连续性肾脏替代疗法在重症医学科中的合理应用评价

发布时间：2018-05-09 12:17

本文选题：连续性肾脏替代疗法 + 重症医学科　；参考：《中国药学杂志》2016年11期

【摘要】：目的评价连续性肾脏替代疗法(continuous renal replacement therapy,CRRT)在重症医学科(intensive care unit,ICU)患者中的应用现状。方法回顾性分析2014年1~12月西安交通大学第一附属医院ICU的CRRT适应证患者171例的临床资料,分为行CRRT组(n=148)和未行CRRT组(n=23),其中CRRT组分为两个亚组:连续静脉-静脉血液滤过(continuous veno-venous hemofiltration,CVVH)组(n=66)和非CVVH组(n=82)。行CRRT治疗的148例患者按治疗效果分为好转组(n=83)、无好转组(n=46)及死亡组(n=19);行CVVH治疗的66例患者按治疗效果分好转组(n=39)和无好转组(n=27)。对171例患者的适应证及行CRRT的148例患者的首选抗凝方案、置管方案、置换液、CRRT管路冲洗的5个指标进行统计评估,并对患者临床数据与CRRT治疗模式和患者治疗效果(好转、无好转及死亡)之间的相关性进行统计学分析。结果 171例患者的适应证及行CRRT的148例患者的首选抗凝方案、置管方案、置换液、CRRT管路冲洗这5个方面指标的合理率分别为86.55%、84.76%、66.89%、100%、100%。单因素分析显示,在3种治疗模式下(CVVH组、非CVVH组、未行CRRT组),171例患者的尿素氮基线(P=0.035)、肌酐基线(P=0.007)、治疗前3天每日尿量中d2(P=0.004)、d3(P=0.034),差异有统计学意义;CRRT组中首选置管方案与患者存活率(P=0.01)间差异有统计学意义、首选置管方案与存活患者预后之间(P=0.007)差异有统计学意义。多因素分析显示,CVVH组中ICU入住时长[P=0.005,OR:0.734,95%CI(0.592,0.910)]、首选置管方案[P=0.016,OR:5.302,95%CI(1.369,20.527)],与患者预后呈显著相关性。结论本研究中,171例患者的适应证及行CRRT的148例患者的首选抗凝方案、置管方案这3个指标存在不合理性,其不合理率分别为13.45%、15.24%、33.11%。临床药师应该结合患者的病理生理基础特征,考虑到ICU患者用药的复杂性,对患者行CRRT过程中的整体化用药,进行重点追踪、个体化监测,提高临床药物治疗水平,发挥药学人员在临床药物治疗管理方面的优势。
[Abstract]:Objective to evaluate the application of continuous renal replacement therapy (CRRT) in intensive care unit (ICU) patients. Methods the clinical data of 171 CRRT patients with ICU in the first affiliated Hospital of Xi'an Jiaotong University from January to December 2014 were analyzed retrospectively. CRRT group was divided into two subgroups: continuous veno-venous hemofiltration group (n = 66) and non CVVH group (n = 82). According to the effect of CRRT, 148 patients were divided into two groups: improvement group (n = 83), no improvement group (n = 46) and death group (n = 19); 66 patients who were treated with CVVH were divided into two groups according to the effect of treatment: improvement group (n = 39) and no improvement group (n = 27). The indications of 171 patients and the first choice of anticoagulant regimen, catheterization regimen and irrigation of CRRT pipeline in 148 patients with CRRT were evaluated statistically. The clinical data, CRRT treatment mode and therapeutic effect were evaluated statistically. The correlation between no improvement and death was statistically analyzed. Results the reasonable rates of the indications of 171 patients and 148 patients with CRRT were 86.55 and 84.7666.89, respectively. The first choice of anticoagulant regimen, catheterization, and irrigation of CRRT were 86.55and 84.7666.89. the reasonable rates of the five indexes were 86.55and 84.7666.89.The reasonable rates of the five indexes were 86.55 and 84.7666.89, respectively. Univariate analysis showed that CVVH group, non-CVVH group and non-CVVH group were treated in three different treatment modes. The urea nitrogen baseline and creatinine baseline were 0.035, 0.007 and 0.004 days before treatment in the CRRT group, respectively. The difference was statistically significant. There was significant difference between the first choice of catheterization and the survival rate (P0.01) in the CRRT group. There was a statistically significant difference between the first-choice catheterization regimen and the prognosis of the surviving patients (P 0. 007). Multivariate analysis showed that the duration of ICU admission in CVVH group was 0.005 / 0.73495 / 0.5920.910, and the first choice was placed tube [P0.016: OR5.302 / 95CI1.369- 20.527], which was significantly correlated with the prognosis of the patients. Conclusion in this study, the indications of 171 patients and the first choice of anticoagulant regimen for 148 patients with CRRT were unreasonable, and the unreasonable rates were 13.454.24% and 33.11.1%, respectively. The clinical pharmacists should combine the pathophysiological characteristics of the patients, consider the complexity of the drug use in patients with ICU, carry out the key tracing, individualized monitoring, and improve the level of clinical drug treatment in the process of CRRT. Give full play to the advantages of pharmacists in the management of clinical drug treatment.
【作者单位】：西安交通大学第一附属医院;
【分类号】：R459.7

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