血浆置换联合连续性血液净化与间歇性血液透析对尿毒症脑病疗效比较

Comparison of the effects of plasma exchange plus continuous blood purfication and intermittent hemodialysis on patients with serious uremic encephalopathy

目的:比较血浆置换联合连续性血液净化与间歇性血液透析治疗尿毒症脑病的疗效。方法:23例尿毒症脑病患者,14例行血浆置换联合连续性血液净化(Ⅰ组),9例行间歇性血液透析(Ⅱ组)治疗。观察病情缓解所需的时间、不良反应,以及透析前、透析后1,2,3,4 d清晨血肌酐、尿素氮、碳酸氢根离子及动脉血pH值的变化。结果:Ⅰ组患者1周内病情全部缓解,缓解率100%;Ⅱ组治疗1周缓解率仅37.5%;2周缓解率87.5%。Ⅰ组病情缓解平均时间(3.2±2.1)d;Ⅱ组(9.2±3.6)d,差异有统计学意义(P<0.01)。治疗期间Ⅰ组血肌酐、尿素氮、血碳酸氢盐、动脉血pH值波动小,组间比较差异无统计学意义(P>0.05);而Ⅱ组波动大(P<0.05)。Ⅱ组每日晨血肌酐、尿素氮均高于Ⅰ组,血碳酸氢根和动脉血pH值低于连续性血液净化组(P<0.05)。结论:治疗尿毒症脑病尤其是重症患者的疗效血浆置换联合连续性血液净化优于间歇性血液透析。

Objective To compare the efficacy of plasma exchange plus continuous blood purification and intermittent hemodialysis on patients with uremic encephalopathy. Methods Of 23 cases of uremic encephalopathy, 14 received plasma exchange plus continuous blood purification and 9 underwent intermittent hemodialysis. Serum creatinine, blood urea nitrogen, hydrocarbonic redical and arterial blood pH were detected in all patients before treatment and every morning after hemodialysis. Results The rate of efficacy in group Ⅰ was 100% within one week, and 37.5% in one week and 87.5% in two weeks in group Ⅱ.The average time of amelioration in group Ⅰ （3.2±2.1 days） was significantly shorter than that in group Ⅱ （9. 2±3.6 days）. The mean levels of daily morning serum creatinine, blood urea nitrogen, hydrocarbonic redical and arterial blood pH showed significant fluctuation in group Ⅱ , but no significant fluctuation in group Ⅰ. Conclusion Plasma exchange plus continuous blood purification is more effective for patients with uremic encephalopathy than intermittent hemodialysis, especially for those with severe uremic encephalopathy.