【摘要】目的从透析设备和注射器方面判断和分析导致血液透析治疗肝素用量偏差的原因。方法将透析机肝素泵速度分别设置为1、2、5、10ml/h。注射器种类不变，测量不同运转时间的透析机肝素泵注入流量；测量同一台透析机的肝素泵分别应用6 种品牌20ml 医用一次性注射器后的注入流量。结果①不同运转时间的透析机肝素泵流量误差均小于±5%。B 组(运转时间在20000～35000h，n=6)透析机肝素泵检测流量在不同速度测量点均低于设定值，与A 组(运转时间在10000～20000h，n=6)透析机测量结果的差异具有统计学意义(1ml/h：t=2.857，P=0.021；2ml/h：t=2.32,P=0.042；5ml/h：t=3.295,P=0.007)。②6 种品牌注射器在不同设定速度的测量点检测结果之间的差异具有统计学意义(1ml/h：H=16.685，P=0.005；2ml/h：H=18.675，P=0.002；5ml/h：H=21.654，P=0.001；10ml/h：H=19.773，P=0.001)。结论为了保证肝素泵能够精准稳定的工作，日常保养与维护工作非常重要。在更换注射器品牌时应详细了解注射器的内径等重要参数，如较之前有所不同应及时更改透析机内设定参数。
【Abstract】Objective To judge and analyze the causes of heparin dosage deviation in hemodialysis from the aspects of dialysis equipment and syringe. Method The speed of heparin pump in dialyzer was set as 1 ml/h, 2ml/h, 5 ml/h, and 10ml/h, respectively. ①The injection flow of heparin pump in dialyzer with different operatingtime was measured without changing the type of syringes. ② The injection flow of heparin pump was measured in the same dialysis machine after applying 6 brands of 20ml disposable medical syringes. Results ①The flow errors of heparin pump in dialyzer with different operating time were all less than ±5%. The measured flow of heparin pump in the dialyzer of group B (running time of 20000h to 35000h,n=6) was lower than the set value at different speed measurement points, which was significantly different from that of group A (running time of 10,000h to 20,000 h, n=6)(1ml/h：t=2.857，P=0.021；2ml/h：t=2.32,P=0.042; 5ml/h: t=3.295, P= 0.007). ②There were significant differences in the detection results of the 6 brands of syringes at the measuring points with different set speeds. (1ml/h:H=16.685，P=0.005；2ml/h：H=18.675， P=0.002，P=0.042;5ml/h: H=21.654，P=0.001；10ml/h：H=19.773，P=0.001). Conclusion In order to ensure accurate and stable operation of heparin pump, daily maintenance and maintenance are very important. When replacing the brand of the syringe, important parameters such as the inner diameter of the syringe should be understood in detail,and the setting parameters in the dialysis machine should be changed in time if they are different from those before.
[1] 王质刚.血液净化学（第4版）[M].2016:125-126.
[2] 董斌,朱宇,吴丹,等. 肝素泵在血液透析中的临床应用与故障处理[J].中国医学装备,2018,15(2):132-134.
[3] JJF 1353—2012,《血液透析装置校准规范》[S].
[4] YY1259—2018《医用注射泵和输液泵校准规范》[S].
[5]耿铭剑,邹德春. 贝朗Dialog+透析机常见故障及处理[J].中国医学装备, 2014, 11(8):123-124.
[6]董斌,张飞鸿. 血液透析机日常保养管理方案[J]. 中国医疗设备,2015(12):135-137.
[7]黄华敏、柯晓洁、宋羽成、吴亮、陈知昊、邹建洲、丁小强. 血液透析机的基本组成与日常管理维护[J].
中国医疗设备, 2020, v.35(S1):177-179+188.
[8] 严嘉伟,张飞鸿,赵丽萍,胡晓颖,何立群.血透临床工程师对血透机的日常管理及维护保养[J].中国医疗设备,2013,28(12):86-88.
[9] 中国医院协会血液净化中心管理分会临床工程技师学组. 血液净化临床工程技师日常工作内容和常规操作的指导意见[J]. 中国血液净化,2016,15(12):641-655.
[10]何江江. 浅谈费森尤斯血液透析机的常见故障与维护保养[J]. 中国设备工程, 2021(9):49-50.
[11]陈香美.血液净化标准操作规程[M].2010:48
[12] 姜筠,刘平.血液透析中肝素与小分子肝素的抗凝作用[J].中国实用内科杂志, 1998(06):43-45.
[13] 徐佳佳,李应明. 注射器与注射泵的兼容性对注射精度影响的研究[J].中国医疗设备,2017,32(9):90-92.
[14] 汤栋生. 三种品牌注射器对同一注射泵的质量控制检测及研究[J].医疗装备, 2018, 31(8):55-56.
[15] 张红梅. 应用不同品牌注射器对微量注射泵输注精度影响的研究进展[J].医疗卫生装备,2016,37(2):121-123.
[16]王杰.注射器材对医用注射泵流量误差的影响特性研究[J].中国计量,2020(12):95-97. [17] 武振虎.血液透析机质控检测方法及问题探讨[J].中国医疗设备,2015(3):121–123.
[18]李叶勇,朱远军,杨建龙,等. 具有管径检测结构的肝素泵: CN202146466U[P]. 2012.
[19]高光勇,朱平,尹仕伟,等.肝素泵多型号注射器监测控制方法及控制系统: CN109718409A[P]. 2019.
[20]高光勇,朱平,尹仕伟,等. 肝素泵多型号注射器参数采集系统: CN209770978U[P]. 2019.
