联机腹水浓缩回输在尿毒症顽固性腹水中的应用

Online ascites reinfusion through extracorporeal condensing method in uremia patients with refractory ascites

目的 探讨联机腹水浓缩回输对尿毒症顽固性腹水的疗效及安全性。方法 对 16例维持性血液透析伴有顽固性腹水的患者 ,在血液透析的过程中将腹水引流到血透体外循环 ,同步进行腹水超滤、浓缩回输静脉 ,并观察治疗前后体重、腹围、尿量、腹水B超探测值改变情况以及测定血浆白蛋白、肾功能、电解质水平。每次治疗量 30 0 0～ 6 0 0 0ml,共计 5 2例次。结果 腹水回输治疗后与治疗前比较 ,患者腹围、体重有明显下降 ,B超探测腹水量减少 ,尿量明显增加 ,血浆白蛋白含量显著增加 (P均 <0 0 1) ,而血清电解质水平无明显 (P >0 0 5 )。血清肌酐和尿素氮的下降率分别达到 5 2 16 %± 6 32 %和 5 8 93%± 7 5 1%。不良反应有热源反应 5例次 ,血性腹水 3例次 ,滤器部分堵塞报警及一过性心力衰竭各 2例次 ,仅需一般性对症处理即可纠正 ,治疗过程未影响。结论 血液透析和腹水回输同步进行可达到腹水浓缩回输和清除代谢产物的双重效果 ,操作安全 。

Objective To explore the effectiveness and safety of online ascites reinfusion through extracorporeal condensing method in uremia patients with refractory ascites.Methods Reinfusion of condensed ascites to the extracorporeal circulation ultrafiltration was used in 16 hemodialysis uremia patients with refractory ascites.The changes in body weight,abdominal circumference,urine volume and B ultrasound detected value were observed before and after the treatment.The plasma albumin,renal function and electrolyte level were measured.The volume of each treatment was 3000～6000ml,52 times in total.Results After the reinfusion of the ascites,body weight,abdominal circumference and B ultrasound detected value decreased significantly,urine volume and plasma albumin increased significantly(P<0.01),and there was no significant difference of blood serum electrolyte level(P>0.05).The decrease rate of Cr and BUN reached 52.16%±6.32% and 58.93±7.51%.Complications included:fever 5/52,hemoascites 3/52,part blockage of the filter 2/52 and heart failure 2/52.All of the complications were corrected only by the routine methods,and did not affect the treatment.Conclusion With this method,hemodialysis and reinfusion of ascites could be performed at the same time,which provides the dual-effect of ascites effusion and elimination of nitrogen production.It is safe and effective in treating patients with refractory ascites and has good clinical value.