2018 年第 5 期 第 13 卷

低分子肝素抗凝时影响重症患者连续性肾脏替代治疗时间的相关因素分析

Influence factors of duration of continuous renal replacement therapy with low molecular weight heparin anticoagulation in critical patients

作者：赵小利刘革婷张蕾谢丰君刘昱汪滢樊静群王雪慧郭利涛

英文作者：

单位：710061西安交通大学第一附属医院重症医学科

英文单位：

关键词：连续性肾脏替代治疗；治疗时间；低分子肝素；抗凝

英文关键词：

• 摘要：

• 目的    分析使用低分子肝素抗凝对重症患者进行连续性肾脏替代治疗（CRRT）时影响治疗时间的相关因素。方法    回顾性分析2015年11月至2016年10月入住西安交通大学第一附属医院重症医学科使用低分子肝素抗凝行CRRT的48例重症患者的病历资料。比较治疗前后相关生化指标的变化，通过单因素回归分析及多因素线性回归分析影响治疗时间的相关因素。结果    共进行114次CRRT，平均治疗时间（38±21）h，下机时的跨膜压（356±100）cmH2O（1 cmH2O=0.098 kPa）。治疗后的血尿素氮、血肌酐、血小板计数、纤维蛋白原水平较治疗前明显下降［（7±6）mmol/L比（12±9）mmol/L、（132±112）μmol/L比（187±158）μmol/L、（126±76）×109/L比（142±89）×109/L、（3.4±1.2）g/L比（3.7±1.4）g/L］，Ca2+、HCO-3较治疗前明显升高［（2.31±0.26）mmol/L比（2.16±0.34）mmol/L、（26±8）mmol/L比（24±5）mmol/L］，差异均有统计学意义（P＜0.05）。多因素线性回归分析显示，护士工作年限和血肌酐水平与CRRT时间存在正相关性［B＝10.130，95%置信区间：2.725～17.534，P＝0.008；B＝0.035，95%置信区间：0.013～0.057，P＝0.002］，纤维蛋白原水平与CRRT时间存在负相关性［B＝-3.059，95%置信区间：-5.750～-0.369，P＝0.026］。结论    低分子肝素抗凝进行CRRT时护士工作年限、血肌酐水平与治疗时间存在正相关性，纤维蛋白原水平与治疗时间存在负相关性。

• 【Abstract】Objective    To analyze the influence factors of duration of continuous renal replacement therapy（CRRT） with low molecular weight heparin anticoagulation in critical patients. Methods    Clinical records of 48 critical patients who had CRRT with low molecular weight heparin anticoagulation from November 2015 to October 2016 in the First Affiliated Hospital of Xi′an Jiaotong University were retrospectively analyzed. Influence factors of CRRT time were analyzed by univariate and multivariate linear regression. Results    Totally 114 CRRT were performed; the mean therapeutic time was （38±21）h; transmembrane pressure at the end of therapy was （356±100）cmH2O. After CRRT, levels of serum urea nitrogen, creatinine, platelet count and fibrinogen were significantly lower than those before treatment［（7±6）mmol/L vs （12±9）mmol/L, （132±112）μmol/L vs （187±158）μmol/L, （126±76）×109/L vs （142±89）×109/L, （3.4±1.2）g/L vs （3.7±1.4）g/L］; levels of Ca2+ and HCO-3 were significantly higher than those before treatment［（2.31±0.26）mmol/L vs （2.16±0.34）mmol/L, （26±8）mmol/L vs （24±5）mmol/L］（P＜0.05）. Multivariate regression analysis showed that work experience of nurse and serum level of creatinine were positively related to CRRT time(B＝10.130, 95% confidence interval: 2.725 to 17.534, P＝0.008; B＝0.035, 95% confidence interval: 0.013 to 0.057, P＝0.002); fibrinogen level was negatively related to CRRT time(B＝-3.059, 95% confidence interval: -5.750 to -0.369, P＝0.026). Conclusion    In patients undergoing CRRT with low molecular weight heparin anticoagulation, therapeutic time of CRRT is positively related to work experience of nurse and serum level of creatinine, and it is negatively related to fibrinogen level.

  【Key words】Continuous renal replacement therapy;Time of therapy;Low molecular heparin;Anticoagulation

  【Fund program】National Clinical Key Specialty Construction Project of China（2011-872）