高频次血液灌流对尿毒症性心包炎的疗效  

The therapeutic effect of high frequency hemoperfusion for treatment of patients with uremic pericarditis

作　　者：王现秋 朱本燕 

机构地区：[1]邹城市人民医院肾内科,山东邹城273500

出　　处：《中国中西医结合急救杂志》2016年第1期89-91,共3页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

摘　　要：目的探讨在血液透析（HD）基础上加用高频次血液灌流（HP）对尿毒症性心包炎的临床疗效。方法选择2013年1月至2015年1月山东省邹城市人民医院肾内科收治的尿毒症性心包炎患者39例，在每周常规3次HD治疗的基础上，每周再加用2次HP治疗（先行HP2h，后继续常规HD2h），疗程为4周。观察患者治疗前后的临床表现、心脏彩超、脉压差、心脏射血分数（EF）、血清白蛋白（Alb）、血尿素氮（BUN）、血肌酐（SCr）、血钙、血磷、β2微球蛋白（β2-MG）、甲状旁腺激素（PTH）、同型半胱氨酸（Hcy）等变化。结果HD＋HP后患者临床症状明显改善，胸闷、气促、心包积液患者例数较HD＋HP前明显减少（分别为1比39例、1比39例、0比39例），脉压差明显增大（mmHg：30．59±4．22比24．97±5．98，1mmHg=O．133kPa），EF明显增加（0．52±0．03比0．38±0．05）；血BUN（mmol／L：24．23±3．29比39．38±4．08）、SCr（μmol／L：382．74±42．83比828．69±68．58）、血磷（mmol／L：1．89±0．20比2．09±0．29）、PTH（ng／L：529．11±73．25比822．67±92．63）、β2-MG（nmol／L：25．90±3．19比34．23±4．75）、Hey（μmol／L：21．69±3．27比30．54±2．41）均明显下降，血钙明显升高（mmol／L：2．14±0．18比2．12±O．25），差异均有统计学意义（均P〈0．05）；而Alb于治疗前后比较差异无统计学意义（g／L：34．69±3．09比36．56±3．72，P〉0．05）。结论在常规HD基础上加用高频次HP治疗尿毒症性心包炎，可有效降低中分子毒素，明显改善尿毒症性心包炎的临床症状。Objective To observe the therapeutic effect of hemodialysis （HD） combined with high frequency hemoperfusion （HP） on patients with uremic pericarditis. Methods A total of 39 patients with uremic pericarditis admitted to the Department of Nephrology, Zoucheng Municipal People＇s Hospital in Shandong Province from January 2013 to January 2015 were enrolled. All patients underwent routine HD 3 times a week, every week 2 times of HD±HP treatment were added, first HP 2 hours and then 2 hours of conventional HD, the therapeutic course being 4 weeks. The changes of clinical manifestations, heart color ultrasound, pulse pressure difference, heart ejection fraction （EF）, serum albumin（Alb）, blood urea nitrogen （BUN）, serum creatinine （SCr）, blood calcium, blood phosphorus, β2-microglobulin （β2-MG）, parathyroid hormone （PTH）, homocysteine （Hey）, etc were observed before and after treatment. Results After treatment with HD ± HP, the clinical symptoms were improved significantly, the numbers of patients with chest tightness, shortness of breath and pericardial effusion were obviously reduced compared with those before HD ± HP treatment being applied （1 vs. 39 cases, 1 vs. 39 cases, 0 vs. 39 cases respectively）, the pulse pressure difference increased markedly （mmHg： 30.59 ± 4.22 vs. 24.97± 5.98, 1 mmHg = 0.133 kPa）, EF increased significantly （0.52± 0.03 vs. 0.38 ±0.05）, blood BUN （mmol/L： 24.23 ± 3.29 vs. 39.38±4.08）, SCr （μmol/L： 382.74±42.83 vs. 828.69 ± 68.58）, blood phosphorus （mmol/L： 1.89 ± 0.20 vs. 2.09 ± 0.29）, PTH （ng/L： 529.11 ± 73.25 vs. 822.67 ± 92.63）, 2-MG （nmol/L： 25.90 ± 3.19 vs. 34.23 ± 4.75）, Hcy （ μmol/L： 21.69 ± 3.27 vs. 30.54 ± 2.41） were decreased obviously, blood calcium significantly increased （mmol/L： 2.14 ± 0.18 vs. 2.12 ±0.25）, the differences were statistically significant （all P 〈 0.05）; and there was no statistically significant difference in Alb before and after treatment

关 键 词：尿毒症 心包炎 高频次血液灌流 血液透析 中分子毒素 

分 类 号：R542.11[医药卫生—心血管疾病]