本文選題：血液濾過 + 血液灌流��； 參考：《山東大學(xué)》2014年碩士論文

【摘要】：目的：探討血液灌流聯(lián)合血液濾過治療慢性腎臟病腦病患者臨床效果。 方法：選取2010年10月-2013年10月30例在我院腎臟內(nèi)科以靜脈內(nèi)瘺或半永久長期留置管進(jìn)行規(guī)律血液透析治療的慢性腎臟病患者并尿毒癥腦病的患者,其中男性18例,女性12例。所有入選患者在住院診療期間,顱腦CT、MRI、腦電圖等檢查,排除腦血管意外、癲癇等中樞神經(jīng)系統(tǒng)疾病,并且患者既往無腦外傷及中樞性神經(jīng)系統(tǒng)疾病,診斷為慢性腎臟病相關(guān)性腦病。所有患者格拉斯哥評(píng)分標(biāo)準(zhǔn)低于7分,昏迷超過6小時(shí)。所用入選患者按照隨機(jī)化原則隨機(jī)分組為：對(duì)照組和干預(yù)組,對(duì)照組12例,予以常規(guī)血液透析(Hemodialysis,HD)治療(3次/周),干預(yù)組18例,采用常規(guī)血液透析(3次/周)以外,同時(shí)加用每周兩次的血液濾過(Continuous venovenous hemoftltration,HDF)聯(lián)合血液灌流(Hemoperfusion HP)治療。觀察兩組在治療后第4周、6周、8周及3個(gè)月時(shí)的血壓、尿素氮、肌酐、甲狀旁腺素、β2-微球蛋白的變化及運(yùn)用格拉斯哥評(píng)分對(duì)患者治療前后的意識(shí)狀況進(jìn)行比較。對(duì)兩組患者腎臟替代治療天數(shù)及死亡率進(jìn)行分析,評(píng)價(jià)血液濾過聯(lián)合血液灌流治療尿毒癥腦病的效果。 結(jié)果： 1.治療3個(gè)月后干預(yù)組血壓較治療前明顯下降(15-30mmHg)(P0.05)、尿素氮(BUN)、肌酐(Cr)較前明顯下降(P0.05),格拉斯哥評(píng)分明顯改善. 2.對(duì)照組治療后血壓較前明顯下降(P0.05)、尿素氮(BUN)、肌酐(Cr)較前明顯下降(P0.05)格拉斯哥評(píng)分減低無明顯意義. 3.兩組治療后甲狀旁腺素(PTH)、β2-微球蛋白水平無統(tǒng)計(jì)學(xué)差異.4.兩組患者在治療后低血壓、高鉀血癥和急性呼吸窘迫綜合征(Adult respiratory distress syndrome ARDS)危險(xiǎn)事件的發(fā)生率無統(tǒng)計(jì)學(xué)差異. 5.治療后干預(yù)組中11例患者(61.11%)神志完全恢復(fù),4例患者(22.22%)發(fā)生神志延遲恢復(fù),3例轉(zhuǎn)其他醫(yī)院繼續(xù)治療。其神志恢復(fù)的發(fā)生率(61.11%)明顯高于對(duì)照組(12.98%),具有統(tǒng)計(jì)學(xué)意義(x2=1.594,P=0.042)。 結(jié)論：血液濾過聯(lián)合血液灌流治療尿毒癥腦病效果顯著,對(duì)于改善尿毒癥腦病生活質(zhì)量,減少并發(fā)癥的發(fā)生起到重要作用,值得臨床推廣
[Abstract]:Objective: to investigate the clinical effect of hemoperfusion combined with hemofiltration in the treatment of chronic kidney disease and encephalopathy. Methods: from October 2010 to October 2013, 30 patients with chronic kidney disease and uremic encephalopathy were treated with venous fistula or semi-permanent long-term indwelling catheter in our hospital, including 18 males and 12 females. During the period of hospitalization, all patients were excluded from cerebrovascular accidents, epilepsy and other central nervous system diseases, and no brain trauma and central nervous system diseases were found in the past. Diagnosis of chronic kidney disease associated encephalopathy. All patients had a Glasgow score below 7 and coma for more than 6 hours. According to the principle of randomization, the selected patients were randomly divided into two groups: control group (n = 12), and control group (n = 12). They were treated with routine hemodialysis (HD) for 3 times per week, and the intervention group (n = 18, with routine hemodialysis for 3 times per week). Meanwhile, continuous venovenous hemofiltration combined with hemoperfusion was given twice a week. The changes of blood pressure, urea nitrogen, creatinine, parathyroid hormone and 尾 _ 2-microglobulin were observed at the 4th week, 6th week, 8th week and 3rd month after treatment, and the consciousness status of the patients before and after treatment were compared with Glasgow score. The days and mortality of renal replacement therapy were analyzed to evaluate the effect of hemofiltration combined with hemoperfusion on uremic encephalopathy. Results: 1. After 3 months of treatment, the blood pressure of the intervention group was significantly lower than that of the pre-treatment group (P 0.05), the urea nitrogen bun, creatinine Cr were significantly lower than before, and the Glasgow score was obviously improved. 2. In the control group, the blood pressure was significantly lower than before (P 0.05), urea nitrogen bun, creatinine (Cr) was significantly lower than that before treatment (P 0.05) the Glasgow score was not significantly decreased. 3. There was no significant difference in PTH, 尾 2-microglobulin levels between the two groups after treatment. There was no significant difference in the incidence of respiratory distress syndrome ARDS) risk events between the two groups in terms of hypotension, hyperkalemia and acute respiratory distress syndrome (ARDS). 5. In the intervention group, 11 cases (61.11) were completely recovered and 4 cases (22.22%) had delayed recovery. 3 cases were transferred to other hospitals for further treatment. The incidence of mental recovery (61.11) was significantly higher than that of the control group (12.98%), with statistical significance of 1.594% (P < 0.01) and 0.042% (P < 0.05). Conclusion: hemofiltration combined with hemoperfusion is effective in the treatment of uremic encephalopathy, which plays an important role in improving the quality of life of uremic encephalopathy and reducing the occurrence of complications. It is worth popularizing in clinic.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R692.5;R747.9

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