h、8 h降钠值均有统计学差异(P<0.001),无交互作用(P>0.05)。精准调钠组在达到精准平稳降钠的时间、8 h平均降钠速度、置换液计算时长及医务人员满意度上均优于试错组(P<0.001)。结论:置换液精准调钠小程序在CRRT联合枸橼酸钠抗凝治疗高钠血症患者中安全有效,提高了工作效率。Objective:To construct a precise natriuretic adjustment mini-program with replacement fluid and evaluate its efficacy and safety in continuous renal replacement therapy(CRRT)combined with sodium citrate anticoagulant therapy in patients with hypernatremia.Methodology:A total of 36 patients with hypernatremia from January 2021 to June 2024 were randomly divided into trial and error group and precision sodium regulation group,both of which received conventional treatment plus CRRT and sodium citrate anticoagulation.The trial-and-error group adjusted the replacement fluid based on physician experience,while the precision sodium regulation group utilized a mini-program to automatically calculate the composition of the replacement fluid.Compare the heart rate,mean arterial pressure,peripheral blood free calcium ions,pH value,HCO_(3)^(-),BE,serum chloride levels,clinical efficacy at 14 days post-treatment,sodium-lowering effect,and the work efficiency and satisfaction of medical staff between the two groups before and after treatment.Results:After 8 h of treatment,the heart rate and mean arterial pressure in the precision sodium regulation group were significantly decreased(P<0.05),outperforming the trial-and-error group.There were no significant differences in peripheral blood free calcium concentration,serum chloride ion and 14-day curative effect between the two groups(P>0.05).After treatment,the pH value,HCO_(3)^(-),BE and serum sodium ion were all improved(P<0.05),but there was no significant difference between the two groups.There were statistically significant differences in sodium reduction at 2 h,4 h and 8 h between and within the two groups(P<0.001),but no interaction(P>0.05).The precision sodium regulation group was superior to the trial-and-error group in the time to achieve accurate and stable sodium reduction,8h average speed of sodium reduction,calculation time of replacement solution and satisfaction of medical staff(P<0.001).Conclusion:The use of a precision sodium adjustment mini-program for replaceme

关 键 词：高钠血症 置换液精准调钠 枸橼酸钠抗凝 连续性血液净化治疗 

分 类 号：R589[医药卫生—内分泌] R459.5[医药卫生—内科学]