尿毒症血液透析病人不典型脑缺血病变的临床分析

Clinical analysis of atypical cerebral ischemia in uremia patients receiving blood dialyzation

目的探讨尿毒症血液透析病人不典型缺血性脑病变的临床特点，以引起临床注意，利于早期诊断，及时治疗．方法回顾性分析14例经颅脑CT、经颅多普勒脑血流（TCD）检查证实的尿毒症血液透析病人不典型脑缺血病变的临床特点．结果血透过程中，干体重测试不佳，超滤过多，血压降低，血脂、血糖升高，使血粘度增加，血液浓缩是引发脑缺血性病变的原因；病人发生行走不稳、吞咽呛咳、意识一过性障碍等表现；脑CT、脑TCD检查证实。结论尿毒症血液透析病人不典型脑缺血临床表现少见，发病隐匿，易被疏忽，延误治疗；血粘度增高、血压偏低，引起低灌注，是该病的发病机制；病人存在着脑卒中的风险，降低了血透病人的生活质量，增加了死亡率。

Objective Uremia blood dialyzation patients have the clinical performance when their brains are atypically cerebral iscbemia such as unstable walking, chocking and coughing while swallowing, temporary consciousness obstacle etc. These symptoms should be noticed as early as possible so that the patients can get diagnosis and therapy in time. Method After reviewing and analyzing the sufferers＇ clinical symptoms from fourteen cases, we find that brain CT and TCD can be used to diagnoseatypical cerebral ischemia. Result When doing the blood dialyzation, if the result of net weight test is not good, or there exists hyper filtration, low blood pressure, increasing blood fat and blood sugar, we can use brain CT and brain TCD to diagnose the case. Conclusion The clinical symptoms of atypical cerebral ischemia are rarely found. Since the symptoms are concealing, they are tend to be neglected. In these cases, patients may be delayed to get therapy. The cases may follow the rules like this： blood viscosity increases with low blood pressure, which causes low perfusion. The brain consumes less oxygen and the patient may suffer the risk of brain apoplexy. This risk lower patients＇ life quality and increase the death rate.