采用不同方式连续性肾脏替代疗法对中枢性高钠血症的疗效及预后分析

Efficacy and prognosis of different continuous renal replacement therapies for central hypernatremia

目的探讨采用连续性肾脏替代疗法（CRRT）治疗对中枢性高钠血症疗效及不同CRRT治疗模式对患者预后的影响。方法采用费森尤斯血液净化仪进行连续性静脉一静脉血液透析（CVVHD）、前稀释及后稀释连续性静脉一静脉血液滤过（CVVH）以及前稀释及后稀释连续性静脉一静脉血液透析滤过（CVVHDF），测定不同透析液和置换液流量下对62例中枢性高钠血症疗前后血钠及其纠正速度、等临床生化指标改变，并采用多因素回归分析不同治疗方案对患者预后的影响。结果与对照组相比，CRRT治疗组血钠达标率和死亡率差异均有统计学意义（P〈0．05）。采用不同CRRT治疗模式治疗后血钠、肌酐、血浆渗透压差异均有统计学意义（P〈0．05），但心率与平均动脉压差异无统计学意义（P〉0．05），不同模式治疗前后APACHEⅡ评分差异有统计学意义（P〈0．05）。采用CRRT治疗中枢性高钠血症患者生存率差异有统计学意义（P〈0．05），不同CRRT治疗模式对患者预后差异无统计学意义（P〉0．05）。结论CRRT治疗中枢性高钠血症安全有效，不同的CRRT治疗模式对患者预后差异无统计学意义。

Objective To investigate the efficacy of continuous renal replacement therapy （CRRT） in the treatment of central hypernatremia and evaluate the effect of different CRRT on prognosis. Methods Fresenius hemodialysis machine was employed to perform continuous veno-venous hemodialysis （CVVHD）, continuous veno-enous hemofiltration （CVVH）and continuous veno-enous hemodiafihration （CVVHDF） in predilution or postdilution mode. The changes of hyponatremia level, recovery speed and other biochemical indicators in 62 cases of central hypernatremia were determined at different dialysate and ultrafiltrate flow rate. Multivariate regression analysis was performed to explore the effect of different treatment options on the prognosis of patients. Results Compared with the patients who underwent conserva- tive treatment, the recovery of hyponatremia and mortality in patients who performred CRRT were significantly different（ P 〈 0.05 ）. In patients who underwent different types of CRRT, the differences of serum sodium, creatinine and plasma osmolality were significant, while the differences of heart rate and mean arterial blood pressure were not The APACHE lI scores in different types of CRRT were significantly different. Application of CRRT in central hypernatremia resulted in survival rate of patients with significant difference. Different CRRT did not have significant effects on the prognosis of central hypernatremia patients （ P 〉 0.05 ）. Conclusion CRRT is both safe and effective in the treatment of central hypernatremia, and different types of CRRT do not have significant influence on the prognosis of patients.