摘要
目的评估重症医学科接受连续性肾脏代替治疗(CRRT)的病人低体温的发生率及发生低体温的影响因素,并比较了两种CRRT治疗模式(CVVH与CVVHFD)对患者的低体温发生率的影响。方法采用前瞻性队列研究方法,选择2020年1月—2023年3月在本院重症医学科行CRRT的68例患者为研究对象。根据使用费森尤斯透析血液治疗机multiFiltrate(德国)行CRRT治疗模式分为CVVHDF组(35例)和CVVH组(33例)两组。两组医生按照病情调节适合患者的治疗模式,患者参数设置是由床位医生根据患者具体的病情提供一个合理的参数设置,患者体温均使用迈瑞BeneVision N12监护仪连接温度监测传感器,进行体温持续监测,患者体温低于36℃或者体温较基础下降超过1℃定义为低体温,收集两组患者低体温的发生率及发生时间,采用二元Logistic分析探究行CRRT治疗的患者出现低体温的影响因素。结果CVVHDF组患者低体温的发生率为68.57%,高于CVVH组的39.39%,差异具有统计学意义(P<0.05),CVVHDF组低体温的发生时间早于CVVH组,分别为(4.80±2.42)h与(6.72±1.84)h,差异具有统计学意义(P<0.05)。将患者按照是否出现低体温分为低体温组和非低体温组,将所有指标进行单因素分析,得出平均动脉压(MAP)、休克、中大剂量去甲肾上腺素使用、CRRT治疗剂量及CRRT治疗模式CVVHDF,差异具有统计学意义(P<0.05),将其进入二元Logistic分析,得出休克、中大剂量去甲肾上腺素使用、CRRT治疗剂量及CRRT治疗模式CVVHDF为患者出现低体温的危险因素,其OR(95%CI)分别为9.524(1.038~87.422)、8.633(1.063~70.133)、1.155(1.025~1.3017)、18.281(1.829~182.762),差异均有统计学意义(P<0.05),而MAP为患者出现低体温的保护因素OR(95%CI)为0.909(0.843~0.981)具有统计学意义(P<0.05)。结论行CRRT治疗患者具有较高的低体温的发生率,使用CVVHDF较CVVH模式下有着较高的低体温发生率,休克、中大剂量去甲肾上腺素使用、CRRT治疗模式CVVHDF及CRRT治疗剂量为患者出现低体温的危险因素,而MAP为患者出现低体温的保护因素。
Objective To assess the incidence of hypothermia and factors influencing the occurrence of hypothermia in patients receiving continuous renal replacement therapy(CRRT)in the intensive care medicine unit,and to compare the effects of two CRRT treatment model(CVVH and CVVHFD)on the incidence of hypothermia in patients.Methods A prospective cohort study was conducted in this study,from January 2020 to March 2023,68 critically ill patients receiving CRRT in our intensive care unit were enrolled as study subjects.According to the CRRT treatment mode using the Fresenius hemodialysis machine MultiFiltrate(Germany),the patients were divided into the CVVHDF group(n=35)and the CVVH group(n=33).The two groups of doctors adjusted the appropriate treatment mode according to the patient's condition,and the patient parameters were set by the bedside doctor based on the patient's specific condition.The patient's temperature was continuously monitored using a temperature monitoring sensor connected to the Mindray BeneVision N12 monitor.Hypothermia was defined as a body temperature below 36℃or a decrease in temperature by more than 1℃from the baseline.The incidence and timing of hypothermia in both groups were collected,and binary logistic regression analysis was used to explore the influencing factors of hypothermia in patients.Results The incidence of hypothermia in the CVVHDF group was 68.57%,higher than the incidence of hypothermia in the CVVH group which was 39.39%,the difference was statistically significant(P<0.05).The time of onset of hypothermia in the CVVHDF group was earlier than that in the CVVH group,with(4.80±2.42)hours and(6.72±1.84)hours,respectively,the difference was statistically significant(P<0.05).Patients were divided into hypothermia group and non-hypothermia group,and all indicators were analyzed by one-way ANOVA.Mean arterial pressure(MAP),shock,high-dose adrenaline use,CRRT treatment dose,and CRRT treatment mode CVVHDF showed statistically significant differences(P<0.05).These factors were then entered into a binary logistic analysis,and shock,high-dose adrenaline use,CRRT treatment dose,and CRRT treatment mode CVVHDF were identified as risk factors for hypothermia in patients.The OR(95%CI)values were 9.524(1.038~87.422),8.633(1.063~70.133),1.155(1.025~1.317),and 18.281(1.829~182.762),respectively,all of which were statistically significant(P<0.05).On the other hand,MAP was identified as a protective factor for hypothermia with an OR(95%CI)value of 0.909(0.843~0.981),which was also statistically significant(P<0.05).Conclusions Patients treated with CRRT have a higher incidence of hypothermia and a higher incidence of hypothermia with CVVHDF than with CVVH mode,and shock,medium to high dose norepinephrine use,CRRT treatment mode CVVHDF and CRRT treatment dose are risk factors for hypothermia,while MAP is a protective factor for hypothermia.
作者
李晓艳
岳燕红
赵翠侠
郭国飞
王迪
朱玉
谢敏
Li Xiaoyan;Yue Yanhong;Zhao Cuixia;Guo Guofei;Wang Di;Zhu Yu;Xie Min(Department of Critical Care Medicine,Jieshou People's Hospital,Jieshou,Anhui 236500,China)
出处
《齐齐哈尔医学院学报》
2024年第3期296-300,F0003,共6页
Journal of Qiqihar Medical University
作者简介
通信作者:岳燕红,Email:763646039@qq.com。
