本文關(guān)鍵詞： 尿毒癥性腦病 連續(xù)性血液凈化 間歇性血液透析　出處：《吉林大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：背景及目的:尿毒癥性腦病(uremic encephalopathy,UE)是終末期腎臟病患者急性或亞急性的可逆性神經(jīng)精神癥狀,嚴(yán)重影響了患者的生活及生存質(zhì)量。尿毒癥性腦病的發(fā)病機(jī)制尚不完全明確�？赡芘c尿毒癥毒素、內(nèi)環(huán)境紊亂及藥物因素等有關(guān),其中某些大中分子物質(zhì)如PTH對UE發(fā)病起重要作用。尿毒癥性腦病的臨床表現(xiàn)多樣,早期表現(xiàn)為疲勞、乏力、理解力和記憶力減退等,隨著病情進(jìn)展,可出現(xiàn)躁動(dòng)或反應(yīng)淡漠、意識(shí)障礙等,重癥患者可表現(xiàn)為譫妄、昏迷、撲翼樣震顫等。尿毒癥性腦病的治療包括一般治療與病因治療,透析治療等。目前最常用的治療方法是血液凈化治療。本文通過觀察并比較連續(xù)性血液凈化與間歇性血液透析在治療尿毒癥性腦病中的優(yōu)劣,為尿毒癥性腦病的合理治療提供依據(jù)。方法:非隨機(jī)回顧性分析2012年01月至2016年12月期間我院收治的尿毒癥性腦病患者75例,均符合尿毒癥性腦病的診斷標(biāo)準(zhǔn),并排除其他原因所致的神經(jīng)精神疾病,其中50例行單純連續(xù)性血液凈化治療(CBP組),25例行單純間歇性血液透析治療(IHD組)。臨床資料均來自患者病歷記錄及透析記錄,包括性別、發(fā)病年齡、原發(fā)病、誘發(fā)因素、臨床表現(xiàn)、癥狀緩解所需時(shí)間、血液學(xué)及血清生化學(xué)檢驗(yàn)指標(biāo)、生命體征以及治療并發(fā)癥等。比較兩組患者癥狀改善所需時(shí)間、費(fèi)用,以及治療前后檢驗(yàn)指標(biāo)及生命體征的改變。結(jié)果:1兩組患者的性別、發(fā)病年齡、原發(fā)疾病構(gòu)成、誘發(fā)因素以及臨床表現(xiàn)之間的比較無統(tǒng)計(jì)學(xué)差異(P0.05)。2.CBP組的透析費(fèi)用及透析時(shí)間明顯高于IHD組(P0.05),好轉(zhuǎn)時(shí)間及痊愈時(shí)間明顯小于IHD組(P0.05)。3.治療后兩組患者的小分子毒素水平較治療前明顯下降(P0.05),IHD組的下降比例大于CBP組(P0.05);治療后CBP組患者的大中分子毒素水平較治療前明顯下降(P0.05)。4.治療后兩組的血磷水平較治療前明顯下降(P0.05)。5.CBP組的紅細(xì)胞、血紅蛋白、紅細(xì)胞比容及血小板水平較治療前明顯下降(P0.05)。6.CBP組的白蛋白水平較治療前明顯下降(P0.05)。7.治療中及治療后兩組的心率、血壓較治療前無明顯變化(P0.05)。8.CBP組透析中高血壓比例明顯高于IHD組(P0.05),而IHD組透析中低血壓比例明顯高于CBP組(P0.05)。結(jié)論:1.CBP治療癥狀緩解時(shí)間小于IHD治療,但耗費(fèi)高于IHD治療。2.CBP治療和IHD治療均能降低毒素水平,其中CBP治療的能力更佳,但可能影響其血象及營養(yǎng)指標(biāo)。3.本研究中CBP治療和IHD治療對患者的生命體征影響較小,但兩者在并發(fā)癥方面存在差異。
[Abstract]:Background and objective: uremic encephalopathy UEE is an acute or subacute reversible neuropsychiatric symptom in patients with end-stage kidney disease. The pathogenesis of uremic encephalopathy is not completely clear. It may be related to uremic toxin, internal environment disorder and drug factors, etc. Some of these molecules, such as PTH, play an important role in the pathogenesis of UE. The clinical manifestations of uremic encephalopathy are diverse, early symptoms such as fatigue, fatigue, lack of understanding and memory, etc., which may lead to restlessness or indifference with the progression of the disease. Severe patients may present with delirium, coma, fluttering tremor, etc. The treatment of uremic encephalopathy includes general treatment and etiological treatment. At present, the most commonly used treatment is blood purification therapy. This article observed and compared the advantages and disadvantages of continuous blood purification and intermittent hemodialysis in the treatment of uremic encephalopathy. Methods: 75 cases of uremic encephalopathy admitted in our hospital from January 2012 to December 2016 were analyzed retrospectively. All of them were in accordance with the diagnostic criteria of uremic encephalopathy. The neuropsychiatric diseases caused by other causes were excluded, of which 50 cases were treated with continuous blood purification therapy. 25 cases of CBP group were treated with intermittent hemodialysis alone and IHD group. The clinical data were obtained from the patient's medical records and dialysis records, including gender. Age of onset, primary disease, inducing factors, clinical manifestation, time for remission of symptoms, hematological and serum biochemical indicators, vital signs and treatment complications were compared between the two groups, and the time and cost of symptom improvement were compared between the two groups. Results the sex, age of onset, and composition of primary disease of the two groups of patients were analyzed before and after treatment. There was no statistical difference between the inducing factors and clinical manifestations. 2. The cost and duration of dialysis in CBP group was significantly higher than that in IHD group, and the improvement time and recovery time were significantly lower than that in IHD group. After treatment, the levels of large and medium molecular toxins in patients with CBP were significantly lower than those before treatment. After treatment, the levels of blood phosphorus in the two groups were significantly lower than those before treatment, and the levels of erythrocytes in the CBP group were significantly lower than those in the pre-treatment group. The levels of hemoglobin, erythrocyte volume and platelet were significantly decreased in CBP group than before treatment. 6. The albumin level in CBP group was significantly lower than that before treatment. The heart rate of the two groups during and after treatment was significantly lower than that before treatment. The percentage of hypertension in IHD group was significantly higher than that in IHD group, while the proportion of hypotension in IHD group was significantly higher than that in CBP group. Conclusion 1. But the cost was higher than that of IHD. 2.CBP and IHD could decrease the level of toxin, and the ability of CBP treatment was better, but it might affect the blood and nutrition index .3.In this study, the effect of CBP and IHD treatment on the vital signs of the patients was relatively small. But there were differences in complications between the two groups.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R692.5;R747.9

【相似文獻(xiàn)】

相關(guān)期刊論文 前10條

1 遲英;;尿毒癥性腦病的護(hù)理[J];中國社區(qū)醫(yī)師(綜合版);2006年05期

2 董艷娟;;尿毒癥性腦病[J];腦與神經(jīng)疾病雜志;2007年04期

3 溫月;溫怡;廖周誼;林麗;;尿毒癥性腦病的護(hù)理效果分析[J];西部醫(yī)學(xué);2009年12期

4 許正華;王淑艷;許正波;;尿毒癥性腦病患者危險(xiǎn)因素的特點(diǎn)分析及護(hù)理對策[J];中國醫(yī)藥指南;2013年16期

5 孟慶余;;尿毒癥性腦病[J];醫(yī)師進(jìn)修雜志;1986年05期

6 洪珍平;;29例尿毒癥性腦病患者臨床分析[J];中國實(shí)用神經(jīng)疾病雜志;2013年19期

7 房淑清,謝玉英,李宇虹;36例尿毒癥性腦病分析[J];黑龍江醫(yī)藥科學(xué);2002年06期

8 馬建,王新,黃智勇,李順德;43例尿毒癥性腦病的治療體會(huì)[J];西南國防醫(yī)藥;2003年03期

9 李碧蓮;;尿毒癥性腦病的臨床觀察與護(hù)理[J];現(xiàn)代中西醫(yī)結(jié)合雜志;2007年30期

10 徐旭軍;;影像學(xué)分析在尿毒癥性腦病中的應(yīng)用[J];西南軍醫(yī);2008年02期

相關(guān)會(huì)議論文 前1條

1 羅玉清;;血液透析聯(lián)合血液灌流治療尿素癥腦病12例臨床分析[A];全國第二屆中醫(yī)中西醫(yī)結(jié)合腎臟病臨床進(jìn)展學(xué)術(shù)研討會(huì)論文集[C];2007年

相關(guān)重要報(bào)紙文章 前1條

1 湖南省第二人民醫(yī)院 楊文;胡言亂語 不一定是精神病[N];大眾衛(wèi)生報(bào);2014年

相關(guān)碩士學(xué)位論文 前2條

1 曹坤;41例尿毒癥性腦病患者臨床特點(diǎn)分析[D];吉林大學(xué);2011年

2 李朝園;連續(xù)性血液凈化與間歇性血液透析治療尿毒癥性腦病的優(yōu)劣比較[D];吉林大學(xué);2017年

，

本文編號：1514202