连续性肾脏替代治疗管路寿命风险预测模型的研究进展

doi:10.3761/j.issn.2096-7446.2024.02.018

摘要/Abstract

摘要： 连续性肾脏替代治疗是重症患者重要的生命支持技术,但其管路寿命过早衰竭严重降低了患者治疗的充分性。该文综述了连续性肾脏替代治疗管路寿命风险预测模型的适用人群、预测因子、结局指标、预测性能以及对临床实践的意义。连续性肾脏替代治疗管路寿命的风险预测模型各有侧重,泛化能力有待验证,医护人员在应用时需甄别模型适用范围与预测性能。

关键词: 连续性肾脏替代疗法, 管路寿命, 模型, 统计学, 质量控制, 综述文献（主题）

Abstract: Continuous renal replacement therapy is an important life support technique for critically ill patients,but the premature failure of its circuit significantly reduces the adequacy of patient treatment. This paper reviews the applicable population,predictive factors,outcome measures,prediction performance,and clinical implications of the risk prediction models for the circuit lifespan of continuous renal replacement therapy. The models have different focuses,and their generalizability needs to be validated,so healthcare professionals need to screen the applicability and prediction performance when applying them.

Key words: Continuous Renal Replacement Therapy, Circuit Lifespan, Models, Statistical, Quality Control, Review Literature as Topic

杨二明, 王巧红, 毛娅, 吴燕铭, 杨辉. 连续性肾脏替代治疗管路寿命风险预测模型的研究进展[J]. 中华急危重症护理杂志, 2024, 5(2): 188-192.

YANG Erming, WANG Qiaohong, MAO Ya, WU Yanming, YANG Hui. Research progress on risk prediction models for the circuit lifespan of continuous renal replacement therapy[J]. Chinese Journal of Emergency and Critical Care Nursing, 2024, 5(2): 188-192.

参考文献

[1] 国家卫生健康委办公厅. 血液净化标准操作规程(2021版)[S/OL]. (2021-11-08)[2023-11-01]. http://www.nhc.gov.cn/yzygj/s7659/202111/6e25b8260b214c55886d6f0512c1e53f.shtml.
General Office of the National Health Commission. Blood purification standard operating procedures(2021 edition)[S/OL].(2021-11-08)[2023-11-01]. http://www.nhc.gov.cn/yzygj/s7659/202111/6e25b8260b214c55886d6f0512c1e53f.shtml.
[2] See E,Ronco C,Bellomo R.The future of continuous renal replacement therapy[J]. Semin Dial,2021,34(6):576-585.
[3] 中华医学会肾脏病学分会专家组. 连续性肾脏替代治疗的抗凝管理指南[J]. 中华肾脏病杂志,2022,38(11):1016-1024.
Expert Group of Nephrology Branch of Chinese Medical Association. Guidelines for the anticoagulant management of continuous renal replacement therapy[J]. Chin J Nephrol,2022, 38(11):1016-1024.
[4] 吴玲玲,许小明,张洪涛,等. 重症患者血液净化非计划性下机危险因素及预防的研究进展[J]. 护士进修杂志,2022,37(8):718-721.
Wu LL,Xu XM,Zhang HT,et al.Research progress on risk factors and prevention of unplanned off-line blood purification in critically ill patients[J]. J Nurses Train,2022,37(8):718-721.
[5] Zhang W,Bai M,Zhang L,et al.Development and external validation of a model for predicting sufficient filter lifespan in anticoagulation-free continuous renal replacement therapy patients[J]. Blood Purif,2022,51(8):668-678.
[6] 袁亚萍,曹丽,穆洪芸. 老年血液净化治疗病人非计划性撤机风险预测及分级护理研究[J]. 全科护理,2022,20(22):3143-3147.
Yuan YP,Cao L,Mu HY.Study on risk prediction and graded nursing of unplanned weaning of elderly patients undergoing blood purification treatment[J]. Chin Gen Pract Nurs,2022,20(22):3143-3147.
[7] 常蓉,李玲玲. 连续性肾脏替代治疗患者发生管路凝血预测模型的构建[J]. 临床肾脏病杂志,2022,22(12):1016-1022.
Chang R,Li LL.Construction of a predictive model for in-circuit coagulation in patients on continuous renal replacement therapy[J]. J Clin Nephrol,2022,22(12):1016-1022.
[8] 李克佳,胡军,苏琳,等. 重症患者连续性肾脏替代治疗非计划下机的相关因素研究[J]. 中国血液净化,2020,19(9):645-648.
Li KJ,Hu J,Su L,et al.Related factors of unexpected interruption of continuous renal replacement therapy in critical care patients[J]. Chin J Blood Purif,2020,19(9):645-648.
[9] 向泳燕,郭锦丽,张颖惠,等. CRRT体外循环寿命非抗凝危险因素的Meta分析[J]. 护理研究,2023,37(1):160-165.
Xiang YY,Guo JL,Zhang YH,et al.Non-anticoagulant risk factors of extracorporeal circulation lifespan in continuous renal replacement therapy:a Meta analysis[J]. Chin Nurs Res,2023,37(1):160-165.
[10] Mann L,Ten Eyck P,Wu CR,et al.CVVHD results in longer filter life than pre-filter CVVH:results of a quasi-randomized clinical trial[J]. PLoS One,2023,18(1):e0278550.
[11] Zarbock A,Küllmar M,Kindgen-Milles D,et al.Effect of regional citrate anticoagulation vs systemic heparin anticoagulation during continuous kidney replacement therapy on dialysis filter life span and mortality among critically ill patients with acute kidney injury:a randomized clinical trial[J]. JAMA,2020,324(16):1629-1639.
[12] 王圆圆. ICU行枸橼酸抗凝连续性肾脏替代治疗病人非计划性下机影响因素研究[J]. 血栓与止血学,2020,26(01):61-63.
Wang YY.Study on factors influencing unplanned discontinuation of continuous renal replacement therapy with citrate anticoagulation in ICU patients[J]. Chin J Thromb Hemost, 2020,26(01):61-63.
[13] 胡璐璐,牛洪艳,韩小云,等. 连续性肾脏替代治疗体外循环装置凝血风险预测模型的构建与验证[J]. 中华护理杂志,2023,58(15):1845-1851.
Hu LL Niu HY,Han XY,et al. Construction and validation of a predictive model for coagulation risk in extracorporeal circulation devices for continuous renal replacement therapy[J]. Chin J Nurs,2023,58(15):1845-1851.
[14] Chua HR,Baldwin I,Bailey M,et al.Circuit lifespan during continuous renal replacement therapy for combined liver and kidney failure[J]. J Crit Care,2012,27(6):744-747.
[15] 庄耀宁,陈一媛,林敏,等. 跨膜压与废液压趋势变化在连续性肾脏替代治疗滤器凝血的预测价值研究[J]. 护士进修杂志,2022,37(15):1357-1362.
Zhuang YN,Chen YY,Lin M,et al.Study on the predictive value of transmembrane pressure and effluent pressure trend changes in predicting filter coagulation in continuous renal replacement therapy[J]. J Nurses Train,2022,37(15):1357-1362.
[16] 万娜,于洋,王淑芹,等. ECMO联合应用期间CRRT非计划性下机的预测模型构建[J]. 护理学杂志,2022,37(12):6-9.
Wan N,Yu Y,Wang SQ,et al.Construction of a predictive model for unplanned discontinuation of CRRT during ECMO combination therapy[J]. J Nurs Sci,2022,37(12):6-9.
[17] Kakajiwala A,Jemielita T,Hughes J Z,et al.Membrane pressures predict clotting of pediatric continuous renal replacement therapy circuits[J]. Pediatr Nephrol,2017,32(7):1251-1261.
[18] Fu X,Liang X,Song L,et al.Building and validation of a prognostic model for predicting extracorporeal circuit clotting in patients with continuous renal replacement therapy[J]. Int Urol Nephrol,2014,46(4):801-807.
[19] Hosmer DW,Lemeshow S,Sturdivant RX.Applied logistic regression[M]. New York:John Wiley & Sons,2013.
[20] Hang C,Liu L,Huang Z,et al.Optimal indicator for changing the filter during the continuous renal replacement therapy in intensive care unit patients with acute kidney injury:A crossover randomized trial[J]. World J Emerg Med,2022,13(3):196-201.
[21] 余毅,王琰,黄继义. 几种连续肾脏替代治疗技术的优缺点比较[J]. 中国血液净化,2021,20(12):801-804.
Yu Y,Wang Y,Huang JY.Comparison of the advantages and disadvantages of several continuous renal replacement therapy technologies[J]. Chin J Blood Purif,2021,20(12):801-804.
[22] 崔丹. 体位管理对CRRT治疗非计划下机的影响分析及护理对策研究[D]. 长春:长春中医药大学,2018.
Cui D.Analysis of the influence of body position management on unplanned weaning of CRRT treatment and research on nursing countermeasures[D]. Changchun:Changchun University of Chinese Medicine,2018.
[23] 唐前容,马良,张凌,等. 局部枸橼酸抗凝行连续性肾脏替代治疗体外循环寿命的影响因素分析[J]. 华西医学,2022,37(7):1001-1008.
Tang QR,Ma L,Zhang L,et al.Analysis of the influencing factors on circuit life during continuous renal replacement therapy with regional citrate anticoagulation[J]. West China Med J,2022,37(7):1001-1008.
[24] Collins GS,Reitsma JB,Altman DG,et al.Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis(TRIPOD):the TRIPOD statement[J]. BMJ,2015,350:g7594.