紧急血液净化原因和预后分析

Analysis of the causes and prognosis of urgent blood purification

目的 了解紧急血液净化的原因和预后 ,探讨紧急血液净化的适宜时机。方法 回顾 1990年 1月 -2 0 0 3年 12月共收治有完整病史记录的紧急血液净化病例 6 31例 (716例次 )。结果 紧急血液净化原因以高血容量性心衰最多 (4 9.9% ) ,严重氮症血症 (2 4 .0 % ) ,高钾血症 (16 .6 % ) ,严重代谢性酸中毒 (5 .3% ) ,尿毒症性脑病(4 .5 % ) ,严重药物或毒物中毒 (3.8% )。本组 6 31例患者死亡 91例 (占 14 .4 % )。痊愈 176例 (占 2 7.9% ,均为急性肾功能衰竭 ,其中 76例伴有消化道出血 ) ,转为维持性血液净化 2 95例 (占 4 6 .8% ) ,因种种原因自动出院 30例 (占4 .8% )。本组 6 31例患者中因急性肾功能减退等急性疾病而伴有消化道出血者 10 3例 ,经过无肝素血液净化 ,其中76例痊愈 ,8例死亡。结论 高血容量性心衰、严重氮症血症、高钾血症是紧急血液净化的主要原因 ,对存在这些主要原因的患者采用血液净化 ,病情大多可缓解。对高危出血的紧急血液净化患者 ,应用无肝素血液净化技术 ,可避免出血加重 ,而且多数患者可顺利接受无肝素血液净化。对有紧急血液净化指征的患者 ,尤其是急性肾功能衰竭患者 ,应予早期预防性血液净化 ,这既有利于原发病的治疗 ,又预防了并发症的发生 ,从而提高了生存率。

Objective To know about the causes and the prognisos of urgent blood purification and how to choose the suitable time of urgnet blood purification.Methods Recollect and analyze 631 cases(716 times) of emergent blood purification with complete records of history of the disease treatment in my hospital from January 1990 and December 2000.Results Of all the causes of emergent blood purification,hypervotemia is the most frequency(49.9%) as well as serious azotemia(24.0%),hyperpotassaemia(16.6%),serious metabolic acidosis well as serious azotemia(24.0%),hyperpotassaemia(16.6%),serious metabolic acidosis(5.3%),uremic encephalopathy(4.5%),and serious drug or poison intoxication(3.8%).Among the 631 cases,91 of them(14.4%) have died,176(27.9%) recovered,295 (46.8%) maintained blood purification and 30(4.8%) left the hospital of their own record for certain reasons.103 of 631 cases suffered from such diseases as acute renal failure accompanied by hemorrhage of digestive tract;Among the 103 cases,76 of them have recovered and 8 died by blood purification without heparin.Conclusion The urgent blood purification mainly deals with the hypervotemia,serious azotemia and hyoerpotassaemia caused by all kinds of diseases.The patients adopted blood purification because of the causes of urgent blood purification and most of them could get recovered.By using blood purification without heparin,the patients with the signs of high dangerous hemorrhage could avoid doubling hemorrhage and most of them could accept it.This kinds of patients,especially with acute renal failure,should be given preventive blood purification as soon as possible.This is available not only to the treatment of primary diseases but also to prevention of the occurrence of complications and the survival rate of patients will increase.