CAJ | 학술논문

目的评估联机血液透析滤过抢救ACVD并发HNDc的疗效及安全性.方法前瞻性选取荆门市第一人民医院2006年1月至2007年6月收治的11例ACVD并发HNDc患者,行治疗前后的对照研究.确诊后1 h行联机血液透析滤过抢救,时间为90 min,采用德国Fressnius 4008S型的双泵血透机,F60的血滤器和管道,血流量150～180 ml/min,置换液后稀释方式输入50～60ml/min,碳酸氢盐透析液流量500 ml/min,在治疗前1 h及治疗后6 h取血测定血钠、血钾、血糖、血尿素氮和血浆渗透压;评估治疗中有无脑水肿或心功能不全加重;观察治疗后24 h的神志改变及不良反应.结果所有患者在治疗中无脑水肿及心功能不全的加重;治疗后6 h血糖、血钠、血尿素氮及血浆渗透压均有明显下降,与治疗前比较差异具有统计学意义(P<0.01);8例患者于治疗后24 h意识障碍明显好转,3例死亡,抢救成功率为73%.结论联机血液透析滤过抢救ACVD并发HNDC的患者,效果显著,并发症少,安全性高,可缩短病程,降低病死率,是抢救此类患者的有效方法.
목적 평고련궤혈액투석려과창구ACVD병발HNDc적료효급안전성.방법 전첨성선취형문시제일인민의원2006년1월지2007년6월수치적11례ACVD병발HNDc환자,행치료전후적대조연구.학진후1 h행련궤혈액투석려과창구,시간위90 min,채용덕국Fressnius 4008S형적쌍빙혈투궤,F60적혈려기화관도,혈류량150～180 ml/min,치환액후희석방식수입50～60ml/min,탄산경염투석액류량500 ml/min,재치료전1 h급치료후6 h취혈측정혈납、혈갑、혈당、혈뇨소담화혈장삼투압;평고치료중유무뇌수종혹심공능불전가중;관찰치료후24 h적신지개변급불량반응.결과 소유환자재치료중무뇌수종급심공능불전적가중;치료후6 h혈당、혈납、혈뇨소담급혈장삼투압균유명현하강,여치료전비교차이구유통계학의의(P<0.01);8례환자우치료후24 h의식장애명현호전,3례사망,창구성공솔위73%.결론 련궤혈액투석려과창구ACVD병발HNDC적환자,효과현저,병발증소,안전성고,가축단병정,강저병사솔,시창구차류환자적유효방법.
Objective To access evaluate the efficacy and safety of on-line hemodiafiltration for treating a-cute cerebrovascular disease (ACVD) patients complicated with hyperosmolar nonketotie diabetic coma (HNDC).Method Totally 11 patients of ACVD complicated with HNDC were observed for this prospective control study.All of them underwent on-line hemodiafiltrafion for 90 minutes using Fressnius 4008S Hemodialysis Machine withONLILNEplus TM and F60 one hour after final diagnosis was made. The bicarbonate ultrafiltrate rate was set at 500ml/min and blood flow at 150 ～ 180 ml/min; and the substitute fluid were infused with post-dilution at 50 ～ 60ml/min. The symptom of brain edema and cardiac insufficiency during the same course of treatment was observed.Blood were taken from the patients to detect serum kalium, serum glucose, serum natrium, BUN and plasma os-motic pressure at one hour before treatment and six hours after treatment, respectively. The change of in conscious-ness and adverse effects were evaluated at 24 hours after treatment. Results All patients were treated successful-ly. The blood glucose, serum natrium, serum kalium, BUN and plasma osmotic pressure were decreased after on-line hemodiafiltration. Among the 11 patients, consciousness was improved obviously in 8 patients, 3 patientsdied, accounting for 73% of successful effectiveness. Conclusions The on-line hemodiafiltration was effectiveand safe for treating ACVD patients complicated with HNDC.