血液透析病人人工腎臟凝固危險因素分析

Risk Factors of Dialyzer Clotting in Hemodialysis Patients

目的：血液透析病人資料庫中，潛藏著一些未曾探索的重要資訊與知識。本研究目的在探討人工腎臟凝固與更換人工腎臟的危險因素。方法：以洗腎中心接受血液透析，透析期間血液迴路管凝固而更換的病人為對象，翻閱2016年2月至2018年3月的病歷做資料收集。採多重邏輯迴歸分析，以確認人工腎臟凝固、更換人工腎臟的因素。結果：透析迴路管有凝固者共計674位，比較人工腎臟內有無凝固，及有無更換人工腎臟的顯著獨立影響因素。單變量分析發現人工腎臟凝固與更換，和人工腎臟種類、血管通路、血小板數值與抗凝劑維持劑量有關。多重邏輯迴歸分析則發現，人工腎臟與血管通路為造成人工腎臟凝固與更換的獨立危險因子。透析前以肝素做管路沖洗，與透析開始、期間使用抗凝劑，則為避免人工腎臟凝固與更換的保護因子。結論：本研究結果支持採用濕式人工腎臟、永久性血管通路、透析前使用肝素沖洗，及使用抗凝劑初劑量與維持劑量，以避免人工腎臟凝固。（澄清醫護管理雜誌2020；16（3）：37-44）

Purposes: Databases of hemodialysis patients contain some important data and information that have not been investigated yet. The purpose of this study was to investigate the risk factors of dialyzer clotting and replacement. Methods: The subjects were patients who received hemodialysis at a kidney dialysis center and whose blood tubing was replaced as clots were observed in the tubing during dialysis. Data were collected from medical records between February 2016 and March 2018. Multiple logistic regression analysis was performed to determine the factors influencing dialyzer clotting and replacement. Results: A total of 674 patients experienced clotting in the dialysis tubing. The significant independent influencing factors for the occurrence of dialyzer clotting requiring tube replacement were compared. A univariate analysis revealed that dialyzer clotting and replacement were associated with the type of dialyzer, vascular access, platelet count, and anticoagulant maintenance dose. A multiple logistic regression analysis revealed that the type of dialyzer and vascular access were independent risk factors of dialyzer clotting and replacement. Rinsing the tubing with heparin before dialysis and using anticoagulants during and at the beginning of dialysis are protective factors against dialyzer clotting and replacement. Conclusions: The results of this study support the use of wet dialyzers, permanent vascular access, rinsing with heparin before dialysis, and initial and maintenance doses of anticoagulants to prevent dialyzer clotting. (Cheng Ching Medical Journal 2020; 16(3): 37-44)