持续血液净化对于重症脑出血的治疗价值初探  

Potential value of continuous blood purification in treatment of severe intracerebral hemorrhage

作　　者：李建国[1] 李丽霞[1] 董小燕[1] 杨铁城[1] 于东明[1] 任添华[1] 袁靖[1] 

机构地区：[1]首都医科大学附属北京天坛医院急诊科,北京100050

出　　处：《中国急救复苏与灾害医学杂志》2011年第9期759-761,共3页China Journal of Emergency Resuscitation and Disaster Medicine

摘　　要：目的探讨持续性血液净化（CBP）对于重症脑出血（ICH）的潜在治疗价值。方法16例43。77岁均存在发热的重症ICH患者（7例合并急性肾功能衰竭及／或严重高钠高氯血症）收入急诊ICU，并接受CBP治疗。结果16例患者共接受CBP治疗29次。CBP治疗前联合解热镇痛药物及物理降温处理6～8h，均无效。CBP治疗6h后，体温降至（36．2±1．3）℃，显著低于CBP前[（38．6±1．7）℃，P〈0．051。经过CBP治疗，肾功能明显改善，高钠高氯血症得到纠正[治疗前后Na^＋（165．3±7．4）mmol/L vs（140．3±3．2）mmoVLP〈0．01；治疗前后CL-（118．0±2．6）mmol/L vs（98．7±0．6）mmol／L P〈0．011。8例于CBP后行头颅cT检查，未发现血肿扩大。结论CBP能有效地控制ICH患者的发热，维持内环境稳定及肾功能，并可能改善预后。Objective To investigate the potential value of continuous blood purification （CBP） in the treatment of severe intracerebral hemorrhage （ICH）. Methods Sixteen severe ICH patients, aged 43-77, all with fever, 7 complicated with acute renal failure （ARF）, hypernatremia, or hyperchloremia, underwent CBP. Results The 16 cases underwent CBP for 29 times totally. Before the CBP antipyretics combined with surface cooling techniques failed to lower the temperature in all 16 patients, while 6 hours after the CBP their body temperature decreased to （36.2± 1.3） ℃, significantly lower than that before the CBP treatment [（38.6± 1.7） ℃, P〈 0.05]. Hypernatremia and hyperchloremia were corrected after CBP[Na ＋ （ 165.3 ±7.4 ） mmol/L vs （ 140.3 ±3.2） mmol/L P 〈 0.01; CL- （118.0±2.6） mmol/L vs （98.7 ±0.6） mmol/L P 〈 0.01].The renal function in 4 cases were also improved after CBP. Head CT scan after CBP on 8 patients did not show enlargement of hematoma. Conclusion CBP effectively lowers fever, helps keep homeostasis, and may improve the prognosis of severe ICH.

关 键 词：脑出血 持续血液净化 发热 内环境稳定 

分 类 号：R743.34[医药卫生—神经病学与精神病学]