脑出血合并维持性血液透析24例临床分析  

Clinical characteristics of 24 cerebral hemorrhage complicated with maintenance hemodialysis patients

作　　者：杜静[1] 王训[1] 高宗良[1] DU Jing;WANG Xun;GAO Zongliang(Department of Neurology,the Second Affiliated Hospital of Anhui Medical University,Hefei 230601,China)

机构地区：[1]安徽医科大学第二附属医院神经内科,安徽合肥230601

出　　处：《中国实用神经疾病杂志》2018年第14期1572-1576,共5页Chinese Journal of Practical Nervous Diseases

摘　　要：目的探讨脑出血合并维持性血液透析的临床特点。方法选择安徽医科大学第二附属医院2014—2018年收治的脑出血合并维持性血液透析患者24例,收集同期我院无肾脏疾病的脑出血患者24例进行对比。分别评定各组血压,血红蛋白、血小板、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、血尿素氮、肌酐、血糖、PT系列。对2组治疗前后的神经功能缺损评分(NIHSS)及格拉斯哥昏迷评分(Glasgow Coma Scale,GCS)、脑出血量及病死率进行评定。结果 (1)脑出血合并血液透析组及对照组的出血量、GCS、NIHSS评分、住院时间比较,差异无统计学意义(P>0.05)。2组血压均高于正常值,但组间无显著差别。(2)脑出血合并血液透析组的血红蛋白、血小板、TC、LDL-C水平均低于对照组,差异有统计学意义(P<0.01)。脑出血合并血液透析组的肌酐及尿素氮水平显著高于对照组(P<0.01)。2组的TG水平、血糖、PT、TT、FIB数值间无显著差异。(3)脑出血合并血液透析组的病死率为29.2%,对照组为4%。2组病死率比较差异有统计学意义(P<0.05)。脑出血合并血液透析组治疗前后出血量、NIHSS、GCS分值差异无统计学意义。对照组治疗后出血量及NIHSS较治疗前显著降低,GCS分值较治疗前增加(P<0.01)。治疗后血液透析组的NIHSS评分高于对照组,差异有统计学意义(P<0.05)。结论脑出血合并血液透析病死率高,预后不佳,应积极防治。改善贫血、低血小板水平及维持一定的血脂水平可能对防治血液透析患者的脑出血有所帮助。Objective To investigate the clinical features of cerebral hemorrhagecomplicated with maintenance hemodialysis （HD） patients. Methods Twenty four patients with cerebral hemorrhage and maintenance hemodialysis admitted to the Second Affiliated Hospital of Anhui Medical University form 2014 to 2018 were enrolled,and twenty four patients with cerebral hemorrhage without renal disease in our hospital were collected for comparison.Blood pressure,hemoglobin,platelets,total cholesterol （TC）,triglyceride （TG）,high density lipoprotein cholesterol （HDL C）,low density lipoprotein cholesterol （LDL C）,blood urea nitrogen,creatinine were evaluated.The neurological deficit scores （NIHSS） and Glasgow Coma Scale （GCS）,cerebral hemorrhage and mortality were evaluated before and after treatment. Results （1） There was no significant difference in the amount of bleeding,GCS,NIHSS score and hospital stay between HD group and control group （ P 〉0.01）.The blood pressure of the 2 groups was higher than the normal value,but the difference between the groups was not statistically significant （ P 〉0.01）.（2） The levels of hemoglobin,platelet,TC and LDL C in HD group were lower than those in the control group （ P 〈0.01）.The levels of creatinine and urea nitrogen in hemorrhage complicated withHD group were significantly higher than those in the control group （ P 〈0.01）.There was no significant difference in TG level,blood glucose,PT,TT and FIB between the two groups （ P 〉0.01）.（3） The mortality rate of cerebral hemorrhage combined with HD group was 29.2%,and the mortality rate of control group was 4%.There was a statistically significant difference in mortality between the two groups （ P 〈0.05）.There was no significant difference in the amount of bleeding,NIHSS and GCS between the cerebral hemorrhage and hemodialysis group （ P 〉0.01）.The amount of bleeding and NIHSS in the control group were significantly lower than those before treatment,and the GCS score was

关 键 词：脑出血 维持性血液透析 预后 血小板 低密度脂蛋白胆固醇 血清 高血压 肾衰竭 

分 类 号：R743.43[医药卫生—神经病学与精神病学]