肾综合征出血热并发低钠性脑水肿临床特征及甘露醇联合高钠血液透析疗效分析

Analysis of clinical features of patients with hemorrhagic fever with renal syndrome complicating hyponatremia eneephaledema and therapeutic effect of manicol and high sodium hemodialysis

目的分析肾综合征出血热（HFRS）并发低钠性脑水肿患者临床特征，并观察甘露醇联合高钠血液透析治疗的疗效。方法83例HFRS并发低钠性脑水肿患者随机分为高钠透析组41例和对照组42例，比较两组患者治疗后血清钾、钠、氯、肌酐和渗透压的水平以及血钠复常率、复常时间和病死率。采用t或X^2检验进行统计学分析。结果高钠透析组患者治疗后血钠、氯、渗透压分别为（128．9±7．3）mmol／L、（96．7±6．2）mmol／L、（253．1±7．5）mOsm／L，明显高于对照组的（117．8±7．1）mmol／L、（92．2±6．9）mmol／L、（242．1±8．4）mOsm／L（t=7．14，t=3．12，t=15．22；均P〈O．05）。19例中度低钠性脑水肿高钠透析组和19例对照组患者血钠复常例数分别为12例和6例（X^2=3．867，P=0．049），两组血钠复常时间分别为（4．9±1．3）d和（8．3±1．9）d（t=6．438，P=0．001）。14例重度低钠性脑水肿高钠透析组和14例对照组患者血钠复常例数分别为7例和2例（X^2=4．094，P=0．043），两组血钠复常时间分别为（7．8±1．9）d和（11．6±2．8）d（t=3．235，P=0．034）。高钠透析组病死率为36．6％（15／41例），明显低于对照组的61．9％（26／42例）（X^2=5．321，P=0．021）。结论HFRS并发低钠性脑水肿患者病情严重，甘露醇联合高钠血液透析治疗能有效地提高中、重度低钠性脑水肿患者血钠复常率，缩短复常时间，降低病死率。

Objective To study the clinical features of patients with hemorrhagic fever with renal syndrome （HFRS） complicating hyponatremia encephaledema and therapeutic effect of manicol and high sodium hemodialysis. Methods Eighty-three patients with HFRS complicating hyponatremia encephaledema were randomly divided into high sodium hemodialysis treatment group （n= 41） and control group （n= 42）. The serum levels of potassium, sodium, chlorine, creatinine, osmotic pressure, normalization rates and normalization time of serum sodium, mortality of patients in two groups post-treatment were compared. Statistical analysis was performed using t test or chi square test. Results The serum levels of sodium [（128. 9±7.3） mmol/L], chlorine [（96. 7±6. 2） mmol/L], osmotic pressure [（253. 1±7. 5） mOsm/L] of patients post-treatment in high sodium hemodialysis treatment group were all significantly higher than those [（117. 8±7. 1） mmol/L], [（92.2!6.9） mmol/L], [（242. 1±8. 4） mOsm/L] of patients in control group （t=7.14, t= 3. 12, t 15.22, respectively; all P〈0.05）. The serum sodium normalization number of patients （12/19 cases） with moderate encephaledema in high sodium hemodialysis treatment group was significantly higher than that （6/19 eases） in control group （X2= 3. 867, P = 0. 049）. The serum sodium normalization time of patients with moderate encephaledema in high sodium hemodialysis treatment group was （4.9±1. 3） d, which was significantly shorter than that [（8. 3 ± 1. 9） d] in control group （t = 6. 438, P = 0. 001）. The serum sodium normalization number of patients （7/14 cases） with severe encephaledema in high sodium hemodialysis treatment group was significantly higher than that （2/14 cases） in control group （X2= 4. 094,P=0. 043）. The serum sodium normalization time of patients with severe encephaledema in high sodium hemodialysis treatment group was （7.8 ± 1.9） d, which was significantly shorter than that E（ll. 6!2.8） d] in control group （t=3. 235,P= 0. 034）. The mortality in high sodium hemodialysis treatment group was 36.6% （15/41 cases）, which was significantly lower than that （61.9%, 26/42 cases） in control group （X2=5.321, P〈0.021）. Conclusions The conditions of patients with HFRS complicating hyponatremia encephaledema tend to be severe. In patients with HFRS complicating moderate or severe encephaledema, manicol and high sodium hemodialysis can improve the normalization rate and normalization time of serum sodium, and reduce the mortality.