华西医学

华西医学

连续性肾脏替代治疗联合血液灌流对糖尿病合并尿毒症脑病患者的治疗观察

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目的 探讨连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)联合血液灌流(hemoperfusion,HP)模式在糖尿病合并尿毒症脑病患者中的治疗效果。 方法 回顾性收集 2010 年 1 月—2017 年 12 月收治的糖尿病合并尿毒症脑病患者 55 例,根据治疗模式不同分为 CRRT 联合 HP 组(CRRT+HP 组)28 例和血液透析(hemodialysis,HD)联合 HP 组(HD+HP 组)27 例,观察两组患者治疗前后生命体征、相关生化指标的变化和疗效对比。 结果 两组患者在一般资料方面具有可比性。两组患者治疗前后的血压及心率变化差异无统计学意义(P>0.05);CRRT+HP 组低血压事件发生率低于 HD+HP 组(P<0.05),心功能改善有效率高于 HD+HP 组(P<0.05);两组患者治疗后的血尿素氮、肌酐、甲状旁腺激素、β2-微球蛋白、磷、C 反应蛋白及脑钠肽指标均较治疗前降低(P<0.05),其中甲状旁腺激素、β2-微球蛋白、C 反应蛋白及脑钠肽指标,CRRT+HP 组较 HD+HP 组降低更为明显(P<0.05);CRRT+HP 组的尿毒症脑病缓解率高于 HD+HP 组(P<0.05)。 结论 与 HD+HP 模式相比,CRRT+HP 模式具有更加稳定的血流动力学,更有利于患者心力衰竭的改善,能更有效地清除炎症介质和尿毒症脑病相关的中大分子毒素,具有更高的尿毒症脑病缓解率,适用于糖尿病合并尿毒症脑病患者的救治。

Objective To investigate the therapeutic effect of continuous renal replacement therapy (CRRT) plus hemoperfusion (HP) on patients with diabetes and uremic encephalopathy. Methods Fifty-five patients with diabetes and uremic encephalopathy from January 2010 to December 2017 were retrospectively collected in this study and divided into CRRT plus HP (CRRT+HP) group (n=28) and hemodialysis (HD) plus HP (HD+HP) group (n=27). The changes of vital signs, related biochemical indicators before and after treatment and curative effects were compared between the two groups. Results The two groups were comparable in general. No significant differences were found in blood pressure or heart rate before and after treatment between the two groups (P>0.05). The incidence of hypotension events in CRRT+HP group was significantly lower than that in HD+HP group (P<0.05), and the effective rate of cardiac function improvement in CRRT+HP group was significantly higher than that in HD+HP group (P<0.05). After treatment, the blood urea nitrogen, creatinine, parathyroid hormone, β2-microglobulin, phosphorus, C-reactive protein and brain natriuretic peptide in the two groups were significantly decreased than those before treatment (P<0.05). Parathyroid hormone, β2-microglobulin, C-reactive protein and brain natriuretic peptide were significantly decreased in CRRT+HP group as compared with those in HD+HP group (P<0.05). The remission rate of uremic encephalopathy in CRRT+HP group was significantly higher than that in HD+HP group (P<0.05). Conclusions As compared with HD+HP pattern, CRRT+HP pattern is more stable in the hemodynamics, and more effective in the improvement of heart failure and the clearance of inflammatory mediators, middle molecular and macromolecular substances associated with uremic encephalopathy. CRRT+HP pattern is suitable for the treatment of patients with diabetes and uremic encephalopathy.

关键词: 尿毒症脑病; 糖尿病; 连续性肾脏替代治疗; 血液灌流; 血液透析

Key words: Uremic encephalopathy; Diabetes; Continuous renal replacement therapy; Hemoperfusion; Hemodialysis

引用本文: 廖宇捷, 舒英, 龚蓉, 韩天曌, 童玉娜, 李友琴, 游畅. 连续性肾脏替代治疗联合血液灌流对糖尿病合并尿毒症脑病患者的治疗观察. 华西医学, 2018, 33(7): 843-847. doi: 10.7507/1002-0179.201806106 复制

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