中文摘要：

目的探讨重症合并急性肾损伤患者血液透析早期滤器凝血的相关因素。方法共收集221例重症合并急性肾损伤患者临床资料，以首次滤器凝血时间是否超过24h为节点将患者分成两组。单因素及多因素Logistic回归分析阐明，重症合并急性肾损伤患者血液透析滤过时滤器凝血的相关危险因素。结果189例滤器凝血患者与32例非滤器凝血患者血小板计数（PLT）、凝血国际标准化比值（INR）及总胆红素数值比较差异有统计学意义（P〈0．05）。因样本量小，为提高结果准确性，移除P〉0．20的因素构建精简模型，最终PLT、总胆红素、INR、低血容量休克、出血及意识障碍符合入选精简模型条件。多因素分析中，PLT[优势比（OR）1．074，95％CI1．042-1．107；P=0．000]、INR（OR7．425，95％CI1．424—197．49；P=0．002）、胆红素（OR1．074，95％cI1．042-1．107；P=0.000）是滤器凝血高风险的独立危险因素。结论高PLT、低INR和低总胆红素是重症合并急性肾损伤患者血液透析滤过时滤器凝血的高危因素，临床治疗中应给予关注。

英文摘要：

Objective To study patient factors associated with clotting of dialysers during haemo- diafiltration in critically ill patients with acute kidney injury. Methods Clinical data of 221 critically ill patients with acute kidney injury were collected. The patients were assigned to two groups according to clotting of dialysers in 24 hours and out 24 hours. Single factor and multiple factors logistic regression analysis were used to clarify factors associated with clotting of dialysers during haemodiafihration in critically ill patients with acute kidney injury. Results Blood clotting platelet count, blood coagulation international standardization ratio （INR） and total bilirubin numerical comparison were significantly different （P 〈 0.05） between the two groups （ 189 patients with clotting of dialysers in 24 hours and 32 cases of out 24 hours）. In the process of single factor analysis, because of the small sample size of this study, a parsimony model was generated to increase the precision of the results by stepwise removal of factors that were associated with a P value 〉 0.20 in the full model. In this parsimony model ,platelet count,total bilirubin, INR, low blood volume shock, hemorrhage, disturbance of consciousness condition were elected to the parsimony mode. Multiple factors analysis, the platelet count （odds ratio, OR = 1.074, 95% CI 1.042-1.107; P = 0.000）, the INR （odds ratio, OR = 7.425,95% CI 1.424-197.49; P = 0.002）, bilirubin （odds ratio, OR = 1.074,95% CI 1.042-1.107; P = 0.000） are independent risk factors for the development of clotting of dialysers risky. Conclusion The high platelet count, low clotting international standard ratio and low total bilirubin are risk factors of early clotting of dialysers during haemodiafiltra- tion in critically ill patients with acute kidney injury. Great attention should be paid during the clinical treatment.