连续血液净化救治慢性肺源性心脏病并重度低钠血症的疗效观察  

Clinical value of continuous blood purification in treatment of chronic pulmonary heart disease complicated with severe hyponatremia

作　　者：陈艺坛[1] 陈光[1] 严培[1] 陈志斌[1] 潘云虎[1] 

机构地区：[1]解放军第92医院呼吸科,福建南平353000

出　　处：《临床军医杂志》2013年第8期780-782,788,共4页Clinical Journal of Medical Officers

摘　　要：目的观察连续性血液净化(CBP)救治慢性肺源性心脏病并重度低钠血症的疗效。方法采用随机数字表法分为两组,对照组19例采用抗感染、改善通气、加强营养、必要时无创机械通气支持等常规方法治疗,并积极寻找病因,去除诱发因素,同时予以静脉补钠纠正低钠血症。CBP组19例在上述常规治疗基础上,联合CBP救治。比较CBP组患者治疗前和治疗后4、8、12、24、36、48 h的血钠及血浆渗透压检测结果;比较对照组和CBP组患者治疗前和治疗后第1、2、3天血钠及血浆渗透压的检测结果;比较对照组及CBP组患者治疗前和治疗后第1、2、3天的Glasgow评分及APACHE评分及两组患者的病死率。结果 CBP组治疗后4 h与治疗前的血钠及血浆渗透压比较,有统计学差异(P<0.05);治疗后8、12、24、36、48 h与治疗前的血钠及血浆渗透压比较明显提高,差异有显著统计学意义(P<0.01)。CBP组患者治疗后24、48、72 h血钠及血浆渗透压与对照组相同时间的指标比较明显升高,有显著统计学差异(P<0.01)。两组患者治疗前的Glasgow评分与APACHE评分比较无统计学差异(P>0.05);与对照组比较,CBP组患者治疗后24 h及48 h Glasgow评分明显上升,而APACHE评分明显下降,差异均有统计学意义(P<0.05);对照组患者病死率明显高于CBP组,差异有显著统计学意义(P<0.01)。结论CBP救治慢性肺源性心脏病伴重度低钠血症的疗效显著,耐受性好,不良反应低,比较安全,并可在床边进行治疗,便于对患者的观察及抢救,为临床提供了一种安全、有效的治疗方法。Objective To investigate the clinical value of continuous blood purification （CBP） in the treatment of chronic pulmona- ry heart disease complicated with severe hyponatremia. Methods Thirty-eight patients with chronic pulmonary heart disease com- plicated with severe hyponatremia were divided into two groups at random, i.e. CBP group （ n = 19） and control group （ n = 19）. The CBP group was treated with CBP in addition to conventional therapy which was applied to the control group at the same time. In the CBP group, the changes in blood sodium and plasma osmotic pressure were compared between before treatment and after treat- ment （4-, 8-, 12-, 24-, 36- and 48 h）. The changes in blood sodium and plasma osmotic pressure, as well as scores of Glasgow and APACHE, were also compared between the two groups at the time points of before and after treatment （ lst-, 2nd- and 3rd day）. Results In the CBP group, the 4 h postoperative blood sodium level and the plasma osmotic pressure showed statistical sig- nificance when compared with before treatment （ P 〈 0.05 ）. The blood sodium level and plasma osmotic pressure after treatment （8-, 12-, 24-, 36- and 48 h） were significantly higher than before treatment （P 〈0.01 ）. The blood sodium level and the plasma osmotic pressure were significantly higher after treatment （24-, 48- and 72 h） in the CBP group than in the control group （ P 〈 0.01 ）. Before treatment, there were no significant differences in the scores of Glasgow and APACHE between the two groups （ P 〉 0.05 ） , while after treatment （24- and 48 h） Glasgow score was significantly higher and APACHE score was significantly lower in the CBP group than in the control group （ P 〈 0.05 ）. The mortality rate of the CBP group was significantly lower than that of the control group （ P 〈 0. 01 ）. Conclusion As a safe therapy, CBP is clinically effective on patients of chronic pulmonary heart disease com- plicated with severe hyponatremia, it is well tolerated wit

关 键 词：连续性血液净化 慢性肺源性心脏病 重度低钠血症 

分 类 号：R541.5[医药卫生—心血管疾病]