摘要
目的：探讨符合重症患者连续性肾脏替代治疗（CRRT）临时性导管的肝素封管液浓度。方法收集CRRT肝素抗凝治疗患者235例，采用随机数字表法分成观察组123例和对照组112例，观察组采用1000 U/ml肝素0.9%氯化钠封管，对照组采用500 U/ml肝素0.9%氯化钠封管，2组均采用正压封管方法，观察出血情况、导管通畅度。结果2组导管通畅度和出血比较差异无统计学意义（P＞0.05）。对观察的8个观察项目（机器类型、稀释方式、置管位置、血流速、是否使用抗凝剂、是否使用免疫抑制剂、是否为高血压、糖尿病）逐项进行Logistic回归分析，未筛选出与注射器回抽情况发生相关的因素（P＞0.05）；筛选出与出血发生相关的2项因素（P＜0.05），其中1项危险因素（最大血流速），1项保护因素（置管位置）。对6个观察项目[Hb、急性生理学和慢性健康状况评分（APACHE）Ⅱ、C反应蛋白、收缩压、舒张压、活化部分凝血活酶时间（APTT）]逐项进行多元线性回归分析，筛选出与导管通畅度相关的2项因素（APACHEⅡ、APTT）（P＜0.05），为保护因素；与出血发生相关的2项因素（APACHEⅡ、APTT）（P＜0.05），为危险因素。结论500 U/ml相比于1000 U/ml肝素0.9%氯化钠不增加血栓发生率，同时减少出血率，重症患者临时性导管的肝素封管液浓度推荐使用500 U/ml。
Objective To explore the better lock solutions of temporary catheter for patients with cont inuous renal replacement therapy (CRRT) in intensive care unit. Methods A total of 235 patients with insertion of temporary central venous catheters were divided into two groups randomly. 500 U/ml heparin saline was used in the observational group (123 cases) and 1 000 U/ml heparin saline was used in the control group (112 cases). Two groups adopted positive pressure seal tube method, and the situation of catheters and bleeding were observed. Results There were no statistical significance of two groups in the situation of catheters and bleeding (P>0.05). Logistic regression:8 observational factors (machine type, dilution method, catheter placement, blood flow velocity, the use of anticoagulants, whether to use immunity inhibitors, whether for high blood pressure, diabetes) in the Logistic regression, no factors was found to have association with the situation of catheters (P>0.05 ), 2 factors were found to have association with bleeding (P<0.05 ), one hazard effect:the maximum flow of blood, one positive effect:the position of catheter. Multiple linear regression: 6 observational factors [hemoglobin, acute physiology and chronic health evaluation (APACHE)Ⅱ, C-reactive protein, systolic pressure, diastolic pressure, activated partial thromboplastin time (APTT)] in the multiple linear regression, two factors were found to have association with the situation of catheters (P>0.05 ), all of them had positive effect: APACHEⅡ,APTT; two factors were found to have association with bleeding (P < 0.05), all of them had hazard effect: APACHEⅡ,APTT. Conclusions Compared with 1 000 U/ml, 500 U/ml heparin lock solutions doesn′t increase the thrombosis of temporary catheters, and also decrease the rate of bleeding,so 500 U/ml heparin lock solutions can use in CRRT patients who use anticoagulant.
出处
《中国实用护理杂志》
2016年第10期-,共5页
Chinese Journal of Practical Nursing
基金
2015年浙江省医药卫生一般研究计划(A类)(2015KYA027)Fund programGeneral Research Program of Medical Science in Zhejiang Province(A)
关键词
连续性血液净化治疗
肝素封管液
临时性导管
Continuous renal replacement therapy
Heparin lock solutions
Temporary catheters
