连续性静脉-静脉血液滤过治疗慢性肾衰竭合并大容积脑出血疗效观察  

Efficacy of continuous veno-venous hemofiltration in treatment of chronic renal failure complicated with large volume intracerebral hemorrhage

作　　者：付怀栋[1,2] 刘晓巧 刘敏华 FU Huaidong;LIU Xiaoqiao;LIU Minhua(Department of Critical Care Medicine,People’s Hospital of Guanyun County,Lianyungang 222200,China)

机构地区：[1]连云港市灌云县人民医院重症医学科,江苏222200 [2]江苏省无锡市惠山区中医医院重症医学科

出　　处：《浙江医学》2020年第15期1628-1632,共5页Zhejiang Medical Journal

摘　　要：目的观察连续性静脉-静脉血液滤过(CVVH)治疗慢性肾衰竭合并大容积脑出血的疗效,为此类患者选择合适的血液净化方式提供参考。方法回顾性分析2014年1月至2019年5月灌云县人民医院收治的慢性肾衰竭合并大容积脑出血患者59例,按血液净化方式分为间断血液透析(IHD)组(30例)与CVVH组(29例)。比较两组患者入院时、微创穿刺引流术(MIDP)后第1、3、7、14天时的美国国立卫生研究院卒中量表(NIHSS)评分、血肿周围低密度区体积以及医院获得性肺炎(HAP)、急性心力衰竭、再出血的发生率、住院时间、住院费用、住院期间病死率。观察两组患者有无血液净化不良事件发生。结果术后第7、14天,CVVH组的NIHSS评分分别为(16.24±3.25)分和(14.79±3.45)分,较IHD组的(19.03±3.94)分和(17.93±3.89)分降低,血肿周围低密度区体积分别为(23.14±5.47)cm^3和(19.24±4.44)cm^3,低于IHD组的(31.70±6.13)cm^3和(27.27±5.74)cm^3,差异均有统计学意义(均P<0.05);CVVH组术后第7天的NIHSS评分高于术后第1天[(14.10±3.2)分],血肿周围低密度区体积大于术后第1天(17.31±4.8)cm^3,IHD组术后第3、7、14天的NIHSS评分高于术后第1天,血肿周围低密度区体积大于术后第1天,差异均有统计学意义(均P<0.05)。CVVH组的HAP和急性心力衰竭发生率分别为27.6%和17.2%,低于IHD组的56.7%和43.3%,差异均有统计学意义(均P<0.05)。两组再出血发生率比较,差异无统计学意义(P>0.05)。CVVH组住院时间、住院费用和住院期间病死率分别为(22.93±4.29)d、(7.16±0.95)万元和6.9%,低于IHD组的(27.30±5.06)d、(7.69±0.91)万元和30.0%,差异均有统计学意义(均P<0.05)。CVVH组无血液净化不良事件发生。结论CVVH治疗慢性肾衰竭合并大容积脑出血优于IHD治疗,能够减轻血液净化对脑水肿、神经功能缺失症状的影响,降低HAP、急性心力衰竭的发生率,缩短住院时间,降低住院费用,降低住院期间病死�Objective To investigate the efficacy of continuous veno-venous hemofiltration(CVVH)in the treatment of chronic renal failure complicated with large volume intracerebral hemorrhage.Methods Clinical data of 59 patients with chronic renal failure complicated with large volume intracerebral hemorrhage admitted to Guanyun People’s Hospital from January 2014 to May 2019 were retrospectively analyzed.There were 29 cases receiving CVVH(CVVH group)and 30 cases receiving intermittent hemodialysis(IHD group).The NIHSS score and the volume of perihematomal low-density area at admission and 1,3,7,14 d after minimally invasive puncture and drainage(MIDP)were recorded and compared between the two groups.The incidence of hospital-acquired pneumonia(HAP),acute heart failure and rebleeding were recorded and compared between the two groups.The length of hospital stay,medical expenses and fatality during hospitalization were compared between the two groups.The occurrence of adverse events of blood purification in the two groups were observed.Results On d7 and d14 after operation,the NIHSS scores of CVVH group were(16.24±3.25)and(14.79±3.45)points respectively,which were significantly lower than those in IHD group(19.03±3.94 and 17.93±3.89,P<0.05);the volumes of perihematomal low-density area were(23.14±5.47)cm3 and(19.24±4.44)cm3,respectively,which were significantly lower than those in IHD group(31.70±6.13 cm3 and 27.27±5.74cm3,P<0.05).On d7 after the operation,the NIHSS score and the volume of perihematomal low-density area of CVVH group was significantly higher than those on d1(16.24±3.25 vs.14.10±3.2,P<0.05;and 23.14±5.47 cm3 vs.17.31±4.8 cm3,P<0.05).On d3,d7 and d14 after operation,the NIHSS scores of IHD group were(16.02±3.80)points,(19.03±3.94)points and(17.93±3.89)points,respectively,which were significantly higher than that on d1(14.70±3.02);the volume of perihematomal low-density area were(21.27±5.01)cm3,(31.70±6.13)cm3,and(27.27±5.74)cm3,respectively,which were significantly higher than that on d1 af

关 键 词：慢性肾衰竭 大容积脑出血 连续性静脉-静脉血液滤过 间歇性血液透析 神经功能缺失 血肿周围低密度区 

分 类 号：R692.5[医药卫生—泌尿科学] R743.34[医药卫生—外科学]