摘要
目的探讨间歇性血液透析(IHD)联合10%高渗盐水治疗慢性肾衰竭合并大容积脑出血的疗效。方法选择2015年1月至2018年12月灌云县人民医院慢性肾衰竭合并大容积脑出血患者62例,分为对照组30例,观察组32例,均予以常规内科治疗方法,6~24h予以微创穿刺引流术(MIDP)。术后第2天进行IHD,每日1次,观察组在IHD时加用10%高渗盐水治疗,记录比较术后首次IHD开始及结束时的美国国立卫生院神经功能缺失评分(NIHSS)、颅内压(ICP)、血浆晶体渗透压、血浆钠离子水平;组内比较IHD前及IHD后的NIHSS评分、ICP、血浆晶体渗透压、血浆钠离子水平;观察高渗盐水的不良反应。结果术后第2天,IHD后,观察组的NIHSS评分、ICP明显低于对照组,差异有统计学意义(P<0.05),血浆晶体渗透压值、血浆钠离子水平高于对照组,差异有统计学意义(P<0.05)。与IHD前比较,观察组的NIHSS评分、ICP水平有所增高,但差异无统计学意义(P>0.05),血浆钠离子水平增高,差异有统计学意义;对照组的NIHSS评分、ICP水平较IHD前增高,差异有统计学意义(P<0.05),血浆晶体渗透压较IHD前降低,差异有统计学意义(P<0.05);观察组患者未出现明显不良反应。结论IHD联合10%高渗盐水治疗可以减轻IHD治疗对大容积脑出血患者神经功能缺失症状和ICP的影响,且无明显不良反应。
Objective To observe the efficacy of intermittent hemodialysis(IHD)combined with 10%hypertonic saline on chronic renal failure with large volume intracerebral hemorrhage.Methods A total of 62 patients of chronic renal failure with large-volume intracerebral hemorrhage were divided into two groups:the control group(30 cases)and the observation group(32 cases).Both groups were given routine medical treatment,and minimally invasive puncture and drainage(MIDP)were performed at 6-24 hours.IHD was performed on the 2 rd day after operation with once a day.The observation group was treated with 10%hypertonic saline during IHD.National Institutes of Health Stroke Scale(NIHSS),intracranial pressure(ICP),plasma crystalline osmotic pressure and plasma sodiumion level were recorded and compared at the beginning and end of the first IHD.NIHSS score,ICP,plasma crystal osmotic pressure and plasma sodiumion level before and after IHD were compared within the group,and the adverse reactions of hypertonic saline were observed.Results On the 2 rd day after operation,after IHD,the NIHSS score and ICP in the observation group were significantly lower than those in the control group(P<0.05),the plasma crystalloid osmotic pressure and plasma sodiumion level were higher than those in the control group(P<0.05).Compared with those before IHD,the NIHSS score and ICP level in the observation group were higher,but there was no significant difference(P>0.05),the plasma sodium ion level in the observation group increased,and the difference was statistically significant(P<0.05).The NIHSS score and ICP level in the control group were higher than those before IHD,the difference was statistically significant(P<0.05),and the plasma crystal osmotic pressure was lower than that before IHD,the difference was statistically significant(P<0.05).And there was no significant adverse reaction in the observation group.Conclusion IHD combined with 10%hypertonic saline could alleviate the effects of IHD on neurological deficit symptoms and ICP in patients with large-volume intracerebral hemorrhage,and without obvious adverse reactions.
作者
付怀栋
周明
刘敏华
FU Huaidong;ZHOU Ming;LIU Minhua(Department of Critical Care Medicine,Huishan Traditional Chinese Medicine Hospital,Wuxi Jiangsu 214177,China;Department of Internal Medicine,Guanyun County People's Hospital,Lianyungang,Jiangsu 222200,China)
出处
《重庆医学》
CAS
2020年第10期1660-1663,共4页
Chongqing medicine
关键词
肾功能不全
脑出血
肾透析
颅内压
神经功能缺失
renal insufficiency
cerebral hemorrhage
renal dialysis
intracranial pressure
neurological functional deficit
