CAJ | 학술논문

【目的】探讨尿毒症合并左心衰患者的病因及对患者行急诊血液透析后的疗效，同时对其并发症发生情况进行总结，为临床救治提供指导。【方法】收集本院急诊科自2008年1月至2014年1月收治的尿毒症合并急性左心衰的患者共67例，分析其发生急性左心衰的病因，评估血液透析后的疗效，调查其发生不良反应的情况。【结果】急性左心衰的诱因中，血容量过多所占比例为35．8％，排在第一位；高血压15例，占22．4％；肺部等感染13例，占19．4％；贫血9例，占13．4％；电解质紊乱6例，占9．0％。治疗后患者的血清肌酐、尿素氮、二氧化碳结合力、血压、心率、呼吸、平均动脉压和血氧饱和度较治疗前均均有改善，且治疗前后相比较差异有显著性（P＜0．01）。治疗后的不良反应主要是低血压，其次是睡眠障碍、皮肤瘙痒、食欲不振、呕吐等。【结论】尿毒症合并急性左心衰的患者的病因复杂，行血液透析治疗的疗效确切，能明显改善患者症状，但是会出现多样复杂的不良反应，严重影响患者的就医体验，故需准确处理，积极沟通。
【목적】탐토뇨독증합병좌심쇠환자적병인급대환자행급진혈액투석후적료효，동시대기병발증발생정황진행총결，위림상구치제공지도。【방법】수집본원급진과자2008년1월지2014년1월수치적뇨독증합병급성좌심쇠적환자공67례，분석기발생급성좌심쇠적병인，평고혈액투석후적료효，조사기발생불량반응적정황。【결과】급성좌심쇠적유인중，혈용량과다소점비례위35．8％，배재제일위；고혈압15례，점22．4％；폐부등감염13례，점19．4％；빈혈9례，점13．4％；전해질문란6례，점9．0％。치료후환자적혈청기항、뇨소담、이양화탄결합력、혈압、심솔、호흡、평균동맥압화혈양포화도교치료전균균유개선，차치료전후상비교차이유현저성（P＜0．01）。치료후적불량반응주요시저혈압，기차시수면장애、피부소양、식욕불진、구토등。【결론】뇨독증합병급성좌심쇠적환자적병인복잡，행혈액투석치료적료효학절，능명현개선환자증상，단시회출현다양복잡적불량반응，엄중영향환자적취의체험，고수준학처리，적겁구통。
[Objective] To explore the etiology of uremic patients with left heart failure, and to observe the efficacy of emergency hemodialysis, and to summarize the incidence of complications in order to guide clinical treatment. [Meth‐ods]A total of 67 uremic patients with acute left heart failure in emergency department of our hospital from Jan. 2008 to Jan. 2014 were collected. The causes of acute heart failure were analyzed. The efficacy of hemodialysis was evaluated. The incidence of adverse reactions was investigated. [Results] The first cause of acute heart failure were hypervolemia (35. 8% ). Other causes was hypertension (15 cases, 22. 4% ), infections of lung or other organs (13 cases, 19. 4% ), a‐nemia(9 cases, 13. 4% ) and electrolyte imbalance(6 cases, 9. 0% ). Compared with before treatment, serum creatinine, urea nitrogen, carbon dioxide combining power, blood pressure, heart rate, respiration, mean arterial pressure and oxy‐gen saturation after treatment were improved, and there was significant difference between before and after treatment ( P<0. 01). Adverse reactions after treatment were mainly hypotension, and followed by sleep disorders, skin itching, loss of appetite and vomiting. [Conclusion]The etiology of uremia patients with acute left heart failure is complex. Hemodial‐ysis has certain efficacy, and can obviously improve the symptoms of patients, but also has multiple and complex adverse reactions which influences the medication experience of patients severely and should be handled precisely. Positive commu‐nication is needed.