连续血液滤过联合甘露醇治疗颅内高压合并肾功能衰竭的临床研究

Mannitol combined with continuous hemofiltration in the treatment of intracranial hypertensive patients with renal failure

目的探讨连续血液滤过联合甘露醇在颅内高压合并肾功能衰竭治疗中的应用价值。方法对珠江医院重症医学科收治的9例颅内高压合并肾功能衰竭患者行2～3次连续血液滤过联合甘露醇治疗，监测治疗前后患者颅内压数值、血肌酐及胱抑素浓度。结果在应用连续血液滤过联合甘露醇治疗后，患者颅内压数值较治疗前明显降低，血肌酐及胱抑素浓度较治疗前明显下降，差异有统计学意义（P〈0．05）。1例脑干出血患者于治疗第2天死于多器官功能衰竭，其余8例患者均未出现脑疝，平稳渡过脑水肿高峰期。结论连续血液滤过联合甘露醇是一种快速有效的治疗颅内高压合并肾功能衰竭的方法。

Objective To explore the effect of continuous venovenous hemofiltration （CVVH） combined with intravenous injection of mannitol in the treatment of intracranial hypertensive patients with renal failure. Methods Nine intracranial hypertensive patients with renal failure from ICU of our hospital were treated with 2-3 times of CVVH combined with intravenous injection of mannitol; their non-invasive intracranial pressure, serum creatinine and cystatin concentrations before and after the treatments were monitored. Results The difference of intracranial pressure was statistically significant before and after CVVH （P〈0.05）, so were the values of serum creatinine and cystatin before and after CVVH （P〈0.05）. One patient with brain stem hemorrhage died from multiple organ failure 2 d after the treatment, and the other 8 patients all smoothed out the rush hours of brain edema without cerebral hernia. Conclusion CVVH combined with intravenous injection of mannitol is a kind of effective treatment for intracranial hypertensive patients with renal failure.