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目的观察连续性静脉-静脉血液滤过治疗尿毒症脑病的作用。方法选取我院收治的尿毒症脑病患者30例,对患者采用连续性静脉-静脉血液滤过方式进行治疗,治疗次数为1～4次不等,每次进行的时间为12 h。收集患者在治疗开始时,和治疗6 h、12 h时的血液和滤液,来测定患者的血常规、肾功能、血生化以及电解质情况。同时采用ELISA法对患者血浆和滤液中的β2-微球蛋白的浓度。结果 30例患者经过连续性静脉-静脉血液滤过治疗之后,26例治愈,占87%;3例好转,占10%;1例无效,占3%。患者治疗前和治疗12 h后的平均血浆β2-微球蛋白浓度分别为(42.8±6.2)mg/L和(26.7±3.7)mg/L,差异有统计学意义(P<0.05);治疗后在各观察点滤液中测及β2-微球蛋白,且二者中的β2-微球蛋白水平呈现出负相关(r=-0.671,P<0.01);患者的平均动脉压、血浆渗透压和心率在治疗前后没有显著变化(P>0.05);患者的血钾和肾功能与治疗前相比有较大的改善(P<0.05)。结论连续性静脉-静脉血液滤过治疗尿毒症脑病,能够使病情得到显著的改善。
Objective To observe the effect of continuous venovenous hemofiltration on uremic encephalopathy. Methods Thirty patients with uremic encephalopathy admitted to our hospital were selected and treated by continuous venovenous hemofiltration. The number of treatments ranged from 1 to 4 times, and each time was 12 hours. Patients were collected at the beginning of treatment, and the treatment of 6 h, 12 h of blood and filtrate, to determine the patient’s blood, kidney function, blood biochemical and electrolyte status. At the same time, the concentration of β2-microglobulin in the plasma and filtrate of patients was measured by ELISA. Results After 30 patients were treated by continuous venovenous hemofiltration, 26 cases were cured, accounting for 87%; 3 cases improved, accounting for 10%; 1 case was ineffective, accounting for 3%. The mean plasma levels of β2-microglobulin in patients before and 12 h after treatment were (42.8 ± 6.2) mg / L and (26.7 ± 3.7) mg / L, respectively, with statistical significance (P <0.05) Β2-microglobulin was detected in the filtrate of each observation point, and the β2-microglobulin level in both was negatively correlated (r = -0.671, P <0.01). The mean arterial pressure, plasma osmotic pressure and The heart rate did not change significantly before and after treatment (P> 0.05). The serum potassium and renal function of patients were significantly improved compared with those before treatment (P <0.05). Conclusion Continuous veno-venous hemofiltration treatment of uremic encephalopathy, can make a significant improvement in the condition.