本文選題：連續(xù)性腎臟替代療法 + 重癥醫(yī)學科　； 參考：《中國藥學雜志》2016年11期

【摘要】：目的評價連續(xù)性腎臟替代療法(continuous renal replacement therapy,CRRT)在重癥醫(yī)學科(intensive care unit,ICU)患者中的應用現(xiàn)狀。方法回顧性分析2014年1~12月西安交通大學第一附屬醫(yī)院ICU的CRRT適應證患者171例的臨床資料,分為行CRRT組(n=148)和未行CRRT組(n=23),其中CRRT組分為兩個亞組:連續(xù)靜脈-靜脈血液濾過(continuous veno-venous hemofiltration,CVVH)組(n=66)和非CVVH組(n=82)。行CRRT治療的148例患者按治療效果分為好轉組(n=83)、無好轉組(n=46)及死亡組(n=19);行CVVH治療的66例患者按治療效果分好轉組(n=39)和無好轉組(n=27)。對171例患者的適應證及行CRRT的148例患者的首選抗凝方案、置管方案、置換液、CRRT管路沖洗的5個指標進行統(tǒng)計評估,并對患者臨床數(shù)據(jù)與CRRT治療模式和患者治療效果(好轉、無好轉及死亡)之間的相關性進行統(tǒng)計學分析。結果 171例患者的適應證及行CRRT的148例患者的首選抗凝方案、置管方案、置換液、CRRT管路沖洗這5個方面指標的合理率分別為86.55%、84.76%、66.89%、100%、100%。單因素分析顯示,在3種治療模式下(CVVH組、非CVVH組、未行CRRT組),171例患者的尿素氮基線(P=0.035)、肌酐基線(P=0.007)、治療前3天每日尿量中d2(P=0.004)、d3(P=0.034),差異有統(tǒng)計學意義;CRRT組中首選置管方案與患者存活率(P=0.01)間差異有統(tǒng)計學意義、首選置管方案與存活患者預后之間(P=0.007)差異有統(tǒng)計學意義。多因素分析顯示,CVVH組中ICU入住時長[P=0.005,OR:0.734,95%CI(0.592,0.910)]、首選置管方案[P=0.016,OR:5.302,95%CI(1.369,20.527)],與患者預后呈顯著相關性。結論本研究中,171例患者的適應證及行CRRT的148例患者的首選抗凝方案、置管方案這3個指標存在不合理性,其不合理率分別為13.45%、15.24%、33.11%。臨床藥師應該結合患者的病理生理基礎特征,考慮到ICU患者用藥的復雜性,對患者行CRRT過程中的整體化用藥,進行重點追蹤、個體化監(jiān)測,提高臨床藥物治療水平,發(fā)揮藥學人員在臨床藥物治療管理方面的優(yōu)勢。
[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.
【作者單位】： 西安交通大學第一附屬醫(yī)院;
【分類號】：R459.7

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