2018 年第 10 期 第 13 卷

局部枸橼酸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 regional citrate anticoagulation in critical patients

作者：赵小利刘革婷谢丰君陈海燕何晓娜刘昱张蕾马红叶朱芝静郭利涛

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；枸橼酸；抗凝

英文关键词：

• 摘要：

• 【摘要】目的    分析局部枸橼酸抗凝时影响重症患者连续性肾脏替代治疗（CRRT）时间的相关因素。方法    回顾性分析2016年1—10月入住西安交通大学第一附属医院重症医学科使用枸橼酸抗凝行CRRT治疗的重症患者的相关资料，比较治疗前及治疗后相关生化指标的变化，通过单因素及多因素回归分析影响治疗时间的相关因素。结果    共纳入27例患者（男13例、女14例），平均年龄（59±18）岁，共行CRRT治疗63次，平均治疗时间（47±25）h，下机时的跨膜压（281±120）cmH2O（1 cmH2O=0.098 kPa）。治疗后血尿素氮、血肌酐低于治疗前，pH值高于治疗前［（9±5）mmol/L比（12±7）mmol/L、（128±95）μmol/L比（162±126）μmol/L、（7.43±0.09）比（7.41±0.09）］，差异均有统计学意义（均P<0.05）。单因素线性回归分析发现护士工作年限（B=14.721，95%置信区间：2.214～27.229，P=0.022）、治疗前的Na+（B=-1.089，95%置信区间：-2.151～-0.027，P=0.045）、凝血酶时间（B=2.942，95%置信区间：0.085～5.799，P=0.044）与治疗时间存在相关性。进一步多因素线性回归分析发现护士工作年限与治疗时间存在正相关性（B=15.330，95%置信区间：3.063～27.598，P=0.015）。结论    局部枸橼酸抗凝时护士工作年限对CRRT时间有影响，与CRRT治疗时间存在正相关性。

• 【Abstract】Objective    To analyze the influence factors of the duration time of continuous renal replacement therapy(CRRT) with regional citrate anticoagulation in critical patients. Methods    Clinical records of critical patients who had CRRT using regional citrate anticoagulation from January to October 2016 in the First Affiliated Hospital of Xi′an Jiaotong University were retrospectively analyzed. Changes of biochemical indicators were analyzed before and after treatment. Influence factors of the duration time of CRRT were analyzed by univariate and multivariate regression. Results    Twenty-seven patients(13 males and 14 females) were included; the mean age was (59±18)years. Sixty-three times of CRRT were performed; the mean therapy time was (47±25)h; the mean transmembrane pressure at the end of therapy was (281±120)cmH2O. After treatment, urea nitrogen and serum creatinine were lower and pH value was higher than those before treatment［（9±5）mmol/L vs （12±7）mmol/L, （128±95）μmol/L vs （162±126）μmol/L, （7.43±0.09） vs （7.41±0.09）］（P<0.05）. Univariate regression showed that work experience of nurse（B=14.721, 95% confidence interval: 2.214-27.229, P=0.022）, serum sodium（B=-1.089, 95% confidence interval: -2.151 to -0.027, P=0.045） and thrombin time（B=2.942, 95% confidence interval: 0.085-5.799, P=0.044） were related to the duration time of CRRT. Multivariate regression showed that work experience of nurse was positively related to the duration time of CRRT（B=15.330, 95% confidence interval: 3.063-27.598, P=0.015）. Conclusion    In patients undergoing CRRT with regional citrate anticoagulation, the work experience of nurse shows a positive relation with the duration of therapy.