血液净化治疗利尿剂抵抗肾病综合征水肿患者的疗效

发布时间：2018-05-26 15:11

本文选题：肾病综合征 + 利尿剂抵抗　；参考：《实用医学杂志》2017年03期

【摘要】：目的:探讨不同血液净化方式治疗利尿剂抵抗肾病综合征水肿患者的疗效及安全性。方法:选取诊断明确的原发性肾病综合征伴有利尿剂抵抗患者40例,采用完全随机化分为普通血液透析(HD)组和连续性血液净化(CVVH)组,每组20例。均给予调脂、抗凝及糖皮质激素等基础治疗,观察时间为4周。观察两组患者治疗前后生化指标(24 h尿蛋白定量、血浆白蛋白、血清尿素氮和血清肌酐)的变化及水肿的缓解情况。结果:血液净化治疗后,患者尿量均明显增加,24 h尿蛋白定量下降的同时血浆白蛋白均显著提升,血尿素氮及肌酐水平均明显下降,差异均有统计学意义(P0.05或P0.01)。与HD组比较,治疗2周后CVVH组患者尿量增加更明显(P0.05),24 h尿蛋白定量下降及血浆白蛋白提升更显著(P0.05),血尿素氮及肌酐水平两组之间无差异(P0.05)。治疗4周后两组患者尿量及肾功能差异无统计学意义(P0.05),CVVH组24 h尿蛋白定量下降及血浆白蛋白提升比HD组更显著,差异均有统计学意义(P0.05)。两组患者均无严重并发症发生。结论:血液净化治疗利尿剂抵抗肾病综合征水肿患者是安全、有效的,连续性血液净化治疗能更有效缓解利尿剂抵抗肾病综合征患者的严重顽固性水肿,促进肾功能恢复,改善肾病预后。
[Abstract]:Objective: to investigate the efficacy and safety of different blood purification methods in the treatment of diuretic resistance to edema in nephrotic syndrome. Methods: forty patients with idiopathic nephrotic syndrome with diuretic resistance were randomly divided into two groups: normal hemodialysis group (HD) group and continuous blood purification group (CVVH) group with 20 cases in each group. All patients were treated with lipid regulation, anticoagulant therapy and glucocorticoid therapy for 4 weeks. The changes of 24 h urinary protein, plasma albumin, serum urea nitrogen and serum creatinine and the remission of edema were observed before and after treatment. Results: after blood purification treatment, the urine volume of the patients increased significantly, while the urinary protein decreased significantly, while the plasma albumin increased significantly, and the levels of blood urea nitrogen and creatinine decreased significantly (P 0.05 or P 0.01). Compared with HD group, the increase of urine volume in CVVH group was more obvious than that in HD group after 2 weeks of treatment. The decrease of urine protein and the elevation of plasma albumin were more significant in CVVH group than in HD group. There was no difference in blood urea nitrogen and creatinine levels between the two groups (P 0.05). After 4 weeks of treatment, there was no significant difference in urine volume and renal function between the two groups. The decrease of urinary protein and the elevation of plasma albumin in CVVH group were more significant than those in HD group (P 0.05). No serious complications occurred in both groups. Conclusion: it is safe and effective to treat patients with diuretic resistance to nephrotic syndrome edema by blood purification. Continuous blood purification therapy can effectively relieve the severe refractory edema in patients with diuretic resistance to nephrotic syndrome and promote the recovery of renal function. To improve the prognosis of nephropathy.
【作者单位】：重庆三峡中心医院肾内科;
【基金】：重庆市万州区科学技术委员会科技计划项目(编号:201503005)
【分类号】：R692

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