血液净化治疗利尿剂抵抗肾病综合征水肿患者的疗效  

Efficacy of blood purification therapy on diuretic resistance in patients withnephrotic edema

作　　者：吴泽成[1] 汤跃武[1] 李良志[1] 史继红[1] 何先红[1] 刘雷[1] 

机构地区：[1]重庆三峡中心医院肾内科,404000

出　　处：《实用医学杂志》2017年第3期402-404,共3页The Journal of Practical Medicine

基　　金：重庆市万州区科学技术委员会科技计划项目(编号:201503005)

摘　　要：目的:探讨不同血液净化方式治疗利尿剂抵抗肾病综合征水肿患者的疗效及安全性。方法:选取诊断明确的原发性肾病综合征伴有利尿剂抵抗患者40例,采用完全随机化分为普通血液透析(HD)组和连续性血液净化(CVVH)组,每组20例。均给予调脂、抗凝及糖皮质激素等基础治疗,观察时间为4周。观察两组患者治疗前后生化指标(24 h尿蛋白定量、血浆白蛋白、血清尿素氮和血清肌酐)的变化及水肿的缓解情况。结果:血液净化治疗后,患者尿量均明显增加,24 h尿蛋白定量下降的同时血浆白蛋白均显著提升,血尿素氮及肌酐水平均明显下降,差异均有统计学意义(P<0.05或P<0.01)。与HD组比较,治疗2周后CVVH组患者尿量增加更明显(P<0.05),24 h尿蛋白定量下降及血浆白蛋白提升更显著(P<0.05),血尿素氮及肌酐水平两组之间无差异(P>0.05)。治疗4周后两组患者尿量及肾功能差异无统计学意义(P>0.05),CVVH组24 h尿蛋白定量下降及血浆白蛋白提升比HD组更显著,差异均有统计学意义(P<0.05)。两组患者均无严重并发症发生。结论:血液净化治疗利尿剂抵抗肾病综合征水肿患者是安全、有效的,连续性血液净化治疗能更有效缓解利尿剂抵抗肾病综合征患者的严重顽固性水肿,促进肾功能恢复,改善肾病预后。Objective To investigate the efficacy and safety of blood purification therapy in the treatment of diuretic resistance in patients with nephrotic edema. Methods 40 cases of primary nephrotic syndrome with diuretic resistance in our hospital were randomly divided into hemodialysis （HD） group and continuous blood purification （CVVH） group and each group were 20 cases. All the patients were given basic treatment （ lipid modulation, anticoagulation and glucocorticoid） and the observation time was 4 weeks. The changes of biochemical indexes （24 h urine protein, plasma albumin, serum urea nitrogen and serum creatinine） were observed before and after treatment in two groups. In addition, the complications of four groups were recorded. Results After blood purification treatment, urinary volume of two groups were significantly increased, the quantity of 24 h urinary protein and serum albumin were significantly improved, levels of serum urea nitrogen and serum creatinine were significantly decreased.The differences were statistically significant （P 〈 0.05 or P 〈 0.01 ）. Compared with HD group, the urine volume increased more obviously in CVVH group after 2 weeks＇ treatment （P 〈 0.05）. The same time, 24 h urinary protein was reduced and plasma albumin was improved more significantly （P 〈 0.05 ）, levels of serum urea nitrogen and serum creatinine were not differ between the two groups （P 〉 0.05 ）. There was no dif- ference in urine volume and renal function between the two groups （P 〉 0.05） after 4 weeks＇ treatment. 24 h urinary protein was significantly decreased and serum albumin was significantly higher than HD group （P 〈 0.05 ）. There were no serious complications in the two groups. Conclusion Blood purification in the treatment of diuretic resistance in patients with nephrotie edema is safe and effective. Continuous blood purification treatment can effectively alleviate nephrotic edema with diuretic resistance, promote the recovery of renal function and improve t

关 键 词：肾病综合征 利尿剂抵抗 水肿 血液净化 

分 类 号：R692[医药卫生—泌尿科学]