尿毒症透析患者心包炎的临床研究

Clinical research of pericarditis in patients under-going hemodialysis

本文回顾性分析了近５年中９６例行维持性血液透析的慢性肾衰患者临床资料。确诊心包炎者１３例，发生率为１４％，其中尿毒症性心包炎８例，透析相关性心包炎５例。前者与机体过度水负荷有关，与ＢＵＮ升高无关，低蛋白血症是尿毒症心包积液形成的辅因；后者与高β２微球蛋白（β２－ｍ）及中分子物质（ＭＭＳ）血症及肝素用量有关。尿毒症心包炎的治疗以限水、脱水、提高胶体渗透压及强化透析为主；血滤、血液透析滤过及减少肝素用量有助于治疗透析相关性心包炎；对大量顽固性血性心包积液者改用腹膜透析仍属必要。

his article retrospectively analyzed clinicaland laboratory data of 96 patients undergoinghemodialysis in recent five years. The resultsshowed the incidence of pericarditis was about14 % ,including 8 patients with uremic pericarditis, 5patients with dialysis-associated pericarditis. Theformer was related to fluid in the pathogenesis ofuremic pericarditis. The later was related to β_2 -m,MMS and dosage of heparin. The major treatmentsof uremic pericarditis were intensive dialysis ,dehy-dration and so on. Hemofiltration ,hemodialfiltrationand decreasing heparin dosage were beneficial todialysis-associated pericarditis , and replacement ofhemodialysis by peritoneal dialysis was essential tothe management of bloody pericardial effusion.