摘要目的 分析重症质控科室连续性肾脏替代治疗(CRRT)设备、人力资源配置及实施情况.方法 重症医学科质控中心通过向各质控对象发问卷式邮件调查2015年6月各质控对象CRRT应用情况.结果 所有69家省质控对象中62家拥有CRRT设备,58家有患者在6月份进行CRRT治疗;62家质控对象中有195名医生和253名护士参加了省级以上CRRT培训;3个区域参加省级以上CRRT培训的医生(≥2名)的医院比例分别为63％、79％和86％,参加省级以上CRRT培训的护士(≥3名)的医院比例分别为34％、38％和43％;CRRT滤器首选的材质以AN69和聚丙烯晴为主,分别占到48％和45％.滤器平均更换频率＜12h占21％,12 ～24 h占34％,＞72 h仅占2％;手工配置是使用CRRT置换液的主要方式,占到75％;普通肝素是使用频率最高的抗凝剂,占48％,枸橼酸抗凝和低分子肝素分别占比31％与21％.出血是CRRT患者最常见临床并发症(43％),其次为低温(22％);CRRT患者平均住院总费用达69 643元/人次,其中CRRT费用占19 525元/人次.结论 CRRT滤器的材质选择、抗凝的方式、更换频率、置换液稀释方式等各区域有所不同,出血是CRRT最常见的临床并发症.参加过省级培训的医生和护士总体占比仍偏低,强化培训、规范合理的实施才可能更好的发挥该项技术的优势,延长滤器寿命,降低费用.

abstractsObjective To investigate the condition of implementation of continuous renal replacement therapy (CRRT) in quality control center of critical care medicine.Methods Questionnaire mails were issued to all of the quality control respondents to survey the application of CRRT in June 2015 from Jiangsu quality control center of critical care medicine.Results Among the 69 quality control respondents,62 were equipped with CRRT devices,and in 58 of which patients were treated with CRRT.There were 195 doctors and 253 nurses in 62 quality control respondents attended CRRT training at or above the provincial level;the proportions of hospitals in southern,central and northern regions of Jiangsu were 63％,79％ and 86％ respectively with trained doctors (more than 2),and 34％,38％ and 43％ respectively with trained nurses (more than 3).The preferred material for CRRT filter were AN69 and acrylic,accounting for 48％ and 45％ respectively.The average life span was less than 12 h for 21％ filters,12-24 h for 34％ filters,and more than 72 h for only 2％ filters.Manual displacement liquids were currently mainly used in our province,accounting for 75％.Heparin is the most frequently used anticoagulants,accounting for 48％.Citrate and low molecular weight heparin used for anticoagulation accounted for 31％ and 21％ respectively.Bleeding was the most common clinical complication (43％) in patients with CRRT,followed by low temperature (22％).The average hospitalization expenses for patients with CRRT amounted to 69 643 yuan RMB per person,in which the cost for CRRT accounted for 19 525 yuan RMB per person.Conclusion The application of CRRT varies in filter materials,anticoagulants,replacement frequencies and dilution mode.Bleeding is the most common clinical complication in patients with CRRT.Besides,the proportion of trained doctors and nurses at the provincial level is still very low.It will be improved with intensive training and reasonable implementation for us to prolong the lifespan of the filters and reduce the cost for patients with CRRT.