血液透析治疗终末期糖尿病肾病  

Treatment of end-stage renal disease in diabetic nephropathy patients using hemodialysis

作　　者：陈小波[1] 祁华[1] 倪雪芳[1] 李婷[1] 虞妙婷[1] 

机构地区：[1]兰州军区乌鲁木齐总医院血透中心,新疆乌鲁木齐8300000

出　　处：《中国现代医学杂志》2005年第4期605-606,共2页China Journal of Modern Medicine

摘　　要：目的观察血液透析(hemodialysis,HD)治疗终末期糖尿病肾病(diabeticnephropathy,DN)的疗效及透析时的并发症。方法25例终末期糖尿病肾病患者HD前均已经临床确诊为2型糖尿病,平均57.4岁,血肌酐(Scr)为(921.4±137.6)μmol/L,血尿素氮(BUN)为(28.7±7.2)mmol/L,合并症主要有高血压、心力衰竭、胸腔积液、腹水、心包积液、上消化道出血、感染和脑梗塞。采用瑞典Gambro透析机,进口透析器,碳酸盐或醋酸盐透析液,每周透析2、3次。结果经透析患者心衰改善,血压控制满意,水、电解质酸碱失衡纠正,上消化道出血控制,大部分患者心包积液、胸腹水减少或消失。HD主要并发症有低血压、心律失常、心力衰竭、高血压、心绞痛和低血糖。死亡13例,转院5例,中止透析或失访6例。死亡原因主要为心血管疾病。结论HD为治疗终末期糖尿病肾病的有效手段,开始HD时机要早。HD时心血管并发症较多,终末期糖尿病肾病HD病死率相对较高,多死于心脑血管原因,临床上应引起注意。To evaluate the effect and complication of treatment of end-stage renal disease (ESRD) in diabetic nephropathy (DN) using himodialysis (HD). 25 cases of ESRD in DN were treatmented by HD. The patients mean age was 57.4 years. Serum creatinine was (921.4±137.6) umol/L, blood urea nitrogen was (28.7±7.2) mmol/L. The main complications before HD were hypertension, cardiac failure, pleural effusion, ascites pericardial effusion, upper gastrointestinal hemorrhage, infection and cerebral infarction. All the patients were treatmented by Gambro HD machines and had 2 or 3 dialysis sessions per week. After HD the cardiac failure was improved, the hypertension and upper gastrointestinal hemorrhage were well controlled, the imbalance of water, electrolyte and acid-base was corrected, the pericardial effusion, pleural effusion and ascites were reduced or disappeared. The main complications of HD were hypotension, arrhythmia, cardiac failure hyertension, angina pectoris and hypoglycemia. Of the 25 cases, 13 cases died, 5 cases transferred hospitalisation. [Conclusions] HD was a effective method for treatmont ESRD in DN, and it should be started early. The main complications of HD were cardiovascular main cause of death was cardiovascular diseases. It is important for preventing cardiovascular diseasesin HD.

关 键 词：糖尿病肾病 终末期肾病 血液透析 

分 类 号：R587.2[医药卫生—内分泌]