连续性肾脏替代治疗在我国五地区重症医学科的应用现况  

Application status of continuous renal replacement therapy in intensive care unit of five regions in China

作　　者：赵佳钰 邱英鹏 刘松桥[3] 杨毅[3] 张凌[4] 于湘友[5] 秦秉玉[6] 邱海波[3] 史黎炜 刘克军 蒲莹莹 陈子扬 赵羽西 刘永军[1] 肖月 Zhao Jiayu;Qiu Yingpeng;Liu Songqiao;Yang Yi;Zhang Ling;Yu Xiangyou;Qin Bingyu;Qiu Haibo;ShiLiwei;Liu Kejun;Pu Yingying;Chen Ziyang;Zhao Yuxi;Liu Yongjun;Xiao Yue(School of International Pharmaceutical Business,China Pharmaceutical University,Nanjing 210000,China;China National Health Development Research Center,National Health Commission,National Center for Medicine and Health Technology Assessment,Beijing 100000,China; Jiangsu Provincial Key Laboratory of Critical Care Medicine,Department of Critical Care Medicine,Zhongda Hospital,School of Medicine,Southeast University,Nanjing 210009,China;Department of Nephrology,West China Hospital of Sichuan University,Chengdu 610000,China;Critical Medicine Center,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830000,China;Department of Intensive Care Medicine,Henan Provincial People’s Hospital,Zhengzhou 450000,China;Chaoyang District Health Supervision Institute,Beijing 100000,China;Yunkang School of Medicine and Health,Guangzhou Nanfang College,Guangzhou 510000,China;Beijing-Tianjin-Hebei Docking Office of Cangzhou Central Hospital,Cangzhou 061000,China)

机构地区：[1]中国药科大学国际医药商学院,南京210000 [2]国家卫生健康委卫生发展研究中心暨国家药品与卫生技术综合评估中心,北京100000 [3]江苏省重症医学重点实验室,东南大学附属中大医院重症医学科,南京210009 [4]四川大学华西医院肾脏内科,成都610000 [5]新疆医科大学第一附属医院重症医学中心,乌鲁木齐830000 [6]河南省人民医院重症医学科,郑州450000 [7]北京市朝阳区卫生健康监督所,北京100000 [8]广州南方学院云康医学与健康学院,广州510000 [9]沧州市中心医院京津冀对接办公室,沧州061000

出　　处：《中华重症医学电子杂志》2024年第4期364-374,共11页Chinese Journal Of Critical Care & Intensive Care Medicine(Electronic Edition)

基　　金：国家卫生健康委卫生发展研究中心科研课题(CNHDRC-KJ-L-2020-30)

摘　　要：目的分析连续性肾脏替代治疗(CRRT)在ICU的资源配置、适应证以及临床使用情况,为CRRT技术在ICU应用的相关政策制定提供参考。方法基于文献研究和专家咨询形成《医疗机构CRRT应用现况调查问卷(ICU)》,对全国中、东、西部5省/自治区共167家医院进行横断面调查,时间为2021年3月1日至31日。问卷内容主要包括:(1)各地区资源配置情况(CRRT设备配置、管理和操作CRRT技术的医护人员配置及培训情况);(2)适应证构成情况(肾脏疾病和非肾脏疾病);(3)临床应用情况(治疗模式及治疗时长、置换液和滤器使用情况、定期质控与消毒措施);(4)治疗效果(患者预后、治疗费用)。结果资源分布上,我国东部地区CRRT设备资源及人力资源较为丰富,参加过国家或省级(学协会)组织开展的CRRT规范化培训的医护人员比例相对较低(医师38.54%~62.70%;护士18.86%~35.26%);临床使用上,CRRT在ICU的适应证以非肾脏疾病居多,前3种适应证为脓毒症或感染性休克(17%),其次为急性(13%)或慢性(12%)肾功能不全合并循环不稳定,首要适应证在各地的分布差距不大;应用最多的2种治疗模式为CVVHDF(37%)及CVVH(33%);各省治疗时间跨度较大,但以次均治疗时间以>24 h为主(59.3%);总体上商品置换液(65.44%)使用多于手工配制置换液(34.56%),但部分地区手工配制置换液占比较高(江苏、新疆占比>50%);滤器更换频率受抗凝方式的影响,无抗凝时滤器更换频率最高,约10.50 h/次,枸橼酸抗凝方式下滤器使用寿命较长,约26.65 h/次;治疗效果上,ICU住院期间病死率总体为21.40%,CRRT治疗后仍需要长期透析的比例为20.19%,河南及新疆与其他地区的治疗效果差距明显;治疗费用上,各地区CRRT收费标准差距较大,收费标准为80~130元/h,CRRT患者例均住院费用为7.4万/人,其中CRRT相关费用约占20%,医保报销比例较高(总体约70%);收费标准中通常包括医护人时费、机器�Objective To analyze the resource allocation,indications,and clinical utilization of continuous renal replacement therapy(CRRT)in ICUs,and provide references for the development of relevant policies regarding the application of CRRT in ICU settings.Methods A cross-sectional survey from a total of 167 hospitals in 5 provinces from the eastern,central,and western regions of China from March 1 to 31,2021 was conducted based on literature research and expert consultation,resulting in the creation of a questionnaire on the current application status of CRRT in medical institutions(ICU).The contents of the questionnaire mainly include:(1)resource allocation in each region(medical staff allocation and training of CRRT equipment configuration,management and operation of CRRT technology);(2)composition of indications(kidney disease and non-renal disease);(3)clinical application(treatment mode and treatment duration,use of replacement fluid and filter,regular quality control and disinfection measures);and(4)treatment effect(patient prognosis and treatment cost).Results In terms of resource distribution,CRRT equipment resources and human resources were more abundant in the eastern part of China,and the proportion of healthcare personnel who had participated in the standardized training on CRRT organized by national or provincial societies/associations was relatively low(38.54%-62.70%for physicians;18.86%-35.26%for nurses);in terms of clinical use,indications for CRRT in ICUs were predominantly for nonrenal diseases,with the top 3 indications were sepsis or infectious shock(17%),followed by acute(13%)or chronic(12%)renal insufficiency combined with circulatory instability,and there was little difference in the distribution of the top indications across the region;the 2 treatment modes with the most applications were CVVHDF(37%)and CVVH(33%);the duration of CRRT treatment in each province spanned a wide range,but with a sub-average treatment duration of>24 h(59.3%);on the whole,more commercial replacement solutions(65.44%)wer

关 键 词：连续性肾脏替代治疗 重症医学 高质量发展 

分 类 号：R459.5[医药卫生—治疗学]