个体化血液净化在糖尿病严重并发症中的应用  

Application of Individualized Blood Purification in Patients with Severe Complications in Diabetes Mellitus

作　　者：钟鸿斌[1,2] 王小华[3] 廖爱能[3] 王新珠[3] 郑全林[1,2] 郑自力[1,2] 詹蔓艺[1,2] 柯玉霜[1,2] 

机构地区：[1]福建医科大学教学医院 [2]晋江市医院肾内科,福建省晋江市362200 [3]福建省三明市第二医院肾内科,366000

出　　处：《中华全科医学》2010年第10期1228-1230,共3页Chinese Journal of General Practice

摘　　要：目的探讨连续性血液净化(CBP)治疗糖尿病并发不同严重并发症患者中的应用价值。方法对晋江市医院2003年3月-2010年3月收治的13例糖尿病并发严重感染诱发多脏器功能障碍综合征(MODS)、糖尿病肾病伴全身顽固性浮肿、双胍类药物相关性严重乳酸酸中毒的临床资料进行回顾性分析。均在常规治疗的基础上应用连续性静脉-静脉血液滤过(CVVH)治疗,观察分析患者治疗前后生命征和血生化指标、二氧化碳结合力(CO2CP)、血pH的变化以及患者的死亡率。结果患者治疗前后血压、脉搏、呼吸平稳,血乳酸和血钾下降、血CO2CP和pH上升均有明显效果。存活12例,1例乳酸酸中毒的尿毒症患者因腹壁血管破裂大出血、失血性休克死亡。结论应用CBP治疗能改善糖尿病并发药物治疗效果差的严重并发症患者的内环境,维持酸碱平衡,按个体化治疗方案,能改善患者的预后。Objective To investigate therapeutic effect of continuous blood purification（CBP） on patients with severe different complications in diabetes mellitus.Methods Retrospective method was applied to analyze 13 cases patients with severe comlications（MODS,severe refractory edemia,Biguantide drug-related severe lactic acidosis）in diabetes mellitus in our hospital from March of 2003 to March of 2010.All patients accepted routine treatment and continuous veno-venous hemofiltration（CVVH）.Life indexs,blood biochemical indices,carbon dioxide combining power（CO2CP）,blood pH changes in plasma before and after treatment and mortality rate were observed.Results Blood pressure,pulse,breathing of patients were stable before and after treatment.The decrease of lactic acid and serum potassium level in plasma and increase of pH and CO2CP of arterial blood were significant.12 cases survival,1 case uremic patients with severe lactic acidosis died of hemorrhagic shock resulting from abdominal bleeding.Conclusion CBP treatment can improve internal environment and maintain the acid-base balance of patients with severe complications.Individualized treatment can improve the prognosis of patients with severe complications.

关 键 词：糖尿病 并发症 血液滤过 疗效 

分 类 号：R587.1[医药卫生—内分泌] R459.52[医药卫生—内科学]