连续性血液净化治疗危重症合并高钠血症疗效观察

Observation of curative effect of continuous blood purification on critical patients with hypernatremia

目的探讨连续性血液净化(CBP)治疗在危重症合并高钠血症患者中的应用价值。方法分析21例ICU病房行CBP治疗的危重症合并高钠血症患者资料,观察CBP前后血钠变化及病情转归、血钠浓度及纠正速度、渗透压及急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ评分)的变化。结果 21例高钠血症患者总病死率为62%(13/21),其中颅脑疾病合并高钠血症患者病死率为77%(10/13)。死亡组中血钠水平中重度增高者占69%(9/13),存活组中血钠水平中重度增高者占38%(3/8)。死亡组CBP前血钠水平和高血钠的持续时间及APACHEⅡ评分均较存活组明显升高(P<0.01)。CBP治疗期间血清钠每日下降11.6 mmol/L,血钠纠正速度为0.88 mmol/(L.h)。所有患者经CBP治疗后血清钠和渗透压明显下降,APACHEⅡ评分改善(P<0.01)。结论危重症合并高钠血症患者CBP治疗前血钠水平越高,持续时间越长,预后越差。CBP治疗高钠血症安全有效,尤其对颅脑疾病合并高钠血症患者应尽早实施。

Objective It is to explore the application value of continuous blood purification（CBP） for critical patients with hypernatremia.Methods Twenty-one critical patients with hypernatremia in ICU were treated with CBP.We observed the changes of serum sodium concentration,serum osmolarity and the acute physiology and chronic health evaluation Ⅱ（APACHE Ⅱ） scores before and after CBP.Results The mortality rates was 62%（13/21）,and the mortality of craniocerebral diseases with hypenatremia was 77%（10/13）.The rate of moderate and severe hypernatremia in the death group was 69%（9/13）,and the rate in survival group was 38%（3/8）.Before CBP,the serum sodium concentration and APACHE Ⅱ scores were significantly higher in the death group than that in the survival group（P0.01）.Serum sodium concentration decreased 11.6 mmol/L per day and the rate of the serum sodium change was 0.88 mmol/L per hour.After CBP,the serum sodium and serum osmolarity decreased,and APACHE Ⅱ scores were improved in al1 patients（P0.01）.Conclusion The higher the serum sodium concentration and the longer the persistence time of high sodium concentration,the worse prognosis in critical patients with hypernatremia before CBP.CBP is safe and effective for critical patients with hypernatremia,and should be applied as quickly as possibly,especially in craniocerebral diseases with hypernatremia.