紧急血液透析病因和预后分析

Analysis of the causes and prognosis of urgent hemodialysis

目的 探讨紧急血液透析的病因和预后 ,以及紧急血液透析的适宜时机。方法 回顾分析 1990年 1月 - 2 0 0 0年 12月收治的有完整病史记录的紧急透析病例 4 11例 (489例次 )。结果 紧急透析的病因中 ,以高血容量性心衰最多 (47.9% ) ,其次为严重氮质血症 (2 3.9% )、高钾血症 (14 .9% )、严重药物或毒物中毒 (5 .5 % )、尿毒症性脑病 (4.3% )、严重代谢性酸中毒 (3.5 % )。本组 4 11例患者死亡 72例 (17.5 % ) ,痊愈 131例 ,转为维持性透析191例 (46 .5 % ) ,因种种原因自动出院 17例 (4.1% )。本组 4 11例患者中因急性肾脏功能减退等急性疾病而伴有消化道出血者 89例 ,经过无肝素透析 ,其中 6 8例痊愈 ,5例死亡。结论 高血容量性心衰、严重氮质血症、高钾血症是紧急透析的主要原因 ,对存在这些主要病因的患者采用血液透析 ,病情大多可缓解。对高危出血的紧急透析患者 ,应用无肝素透析技术 ,可避免出血加重 ,而且多数患者可顺利接受无肝素透析。对有紧急透析指征的患者 ,尤其是急性肾功能衰竭患者 ,应予早期预防性透析 ,这既有利于原发病的治疗 ,又预防了并发症的发生 ,从而提高了生存率。

Objectives To study about the causes and the prognosis of urgent hemodialysis and how to choose the suitable time of urgent hemodialysis.Methods Recollect and analyze 411 cases(489 times) of emergent hemodialysis with complete reccords of the disease treatment in my hospital from January 1990 to December 2000.Results Of all the causes of emergent hemodialysis,hypervotemia is the most frequency(47.9%) as well as serious azotemia(23.9%),hyperpotassaemia(14.9%),serious drug or poison intoxication(5.5%),uremic encephalopathy(4.3%) and serious metabolic acidosis(3.5%).Among the 411 cases,72 of them(17.5%) have died,131(31.9%) recovered,191(46.5%) maintained hemodialysis and 17(4.1%) left the hospital of their own record for certain reasons.89 of 411 cases suffered from such diseases as acute renal failure accompanied by hemorrhage of digestive tract;Among the 89 cases,68 of them have recovered and 5 died by hemodialysis without heparin.Conclusions The urgent hemodialysis mainly deals with the hypervotemia,serious azotemia and hyperpotassaemia caused by all kinds of diseases.The patients adopted hemodialysis because of the causes of urgent hemodialysis and most of them could get recovered.By using hemodialysis without heparin,the patients with the signs of high dangerous hemorrhage could avoid doubling hemorrhage and most of them could accept it.This kinds of patients,especially with acute renal failure,should be given preventive hemodialysis as soon as possible.This is available not only to the treatment of primary diseases but also to prevention of the occurrence of complications and the survival rate of patients will increase.