华西医学

华西医学

高钠血症的连续性肾脏替代治疗

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高钠血症是危重症患者常见的电解质紊乱之一。重度高钠血症发生率为 0.6%~1.0%,然而病死率为 58%~87%。传统治疗主要是限制钠的摄入及根据缺水和持续失水程度补充无盐液体。然而对于部分等容量和高容量高钠血症患者,传统治疗不能有效降低血钠浓度。连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)能够有效清除钠离子,降低血钠浓度,而关于 CRRT 治疗高钠血症的研究较少。该文从高钠血症的流行病学和危害、传统治疗及不足、CRRT 治疗的优势和现状、CRRT 治疗高钠血症的经验 4 个方面介绍高钠血症的 CRRT 治疗。

Hypernatremia is one of the commonly syndromes in critically ill patients. Severe hypernatremia has a low incidence (0.6%–1.0%) but with a very high mortality (58%–87%). Conventional treatments include the limitation of sodium intake and the supplement of sodium free liquid according to the assessed water lost. The reduction rates of conventional treatments are commonly not effective enough to decrease the serum sodium concentration in severe euvolemic or hypervolemic hypernatremia patients. Continuous renal replacement therapy (CRRT) has been reported to be effective on the reduction of sodium level in severe hypernatremia patients. However, the evidences on the use of CRRT for hypernatremia are limited. Our present review summarizes the current evidences on the prevalence of hypernatremia, the outcome of hypernatremia patients, the conventional treatment of hypernatremia, and the advantages and indications of CRRT for the management of hypernatremia. Additionally, we introduce our experiences on the management of hypernatremia using CRRT as well.

关键词: 高钠血症; 连续性肾脏替代治疗; 血钠纠正速率

Key words: Hypernatremia; Continuous renal replacement therapy; Reduction rate of serum sodium concentration

引用本文: 马峰, 柏明, 孙世仁. 高钠血症的连续性肾脏替代治疗. 华西医学, 2018, 33(7): 887-891. doi: 10.7507/1002-0179.201806078 复制

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