不同预冲方法对血液灌流联合血液透析患者凝血和出血的影响

摘要

Objective To investigate the effects of two pre-perfusion methods on coagulation and bleeding in the patients with hemoperfusion combined with hemodialysis.Methods By adopting the randomized controlled trial design,256 cases undertaking hemoperfusion combined with hemodialysis in our center from January 2012 to December 2013 were randomly divided into the two groups.The intervention group(128 cases) adopted the physiological saline wash heparin enclosed circulation.The control group(128 cases) adopted different concentrations of heparin saline slow washing.The pre-washing time and saline and heparin cost performed statistics.The influence of two kinds of method on the perfusion apparatus,dialyzer coagulation rate and bleeding rate were compared between the two groups.Results (1) The pre-washing time in the intervention group was (33.6±2.5)min,and the costs of normal saline and heparin were 17.6 Yuan/per time and 7.6 Yuan/per time;the pre-washing time in the control group was(45.6±3.2) min,and the costs of of normal saline and heparin were respectively.Pre-wash time,saline consumption,and heparin consumption in the control group were 34.4 Yuan/per time and 15.2 Yuan/per time,the differences between the two groups were statistically significant(P<0.05).(2)The coagulation rate of perfusion apparatus in the intervention group was 2.3%,which of dialyzer was 3.9%,which in the control group were 3.9% and 7.0% respectively,the differences between the two groups were statistically significant (P<0.05).(3) The bleeding rate was 3.9% in the intervention group and 14.8% in the control group,the difference was statistically significant (P<0.05).Conclusion Adopting normal saline pre-washing heparin enclosed circulation can obviously reduce the coagulation rate and bleeding rate in the patients with hemoperfusion combined with hemodialysis,saves the nurse′s operating time and costs,and is worth of being further promoted and verified in clinic.%目的 探讨两种不同预冲方法对血液灌流联合血液透析患者凝血和出血的影响.方法 采用完全随机对照研究设计,将2012年1月至2013年12月在四川大学华西医院血液透析中心行血液灌流联合血液透析治疗的256例患者随机分为两组,干预组采用生理盐水冲洗肝素密闭式循环(128例),对照组采用不同浓度肝素生理盐水缓慢冲洗(128例),统计两种方法的预冲时间、生理盐水及肝素成本,比较两种预冲方法对灌流器、透析器凝血率和患者出血率的影响.结果 (1)干预组的预冲时间为每次(33.6±2.5)min,生理盐水及肝素成本分别为17.6元/次和7.6元/次;对照组的预冲时间为每次(45.6±3.2)min,生理盐水及肝素成本分别为34.4元/次和15.2元/次,两组的预冲时间、生理盐水及肝素成本比较差异均有统计学意义(P<0.05).(2)干预组血液灌流器凝血率为2.3%,血液透析器凝血率为3.9%;对照组血液灌流器和血液透析器的凝血率分别为3.9%、7.0%,两组灌流器、透析器凝血率比较差异有统计学意义(P<0.05).(3)干预组患者出血率为3.9%,对照组患者出血率为14.8%,两组患者出血率比较差异有统计学意义(P<0.05).结论 采用生理盐水预冲肝素密闭式循环,可明显降低血液灌流联合血液透析患者的凝血率和出血率,节省护士操作时间、节约成本,值得临床进一步推广与验证.