CAJ | 학술논문

目的：探讨三通回血法在中心静脉置管( CVC)维持性血液透析( MHD)患者中的应用及其效果。方法2013年8月—2014年7月选择在血透中心行MHD治疗的患者90例,随机分为A(开放式回血法)、B(密闭式回血法)、C(三通回血法)三组,各30例,分别记录回血所需时间、回血用0.9%氯化钠溶液量、透析后残余液红细胞计数,监测患者治疗开始、6个月、12个月时C反应蛋白( CRP)变化和中心静脉导管相关性感染(CVC-RI)的发生率。结果三组回血时间分别为(291.04±46.92),(340.75±51．36),(278.99±45.21)s,0.9%氯化钠溶液用量分别为(186.72±27.65),(257.24±40.07),(191.11±32.53)ml,残余液红细胞计数分别为(4628.4±501.6),(5104.5±592.7),(4588.2±546.9)个/μl,三组间比较有统计学意义(F值分别为3.9327,4.5291,3.1338；P<0.05)；两两比较发现,A、C两组各指标差异无统计学意义(P>0.05),但两组回血时间均短于B组,0.9%氯化钠溶液用量和残余液红细胞均少于B组,差异均有统计学意义(P<0.05)。治疗6个月、12个月后,B、C组CRP水平均较A组低,差异有统计学意义(P<0.05)；三组内部不同时间点CRP水平比较,A组CRP随着时间延长有上升趋势,差异有统计学意义(P<0.05),B、C组组内3个时间点差异无统计学意义(P>0.05)。 A、B、C组CVC-RI发生率分别为40.00%,16.67%,13.33%,三组间发生率差异有统计学意义(χ2=7.0807；P<0.05)；B、C两组的CVC-RI发生率均低于A组,差异有统计学意义(P<0.05)；但B、C两组间无统计学差异(P>0．05)。结论在CVC血液透析患者中应用三通回血法,其操作简单,有条理性,使护士省时省力,减少潜在CVC-RI风险,减轻了患者的微炎症状态,又能减少透析后血路管残血量并使用较少0.9%氯化钠溶液量,可在临床上推广使用。
목적：탐토삼통회혈법재중심정맥치관( CVC)유지성혈액투석( MHD)환자중적응용급기효과。방법2013년8월—2014년7월선택재혈투중심행MHD치료적환자90례,수궤분위A(개방식회혈법)、B(밀폐식회혈법)、C(삼통회혈법)삼조,각30례,분별기록회혈소수시간、회혈용0.9%록화납용액량、투석후잔여액홍세포계수,감측환자치료개시、6개월、12개월시C반응단백( CRP)변화화중심정맥도관상관성감염(CVC-RI)적발생솔。결과삼조회혈시간분별위(291.04±46.92),(340.75±51．36),(278.99±45.21)s,0.9%록화납용액용량분별위(186.72±27.65),(257.24±40.07),(191.11±32.53)ml,잔여액홍세포계수분별위(4628.4±501.6),(5104.5±592.7),(4588.2±546.9)개/μl,삼조간비교유통계학의의(F치분별위3.9327,4.5291,3.1338；P<0.05)；량량비교발현,A、C량조각지표차이무통계학의의(P>0.05),단량조회혈시간균단우B조,0.9%록화납용액용량화잔여액홍세포균소우B조,차이균유통계학의의(P<0.05)。치료6개월、12개월후,B、C조CRP수평균교A조저,차이유통계학의의(P<0.05)；삼조내부불동시간점CRP수평비교,A조CRP수착시간연장유상승추세,차이유통계학의의(P<0.05),B、C조조내3개시간점차이무통계학의의(P>0.05)。 A、B、C조CVC-RI발생솔분별위40.00%,16.67%,13.33%,삼조간발생솔차이유통계학의의(χ2=7.0807；P<0.05)；B、C량조적CVC-RI발생솔균저우A조,차이유통계학의의(P<0.05)；단B、C량조간무통계학차이(P>0．05)。결론재CVC혈액투석환자중응용삼통회혈법,기조작간단,유조이성,사호사성시성력,감소잠재CVC-RI풍험,감경료환자적미염증상태,우능감소투석후혈로관잔혈량병사용교소0.9%록화납용액량,가재림상상추엄사용。
Objective To explore the clinical application of blood return by tee union among central venous catheter ( CVC) in hemodialysis patients. Methods A total of 90 MHD patients had been selected and randomly divided into group A (opening blood return), group B (closing blood return), and group C (blood return by tee union) on average from August 2013 to July 2014 in Hemodialysis Center. We documented the length of blood return, the volume of 0. 9% sodium chloride solution, red-cell count ( RCC) in the residual liquid after dialysis, the change of C reactive protein at the beginning of treatment, 6 months and 12 months after treatment, and the rate of CVC relative infection ( CVC-RI) among three groups. Results The length of blood return were (291.04 ±46.92),(340.75 ±51.36), (278.99 ±45.21)s in A, B, C group, the volume of 0. 9% sodium chloride solution (186. 72 ± 27. 65),(257. 24 ± 40. 07),(191. 11 ± 32. 53) ml, the number of RCC in the residual liquid after dialysis (4 628. 4 ± 501. 6),(5 104. 5 ± 592. 7), (4 588. 2 ± 546. 9)/μl (F=3. 932 7,4. 529 1,3. 133 8;P<0. 05). Compared each two of three groups, the differences of each indexes between group A and group C were no statistically significant (P>0. 05), but the length of blood return in these two groups were shorter than that of group B (P<0. 05). After 6 and 12 months, the level of CRP in group B and C was lower than that of group A (P<0. 05);the different time point of CRP, it presented that it increased with the length of treatment in the group A (P <0. 05), but these of group B and C had no statistical significance at three time point (P>0. 05). The incidence rate of CVC-RI were 40. 00%, 16. 67%, 13. 33%in group A, B and C (χ2 =7. 080 7,P<0. 05);these of group B and C was lower than that of group A ( P<0. 05), but the statistical significance did not exist between group B and C (P >0. 05). Conclusions The CVC in hemodialysis patients utilized tee union for blood return which is simple, organized, saving time and labor, and reduced the potential risk of CVC-RI, slight infection symptom and the volume of sodium chloride solution.