CVVH、IHD分别联合高渗盐水治疗CRF合并MICH的疗效及安全性比较  

Efficacy and safety of CVVH and IHD combined with hypertonic saline in the treatment of chronic kidney disease complicated with massive intracerebral hemorrhage

作　　者：欧阳永峰 王飞龙[1] 刘军[1] OUYANG Yongfeng;WANG Feilong;LIU Jun(Department of Nephrology,Bozhou Municipal People's Hospital,Bozhou Anhui 236800,China)

机构地区：[1]亳州市人民医院肾脏内科,安徽亳州236800

出　　处：《中国急救复苏与灾害医学杂志》2022年第7期923-926,共4页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：2018年安徽省自然科学基金(编号:1808085QH246)。

摘　　要：目的 探究间断血液透析(IHD)及连续性静脉血液滤过(CVVH)分别联合10%高渗盐水治疗慢性肾衰竭(CRF)合并大容积脑出血(MICH)的疗效及安全性。方法 选取2017年3月—2021年3月亳州市人民医院60例CRF合并MICH患者,采用随机数字表法分为IHD+10%高渗盐水组(n=30)、CVVH+10%高渗盐水组(n=30)。收集患者一般资料;于入院时、微创穿刺引流术后第1天、第3天、第7天、第14天,采用NIHSS评分评价两组患者神经功能缺损程度;采用头颅CT测量血肿周围低密度区体积;比较住院时间、费用及死亡率;比较不良反应(如急性心力衰竭、低体温、低血压、血流感染、管路凝血、再出血、电解质紊乱等)。结果 术后第7天、14天,CVVH+10%高渗盐水组NIHSS评分、血肿周围低密度区体积低于IHD+10%高渗盐水组(P<0.05)。与IHD+10%高渗盐水组比较,CVVH+10%高渗盐水组患者住院时间、费用及死亡率均降低(P<0.05);IHD+10%高渗盐水组5例患者发生低血压,经降低血流量,减少脱水量后症状得到缓解;两组患者均无低体温等不良事件发生。结论 CRF合并MICH在急性期选用CVVH+10%高渗盐水血液净化方式治疗优于IHD+10%高渗盐水方式治疗。Objective To investigate the efficacy and safety of IHD and CVVH combined with 10% hypertonic saline in the treatment of in patients of chronic renal failure(CRF) combined with massive cerebral hemorrhage.Methods Sixty patients with CRF complicated with massive intracerebral hemorrhage in Bozhou People’s Hospital from March 2017 to March 2021 were selected and randomly divided into IHD + 10% hypertonic saline group(n=30),CVVH + 10%hypertonic saline group(n=30).Collect patient general information.On admission,and on the 1st,3rd,7th,and 14th days after minimally invasive puncture and drainage,the NIHSS was used to evaluate the degree of neurological deficit in two groups.Head CT was performed and Tada formula was used to calculate the volume of low density area around hematoma.The length of stay,hospital expenses,and mortality within 28 days were recorded,and the incidence of adverse reactions(such as acute heart failure,hypothermia,hypotension,infection of blood flow,blood coagulation,rebleeding,electrolyte disturbance) was counted.Results On the 7th and 14th days after the operation,the NIHSS score and the volume of the low-density area around the hematoma in the CVVH+10% hypertonic saline group were lower than those in the IHD + 10% hypertonic saline group(P<0.05).The hospitalization time,cost and mortality of patients in CVVH+10% hypertonic saline group were lower than those in IHD+10% hypertonic saline group(P<0.05).Hypotension occurred in 5 patients in the IHD + 10% hypertonic saline group,and the symptoms were relieved by reducing blood flow and dehydration;there were no adverse events such as hypothermia in the two groups.Conclusion CVVH+10% hypertonic saline blood purification is better than IHD+10% hypertonic saline in the treatment of CRF combined with MICH in acute stage.

关 键 词：间断血液透析 连续性静脉血液滤过 慢性肾衰竭 大容积脑出血 疗效及安全 

分 类 号：R692.5[医药卫生—泌尿科学]