血液滤过联合血液灌流治疗尿毒症脑病的临床研究

发布时间：2018-06-05 08:05

本文选题：血液滤过 + 血液灌流　；参考：《山东大学》2014年硕士论文

【摘要】：目的：探讨血液灌流联合血液滤过治疗慢性肾脏病脑病患者临床效果。方法：选取2010年10月-2013年10月30例在我院肾脏内科以静脉内瘘或半永久长期留置管进行规律血液透析治疗的慢性肾脏病患者并尿毒症脑病的患者,其中男性18例,女性12例。所有入选患者在住院诊疗期间,颅脑CT、MRI、脑电图等检查,排除脑血管意外、癫痫等中枢神经系统疾病,并且患者既往无脑外伤及中枢性神经系统疾病,诊断为慢性肾脏病相关性脑病。所有患者格拉斯哥评分标准低于7分,昏迷超过6小时。所用入选患者按照随机化原则随机分组为：对照组和干预组,对照组12例,予以常规血液透析(Hemodialysis,HD)治疗(3次/周),干预组18例,采用常规血液透析(3次/周)以外,同时加用每周两次的血液滤过(Continuous venovenous hemoftltration,HDF)联合血液灌流(Hemoperfusion HP)治疗。观察两组在治疗后第4周、6周、8周及3个月时的血压、尿素氮、肌酐、甲状旁腺素、β2-微球蛋白的变化及运用格拉斯哥评分对患者治疗前后的意识状况进行比较。对两组患者肾脏替代治疗天数及死亡率进行分析,评价血液滤过联合血液灌流治疗尿毒症脑病的效果。结果： 1.治疗3个月后干预组血压较治疗前明显下降(15-30mmHg)(P0.05)、尿素氮(BUN)、肌酐(Cr)较前明显下降(P0.05),格拉斯哥评分明显改善. 2.对照组治疗后血压较前明显下降(P0.05)、尿素氮(BUN)、肌酐(Cr)较前明显下降(P0.05)格拉斯哥评分减低无明显意义. 3.两组治疗后甲状旁腺素(PTH)、β2-微球蛋白水平无统计学差异.4.两组患者在治疗后低血压、高钾血症和急性呼吸窘迫综合征(Adult respiratory distress syndrome ARDS)危险事件的发生率无统计学差异. 5.治疗后干预组中11例患者(61.11%)神志完全恢复,4例患者(22.22%)发生神志延迟恢复,3例转其他医院继续治疗。其神志恢复的发生率(61.11%)明显高于对照组(12.98%),具有统计学意义(x2=1.594,P=0.042)。结论：血液滤过联合血液灌流治疗尿毒症脑病效果显著,对于改善尿毒症脑病生活质量,减少并发症的发生起到重要作用,值得临床推广
[Abstract]:Objective: to investigate the clinical effect of hemoperfusion combined with hemofiltration in the treatment of chronic kidney disease and encephalopathy. Methods: from October 2010 to October 2013, 30 patients with chronic kidney disease and uremic encephalopathy were treated with venous fistula or semi-permanent long-term indwelling catheter in our hospital, including 18 males and 12 females. During the period of hospitalization, all patients were excluded from cerebrovascular accidents, epilepsy and other central nervous system diseases, and no brain trauma and central nervous system diseases were found in the past. Diagnosis of chronic kidney disease associated encephalopathy. All patients had a Glasgow score below 7 and coma for more than 6 hours. According to the principle of randomization, the selected patients were randomly divided into two groups: control group (n = 12), and control group (n = 12). They were treated with routine hemodialysis (HD) for 3 times per week, and the intervention group (n = 18, with routine hemodialysis for 3 times per week). Meanwhile, continuous venovenous hemofiltration combined with hemoperfusion was given twice a week. The changes of blood pressure, urea nitrogen, creatinine, parathyroid hormone and 尾 _ 2-microglobulin were observed at the 4th week, 6th week, 8th week and 3rd month after treatment, and the consciousness status of the patients before and after treatment were compared with Glasgow score. The days and mortality of renal replacement therapy were analyzed to evaluate the effect of hemofiltration combined with hemoperfusion on uremic encephalopathy. Results: 1. After 3 months of treatment, the blood pressure of the intervention group was significantly lower than that of the pre-treatment group (P 0.05), the urea nitrogen bun, creatinine Cr were significantly lower than before, and the Glasgow score was obviously improved. 2. In the control group, the blood pressure was significantly lower than before (P 0.05), urea nitrogen bun, creatinine (Cr) was significantly lower than that before treatment (P 0.05) the Glasgow score was not significantly decreased. 3. There was no significant difference in PTH, 尾 2-microglobulin levels between the two groups after treatment. There was no significant difference in the incidence of respiratory distress syndrome ARDS) risk events between the two groups in terms of hypotension, hyperkalemia and acute respiratory distress syndrome (ARDS). 5. In the intervention group, 11 cases (61.11) were completely recovered and 4 cases (22.22%) had delayed recovery. 3 cases were transferred to other hospitals for further treatment. The incidence of mental recovery (61.11) was significantly higher than that of the control group (12.98%), with statistical significance of 1.594% (P < 0.01) and 0.042% (P < 0.05). Conclusion: hemofiltration combined with hemoperfusion is effective in the treatment of uremic encephalopathy, which plays an important role in improving the quality of life of uremic encephalopathy and reducing the occurrence of complications. It is worth popularizing in clinic.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R692.5;R747.9

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