尿毒症患者合并低渗性脑病的临床诊治方法研究  

CLINICAL DIAGNOSIS AND TREATMENT METHODS STUDY ON UREMIA COMPLICATED WITH HYPOTONIC ENCEPHALOPATHY

作　　者：武素珍[1] 赵建荣[1] 张凌[2] 赵晨[1] 

机构地区：[1]内蒙古医科大学附属医院肾内科血液净化中心,内蒙古呼和浩特市010050 [2]北京中日友好医院

出　　处：《中国煤炭工业医学杂志》2015年第6期889-891,共3页Chinese Journal of Coal Industry Medicine

基　　金：北京市科技计划课题(D101100050010025)

摘　　要：目的探讨对尿毒症患者合并低渗性脑病的临床诊治。方法选取2013年2月—2014年12月在该院治疗的尿毒症合并低渗性脑病患者43例,结合患者临床症状以及血清电解质测定结果进行治疗。结果43例均有不同程度的神经精神症状,以嗜睡、反应迟钝为主,其中嗜睡18例（41.86%）,反应迟钝15例（34.88%）,意识模糊7例（16.28%）,昏迷2例（4.65%）,抽搐1例（2.33%）;血清氮70~103mmol/L,其中低氮血症（〈98mmol/L）31例;血清钾2.2~4.3mmol/L,其中低血钾（〈3.5mmol/L）29例。尿素氮平均（24.12±1.32）mmol/L,血肌酐平均（1123.45±124.28）mol/L;经过治疗,43例患者中有36例患者精神症状治愈或明显好转,7例因多器官功能衰竭死亡,病死率16.28%。不同原发疾病患者死亡分布比较,差异无统计学意义（P〉0.05）;血清钠〈100mmol/L患者11例,死亡5例,100~120mmol/L患者27例,死亡2例,〉120mmol/L患者5例,无死亡,其中血清钠〈100mmol/L患者死亡情况明显高于其他患者（P〈0.05）。结论对尿毒症患者应及时监测电解质,对合并低渗性脑病患者应及时行补充氯化钠等综合治疗。Objective To investigate clinical diagnosis and treatment of uremia complicated with hypotonic encephalopathy. Methods From February 2013 to December 2014 in author＇s hospital for the treatment of uremia complicated with hypotonic encephalopathy 43 cases patients, combined with clinical symptoms and serum electrolytes measurement results for treatment. Results There were different degree of neuropsy- chiatricsymptoms in 43 patients, mainly in sleepiness and slow reaction, including 18 cases of somnolence （41.86 % ） , 15 cases of slow reaction（34.88 % ）, 7cases of vague consciousness （ 16.28% ）, 2 cases of coma （4.65%）, 1 cases convulsions {2. 33% ）. Serum nitrogen of the patients were 70~103mmol/L, wherein the low azotemia （〈 98mmol/L） in 31 cases; The serum potassium were 2.2 ~ 4. 3mmol/L, of which the low blood potassium （〈3.5mmol/L} in 29 cases. Urea nitrogen was （24.12 ± 1.32） mmol/L, blood creat- inine was {1 123.45 ± 124. 28） mol/L. After treatment, there were 38 cases of 43 patients with psychiatric symptoms were cured or markedly improved, 7 cases died of multiple organ failure, mortality was 16.28%; Death distribution of different primary diseases patients was no significant difference（P〉0.05}; when serum sodium 〈100mmol/L, 5 cases of 11 cases patients were dead; ranged 100 ~ 120mmol/L, 2 cases of 27 cases patients dead; but in 120mmol/L, 5 cases patients without death, the death of the serum sodium 100mmol/L patients was higher than other patients （P〈0.05）. Conclusion Uremic patients should be monitored for electrolyte, the combined hypotonic encephalopathy patients should be promptly added sodi- um chloride and so on comprehensive treatment.

关 键 词：尿毒症 低渗性脑病 低钠血症 

分 类 号：R589.6[医药卫生—内分泌]