连续性静脉-静脉血液滤过治疗脑损伤后高钠血症的探讨

The approach about continuous veno-venous hemofiltration treatment for hypernatremia the brain injured patients

目的探讨连续性静脉-静脉血液滤过(CVVH)治疗对脑损伤后高钠血症的疗效。方法2005年1月至2007年12月收治的23例重型脑损伤合并高钠血症患者,行CVVH治疗。结果48h后血钠、肌酐、血渗量明显下降(P<0.01),HCO3-浓度上升,CVVHF治疗后APACHEⅡ评分明显低于治疗前(P<0.01);随着治疗时间的延长,血钠浓度逐渐降低,与治疗前比较差异有统计学意义(P<0.01);4例死亡,均死于不可逆的脑疝,治疗中未发现有明显的副反应。结论CVVH能有效迅速地降低脑损伤后高钠血症患者的血钠浓度。同时能够改善严重高钠血症患者的预后。对于合并轻度高钠血症患者的预后,尚难以定论。

Objective To investigate the effect of continuous veno-venous hemofihration（CVVHF） for the brain injured（ BI） patients＇ hypernatremia. Methods 23 serious brain injured patients with hypernatremia were treated with CVVHF. Results After the patients were treated with CVVHF for48 hours,The serum sodium concentration, creatinine, osmolarity and the APACHE Ⅱ scores decreased significantly （P 〈 0.01 ）, HCO3 concentration significantly improved; the serum sodium concentration decreased gradually and had significant difference compared with that before CVVHF; Among the 23 patients,4 patients succumbed to inconvertible cerebral hernia. During CVVHF, significant side reactions still hadn＇ t beendetected. Conclusion For the BI patients＇ hypernatremia, CVVHF is effective in decreasing the serum sodium concentration. It can improve the serious hypernatremia patients＇ prognosis,but, to the relative slighter hypernatremia patients＇ prognosis,its effect is still unknown for us.