连续性血液净化与间歇性血液透析治疗尿毒症性脑病的优劣比较

发布时间：2018-02-16 00:08

本文关键词： 尿毒症性脑病连续性血液净化间歇性血液透析　出处：《吉林大学》2017年硕士论文　论文类型：学位论文

【摘要】：背景及目的:尿毒症性脑病(uremic encephalopathy,UE)是终末期肾脏病患者急性或亚急性的可逆性神经精神症状,严重影响了患者的生活及生存质量。尿毒症性脑病的发病机制尚不完全明确。可能与尿毒症毒素、内环境紊乱及药物因素等有关,其中某些大中分子物质如PTH对UE发病起重要作用。尿毒症性脑病的临床表现多样,早期表现为疲劳、乏力、理解力和记忆力减退等,随着病情进展,可出现躁动或反应淡漠、意识障碍等,重症患者可表现为谵妄、昏迷、扑翼样震颤等。尿毒症性脑病的治疗包括一般治疗与病因治疗,透析治疗等。目前最常用的治疗方法是血液净化治疗。本文通过观察并比较连续性血液净化与间歇性血液透析在治疗尿毒症性脑病中的优劣,为尿毒症性脑病的合理治疗提供依据。方法:非随机回顾性分析2012年01月至2016年12月期间我院收治的尿毒症性脑病患者75例,均符合尿毒症性脑病的诊断标准,并排除其他原因所致的神经精神疾病,其中50例行单纯连续性血液净化治疗(CBP组),25例行单纯间歇性血液透析治疗(IHD组)。临床资料均来自患者病历记录及透析记录,包括性别、发病年龄、原发病、诱发因素、临床表现、症状缓解所需时间、血液学及血清生化学检验指标、生命体征以及治疗并发症等。比较两组患者症状改善所需时间、费用,以及治疗前后检验指标及生命体征的改变。结果:1两组患者的性别、发病年龄、原发疾病构成、诱发因素以及临床表现之间的比较无统计学差异(P0.05)。2.CBP组的透析费用及透析时间明显高于IHD组(P0.05),好转时间及痊愈时间明显小于IHD组(P0.05)。3.治疗后两组患者的小分子毒素水平较治疗前明显下降(P0.05),IHD组的下降比例大于CBP组(P0.05);治疗后CBP组患者的大中分子毒素水平较治疗前明显下降(P0.05)。4.治疗后两组的血磷水平较治疗前明显下降(P0.05)。5.CBP组的红细胞、血红蛋白、红细胞比容及血小板水平较治疗前明显下降(P0.05)。6.CBP组的白蛋白水平较治疗前明显下降(P0.05)。7.治疗中及治疗后两组的心率、血压较治疗前无明显变化(P0.05)。8.CBP组透析中高血压比例明显高于IHD组(P0.05),而IHD组透析中低血压比例明显高于CBP组(P0.05)。结论:1.CBP治疗症状缓解时间小于IHD治疗,但耗费高于IHD治疗。2.CBP治疗和IHD治疗均能降低毒素水平,其中CBP治疗的能力更佳,但可能影响其血象及营养指标。3.本研究中CBP治疗和IHD治疗对患者的生命体征影响较小,但两者在并发症方面存在差异。
[Abstract]:Background and objective: uremic encephalopathy UEE is an acute or subacute reversible neuropsychiatric symptom in patients with end-stage kidney disease. The pathogenesis of uremic encephalopathy is not completely clear. It may be related to uremic toxin, internal environment disorder and drug factors, etc. Some of these molecules, such as PTH, play an important role in the pathogenesis of UE. The clinical manifestations of uremic encephalopathy are diverse, early symptoms such as fatigue, fatigue, lack of understanding and memory, etc., which may lead to restlessness or indifference with the progression of the disease. Severe patients may present with delirium, coma, fluttering tremor, etc. The treatment of uremic encephalopathy includes general treatment and etiological treatment. At present, the most commonly used treatment is blood purification therapy. This article observed and compared the advantages and disadvantages of continuous blood purification and intermittent hemodialysis in the treatment of uremic encephalopathy. Methods: 75 cases of uremic encephalopathy admitted in our hospital from January 2012 to December 2016 were analyzed retrospectively. All of them were in accordance with the diagnostic criteria of uremic encephalopathy. The neuropsychiatric diseases caused by other causes were excluded, of which 50 cases were treated with continuous blood purification therapy. 25 cases of CBP group were treated with intermittent hemodialysis alone and IHD group. The clinical data were obtained from the patient's medical records and dialysis records, including gender. Age of onset, primary disease, inducing factors, clinical manifestation, time for remission of symptoms, hematological and serum biochemical indicators, vital signs and treatment complications were compared between the two groups, and the time and cost of symptom improvement were compared between the two groups. Results the sex, age of onset, and composition of primary disease of the two groups of patients were analyzed before and after treatment. There was no statistical difference between the inducing factors and clinical manifestations. 2. The cost and duration of dialysis in CBP group was significantly higher than that in IHD group, and the improvement time and recovery time were significantly lower than that in IHD group. After treatment, the levels of large and medium molecular toxins in patients with CBP were significantly lower than those before treatment. After treatment, the levels of blood phosphorus in the two groups were significantly lower than those before treatment, and the levels of erythrocytes in the CBP group were significantly lower than those in the pre-treatment group. The levels of hemoglobin, erythrocyte volume and platelet were significantly decreased in CBP group than before treatment. 6. The albumin level in CBP group was significantly lower than that before treatment. The heart rate of the two groups during and after treatment was significantly lower than that before treatment. The percentage of hypertension in IHD group was significantly higher than that in IHD group, while the proportion of hypotension in IHD group was significantly higher than that in CBP group. Conclusion 1. But the cost was higher than that of IHD. 2.CBP and IHD could decrease the level of toxin, and the ability of CBP treatment was better, but it might affect the blood and nutrition index .3.In this study, the effect of CBP and IHD treatment on the vital signs of the patients was relatively small. But there were differences in complications between the two groups.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R692.5;R747.9

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