尿毒症合并脑出血无肝素序贯血液透析治疗效果观察

Effectiveness Observation of Sequential Hemodialysis without Heparinum in Treatment of Uremia Complicated by Intracerebral Hemorrhage

目的观察无肝素序贯血液透析治疗尿毒症合并脑出血的临床效果。方法将我院收治的尿毒症合并脑出血40例随机分为无肝素序贯血液透析组和单纯无肝素血液透析组各20例,观察两组脑出血疗效,于发病24 h内及发病后3、7、14 d测定白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)和超敏C反应蛋白(hs-CRP),发病24 h内及发病后7、14 d测量脑血肿和水肿体积、计算心包积液超声检查评分。结果无肝素序贯血液透析组发病后3、7、14 d IL-6、TNF-α、hs-CRP值及发病后7、14 d脑血肿体积、脑水肿体积、心包积液超声检查评分均低于单纯无肝素血液透析组,差异均有统计学意义(P<0.05);脑出血治疗有效率高于单纯无肝素血液透析组,差异亦有统计学意义(P<0.05)。结论无肝素序贯血液透析治疗尿毒症合并脑出血效果优于单纯无肝素血液透析治疗,且并发症相对较少。

Objective To observe the clinical effect of sequential hemodialysis without heparinum in treatment of ure-mic complicated by intracerebral hemorrhage. Methods A total of 40 patients with uremic complicated by intracerebral hemor-rhage were randomly divided into 2 groups. Group A（n=20）underwent sequential hemodialysis without heparinum,and group B（n=20）received traditional hemodialysis without heparinum. In the two groups,curative effects of intracerebral hemorrhage were observed,and values of interleukin-6（IL-6）,tumor necrosis factor-α（TNF-α）and high sensitivity C-reactive protein （ hs-CRP）were detected within 24 h of invasion and 3 d,7 d and 14 d after invasion. Cephalophyma and dropsy volumes and ultrasonography scores of pericardial effusion were also detected within 24 h of invasion and 7 d and 14 d after invasion. Results Values of IL-6,TNF-α and hs-CRP 3 d,7 d and 14 d after invasion,cephalophyma and dropsy volumes and ultrasonography scores of pericardial effusion 7 d and 14 d after invasion in group A were significantly lower than those in group B（P﹤0. 05）;the therapic effective rate of intracerebral hemorrhage in group A was also significantly higher than that in group B（P﹤0. 05）. Conclusion The clinical effect of sequential hemodialysis without heparinum in treatment of uremic complicated by intracere-bral hemorrhage is better with less complications than those by traditional hemodialysis without heparinum.