预防ICU连续肾脏替代治疗患者非计划下机管理方案的构建及适用性分析

doi:10.3761/j.issn.2096-7446.2025.09.002

摘要/Abstract

摘要：

目的构建ICU患者行局部枸橼酸抗凝连续肾脏替代治疗（continuous renal replacement therapy with regional citrate anticoagulation，RCA-CRRT）非计划下机的预防管理方案，为降低非计划下机发生率、提升治疗效率提供理论依据。方法通过文献回顾，并基于故障树理论构建ICU患者RCA-CRRT非计划下机预防管理方案初稿，编制专家函询问卷，应用德尔菲法进行专家函询，结合变异系数、重要性赋值及专家意见对各条目内容进行修改，形成最终方案。结果共遴选20名专家进行两轮函询，问卷有效回收率均为100%，专家权威系数分别为0.943和0.958，肯德尔和谐系数分别为0.224和0.229（P<0.05）。最终形成的ICU患者RCA-CRRT非计划下机预防管理方案包括5个一级条目，包括患者个体层面、CRRT治疗层面、导管功能层面、质量控制层面、仪器设备层面；15个二级条目以及60个三级条目。结论该方案从5个层面出发，能够为RCA-CRRT管理工作的规范化开展提供依据，有助于进一步提高体外循环滤器使用效率，优化医疗资源配置，提升治疗效果。

关键词: 连续肾脏替代治疗, 局部枸橼酸抗凝, 非计划下机, 德尔菲法, 方案构建, 故障树理论, 护理

Abstract:

Objective To construct a prevention and management scheme of unexpected interruption of continuous renal replacement therapy with regional citrate anticoagulation（RCA-CRRT） in ICU patients，and to provide a theoretical basis for reducing the probability of unexpected interruption and improving the efficiency of continuous replacement therapy. Methods Based on fault tree theory，a prevention and management scheme of unexpected interruption of RCA-CRRT in ICU patients was drafted through literature review. Then the expert correspondence questionnaire was prepared，and the Delphi method was used to conduct expert consultation. Combined with the coefficient of variation，average score and expert opinion of the items，the contents of the scheme were amended and screened，forming the final scheme. Results Twenty experts were selected for two rounds of letter consultation. The final effective recovery rates of both rounds were 100%，the expert authority coefficient was 0.943 and 0.958，and the Kendall’s W was 0.224 and 0.229，respectively. The prevention and management scheme for unexpected interruption of RCA-CRRT in ICU patients was finally formed，including 5 first-level items（individual patient level，CRRT treatment level，catheter function level，quality control level，instrument and equipment level），15 second-level items and 60 third-level items. Conclusion The scheme which constructs from five levels provides a basis for the standardization of the management of RCA-CRRT，helps to further improve the use efficiency of extracorporeal circulation filter，optimize the allocation of medical resources and improve the therapeutic effect.

Key words: Continuous Renal Replacement Therapy, Regional Citrate Anticoagulation, Unexpected Interruption, Delphi Method, Scheme Construction, Fault Tree Theory, Nursing Care

彭莉, 徐翠荣, 冯波, 姚媛媛, 邢星敏, 俞琳. 预防ICU连续肾脏替代治疗患者非计划下机管理方案的构建及适用性分析[J]. 中华急危重症护理杂志, 2025, 6(9): 1036-1041.

PENG Li, XU Cuirong, FENG Bo, YAO Yuanyuan, XING Xingmin, YU Lin. Construction and applicability analysis of management scheme for preventing unexpected interruption of continuous renal replacement therapy in ICU patients[J]. Chinese Journal of Emergency and Critical Care Nursing, 2025, 6(9): 1036-1041.

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