关键词: 连续性肾脏替代疗法, 局部枸橼酸抗凝, 软件因素—硬件因素—环境因素—当事人及他人因素管理模式, 钙, 危重病护理

Abstract: Objective To explore the application of software-hardware-environment-liveware（SHEL） mode in the stability management of calcium ion levels in continuous renal replacement therapy（CRRT） with regional citrate anticoagulation（RCA）. Methods Through preliminary baseline surveys,the SHEL model was applied to analyze the causes,formulate countermeasures,control processes,and evaluate the effectiveness of calcium ion management in the implementation of the digital model for calcium ion and citric acid requirements. Using the convenience sampling method,84 patients who underwent RCA-CRRT in the intensive care unit from July to December 2022 were selected as the experimental group,and 84 patients who underwent RCA-CRRT in the intensive care unit from January to June 2022 were selected as the control group. After treatment,the blood iCa²⁺ levels,accuracy of sampling sites of radial artery catheters,accuracy of individual venous calcium supplementation pathways,timely adjustment of calcium and citrate parameters,unplanned downturns,and specialized nurses' satisfaction were compared. Results The results showed that there was no statistically significant difference in the blood iCa²⁺ levels of the experimental group at 2,4,8,and 12 hours after treatment（P=0.534）,there was a statistical difference in the blood iCa²⁺ levels of the control group at 2,4,8,and 12 hours after treatment（P=0.001）. The probability of unplanned downturns in the experimental group was 9.5%,lower than 10.7% in the control group,but there is no statistically significance（P=0.798）. The accuracy rate of the radial artery catheter sampling sites in the experimental group was 97.6%,higher than 81.0% in the control group. The correct rate of calcium supplementation through individual venous access was 96.4%,higher than 86.9% in the control group. The timely adjustment rate of calcium and citric acid parameters was 95.2%,higher than72.6% in the control group. All had statistical significance（P<0.05）. The satisfaction of specialist nurses increased by15.03% compared to the control group,and the role of SHEL mode in calcium management in RCA-CRRT treatment was affirmed（P<0.001）. Conclusion The use of SHEL mode can improve the calcium ion stability in continuous renal replacement therapy with local citrate anticoagulation,and increase the satisfaction of specialized nurses.

Key words: Continuous Renal Replacement Therapy, Regional Citrate Anticoagulation, SHEL Model, Calcium, Critical Care Nursing