郭宏晶，李　莉，向　晶，曾　鹂，王伟杰，耿赫兵，王　艳，孟庆义，朱秀勤，王建荣



无抗凝CRRT体外循环冲洗护理对病人心率、血压的影响

郭宏晶，李莉，向晶，曾鹂，王伟杰，耿赫兵，王艳，孟庆义，朱秀勤，王建荣

摘要:[目的]探讨生理盐水冲洗与免冲洗对有高危出血风险行无抗凝连续性肾脏替代治疗(CRRT)时病人循环的影响。[方法]将有高危出血风险行无抗凝CRRT治疗的病人随机分为生理盐水冲洗组(对照组)与免冲洗组(观察组)，在上机时、上机后1 h、2 h、3 h、4 h、5 h、下机前共7个时间点观察两组病人上机治疗过程中心率、血压变化。[结果]两组病人上机过程中不同时间心率、收缩压、舒张压、平均动脉压比较，差异均无统计学意义(P>0.05)，但两组病人的脉压在上机后2 h、3 h、4 h、5 h及下机时比较差异有统计学意义(P<0.05)。[结论]有高危出血风险的急性或慢性肾衰竭病人行无抗凝CRRT过程中，如合并心血管疾病需慎用生理盐水冲洗。

关键词：持续肾脏替代治疗；生理盐水冲洗；抗凝；凝血；护理

Influence of irrigated nursing with non anticoagulant CRRT extracorporeal circulation on heart rate and blood pressure of patients

Guo Hongjing,Li Li,Xiang Jing,et al

(General Hospital of PLA,Beijing 100853 China)

AbstractObjective:To probe into the influence of Saline irrigation and free irrigation on patients with high risk of hemorrhage receiving non anticoagulation CRRT treatment.Methods:Patients with high risk of hemorrhage receiving non anticoagulation CRRT treatment were randomly divided into Saline irrigation group(control group) and free irrigation group(observation group).The center rate and blood pressure were observed at seven time points respectively the time of treating, after 1 h,2 h,3 h,4 h,5 h and the end of treating between both groups.Results:The results showed that there were not statistically significant differences in the heart rate,systolic pressure,diastolic pressure,mean arterial pressure in different time points during treating between both groups(P>0.05),but the difference was statistical significant in the pulse pressure of patients between both groups at 2 h,3 h,4 h,5 h after the treating and the end of treating(P<0.05).Conclusion:Saline irrigation need to be used carefully for acute or chronic renal failure patients with high risk of hemorrhage risk who underwent non anticoagulation for CRRT and complicated with cardiovascular disease.

Key wordscontinuous renal replacement therapy;saline irrigation;anticoagulation;blood coagulation;nursing

连续性肾脏替代治疗(continuous renal replacement therapy，CRRT)是近年来血液净化技术的一项革新与发展[1-2]，除了超滤、脱水、清除置换液外，还能有效清除致病性介质，通过调节免疫、内皮及上皮细胞功能，清除血液中的代谢废物，连续、缓慢地清理体内过多的水分，重建水、电解质、酸碱和代谢平衡，维护机体内环境稳态，保持血流动力学和心血管功能的稳定[3-7]。对于有高危出血倾向的病人主要采用无抗凝的CRRT治疗方法，在治疗前给予肝素生理盐水预冲管路，保留灌注20 min后，再给予生理盐水500 mL冲洗；治疗过程中每隔30 min～60 min给予100 mL～200mL生理盐水冲洗管路和滤器[1-2]。然而有研究者报道，这种方案由于每小时有100 mL～200 mL生理盐水进入病人的循环系统中，需要通过体外循环超滤方式将这部分液体移出，这对于有潜在低血压或液体超负荷风险的危重病人来讲，造成了更多的液体管理困难[8]。本研……