连续性静脉-静脉血液滤过与血液透析治疗尿毒症脑病的疗效对比

Comparison of the effects between continuous veno-venous hemofiltration and hemodialysis on patients with uremic encephalopathy

目的比较连续性静脉-静脉血液滤过(CVVH)与血液透析(HD)治疗尿毒症脑病患者的疗效。方法 45例慢性肾衰竭并发尿毒症脑病的患者,33例行CVVH治疗(CVVH组),12例行常规HD治疗(HD组)。观察患者疗效以及治疗前、后平均动脉压(MAP)、心率、电解质水平、肾功能、血浆渗透压、β2微球蛋白(β2-MG)浓度、碳酸氢根离子(HCO3-)及血pH值的变化,并进行急性生理和慢性健康状态评分Ⅱ(APACHEⅡ)评分比较。结果治疗后CVVH组的疗效好于HD组(P<0.05);治疗后CVVH组患者血浆渗透压、MAP、心率、肾功能、血pH值、HCO3-波动小,与治疗前比较差异无统计学意义(P>0.05);而HD组在透析后血浆渗透压、MAP、心率、肾功能、血pH值、HCO3-浓度波动大,与治疗前比较差异有统计学意义(P<0.05);治疗后CVVH组β2-MG浓度、APACHEⅡ评分与HD组患者比较明显下降,差异有统计学意义(P<0.01)。结论 CVVH能很好清除尿毒症毒素,可以稳定、持续纠正电解质紊乱和酸碱失衡,其治疗尿毒症脑病的疗效明显优于HD。

Objective To compare the therapeutic efficiency between veno-venous hemofiltration（CVVH） and hemodialysis（HD） on patients with uremic encephalopathy.Methods Employed 45 patients of chronic renal failure with uremic encephalopathy,33 received CVVH therapy,12 received HD therapy.In all patients,the curative effect,mean artery pressure（MAP）,heart rates,serum electrolyte levels,serum beta 2-mciroglobulin（β2-MG）level,HCO3-level,renal function,plasma osmotic pressure,pH value and APACHEⅡ score were observed before and after therapy.Results Before therapy,the change of heart rates,mean artery pressure,pH value,β2-MG and osmotic pressure were not significant difference between CVVH and HD group（P0.05）.After therapy,the curative effect of CVVH group was better then that of HD group（P0.05）.Compared with before therapy,serum electrolyte level,MAP,heart rates,renal function,pH value and HCO3-level were obvious difference in CVVH group after therapy.However,compared with before therapy,serum electrolyte level,MAP,heart rates,renal function,pH value and HCO3-level were obvious difference in HD group after therapy.After therapy,serum β2-MG level and APACHEⅡ score in CVVH group had significant difference between CVVH and HD group（P0.05）.Conclusion CVVH therapy can remove stably uremia toxin,correct turbulence of acid-alkali and electrolyte.CVVH therapy is a more effective measure for patients with uremic encephalopathy than HD.