重症血液净化技术在陕西省ICU开展现状的调查

目的了解陕西省（以下简称我省）ICU开展重症血液净化技术的现状。 方法2021年8月31至9月10日，采用方便抽样法通过网络调查形式向我省境内各级医院ICU医护人员发放调查问卷，收集我省ICU重症血液净化开展现状信息数据，分析其潜在影响因素。 结果本研究共收集到146份调查问卷，剔除10份存在逻辑性错误的问卷，最终136份问卷纳入研究分析；本研究涵盖我省陕南、关中及陕北三个地域，涉及11个不同城市或区域。调查结果表明，我省重症血液净化主要在三级医院ICU开展，三级甲等医院占比50.70%，三级乙等医院占比11.27%，二级甲等医院占比38.03%。重症血液净化技术在医院级别、开展年限、科室床位数、机器保有量、月均治疗例数之间存在一定的相关性（Spearman检验，P＜0.05）。调查结果还显示科室自配置换液为主要构成（50.00%）；治疗病种主要为多器官功能障碍综合征（MODS）、急性肾损伤（AKI）及脓毒症休克（18.20%，17.38%，16.56%）；常见重症血液净化模式为连续性静脉-静脉血液滤过（CVVH）、连续性静脉-静脉血液透析滤过（CVVHDF）、血浆置换（PE）（28.18%，21.95%，15.96%）；置管方法主要依靠解剖定位，常见部位为右股静脉（41.91%）。全身肝素抗凝与局部枸橼酸抗凝均为常见抗凝方式。出血与管路凝血仍为重症血液净化过程中最主要的并发症。 结论我省ICU重症血液净化技术开展存在不均衡现状，基层医院开展重症血液净化的能力有待进一步提升。本研究结果将为我省重症血液净化技术的推动发展和卫生行政部门制定相关的政策及培训制度提供一定的依据。

A survey of the application of critical care blood purification in Shaanxi province

ObjectiveTo investigate the application of critical care blood purification (CCBP) in Intensive care units (ICUs) in Shaanxi province. MethodsFrom August 31^st to September 10^th, 2021, a comprehensive Network Survey with simple sampling was released to ICU staffs in the hospitals of various levels aimed to collect data about the current application and underlying influence factors of CCBP in the ICUs in Shaanxi province. ResultsA total of 146 questionnaires were collected in this cross-sectional study. Ten questionnaires with obvious logical errors were excluded and finally 136 questionnaires were included in this analysis. This study covers 11 different cities or regions in Southern, Central and Northern Shaanxi. The survey showed that CCBP was mainly carried out in the department of critical medicine of tertiary hospitals, 50.70% in class A tertiary hospitals, 11.27% in class B tertiary hospitals and 38.03% in class A secondary hospitals. A Spearman Correlation coefficient analysis of grades of hospital, years of applying purification, numbers of beds and machines and case numbers by month in these ICUs showed correlations between these factors and the application of blood purification (P＜0.05). 50% of ICUs use self-made dialysis fluid. Multiple organ dysfunction syndrome (MODS), acute kidney injury (AKI) and septic shock were the top three diseases treated by CCBP (18.20%, 17.38%, 16.56%). The most commonly used modes were continuous veno-venous hemofiltration (CVVH), continuous veno-venous hemodiafiltration (CVVHD) and plasma exchange (PE) (28.18%, 21.95%, 15.96%). The catheterization mostly was performed with anatomical positioning, and the right femoral vein was the first choice of catheterization (41.91%). Systemic heparin anticoagulation and regional citrate anticoagulation were commonly used. Bleeding and pipeline coagulation were the main complications in the process of CCBP. ConclusionsThis study illustrates an imbalanced development of CCBP in Shaanxi province. Application of CCBP in low-level hospitals needs to be improved. This study provides some valuable information to the local health administration for developing relevant policies and training system and improving CCBP in Shaanxi province.