中国血液净化

›› 2007, Vol. 6 ›› Issue (6): 302-305.

• 论著 • 上一篇    下一篇

连续性血液净化在危重病合并高钠血症治疗中的应用

沈东波1 沈 理1 刘 强2 赵 灵3 翁玉清3 孙爱丽1 周雪珍1 李冰贤1 陈凤娇1 谢广兰1
  

  1. 1. 519000 珠海，暨南大学第三附属医院血液净化中心，3. 重症监护病房 2. 中山大学第五附属医院血液净化中心
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2007-06-12 发布日期:2007-06-12

  • Received:1900-01-01 Revised:1900-01-01 Online:2007-06-12 Published:2007-06-12

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摘要： 目的 探索连续性血液净化(CBP)在危重病合并高钠血症治疗中的应用价值。方法 选择暨南大学第三附属医院血液净化中心29例入住重症监护病房的危重病合并高钠血症患者行CBP治疗，根据血清钠调整置换液钠浓度，观察高血钠与病情的关系及实施CBP前后血清钠浓度及纠正速度、渗透压及急性生理学与慢性健康状况评分Ⅱ(APPECHE Ⅱ评分)等的变化。结果 29例高钠血症患者总死亡率为68.9%(20/29)，其中颅脑疾病合并高钠血症患者死亡率高达83.3%(15/18)。发生高钠血症时，死亡组的血钠水平和APACHE Ⅱ评分均较存活组明显升高(P＜0.01)。共行CBP治疗113次，治疗天数平均4d(2～10d)，每日14h(12～22h)，置换液交换量4.3L/h。血清钠下降每日14.6mmol/L，血钠纠正速度为0.97mmol/(L·h)。所有患者经CBP治疗后血清钠和渗透压明显下降，APPECHE Ⅱ评分改善，治疗过程安全，血流动力学稳定(P＜0.01)。结论 CBP治疗高钠血症效果确切，安全性好，对危重病尤颅脑疾病合并高钠血症者应尽早实施。

关键词: 连续性血液净化, 高钠血症, 危重病, APPECHEⅡ评分

Abstract: Objective To evaluate continuous blood purification (CBP) in treatment of critical patients complicated with hypernatremia. Methods Twenty-nine critical patients complicated with hypernatremia in the intensive care unit were treated with CBP. Sodium concentration in exchange fluid was adjusted according to serum sodium concentration. We analyzed the correlation of serum sodium concentration to patient抯 condition. We also observed changes of serum sodium, serum osmolarity and the acute physiology and chronic health evaluation II (APACHE II) scores before and after CBP. Results Mortality rate of the 29 patients was 68.9% (20/29), and that of craniocerebral disease with hypenatremia was as high as 83.3% (15/18). Serum sodium concentration and the APACHE II scores were significantly higher in death group than in survival group (P＜0.01). We totally performed 113 times of CBP. The average CBP period was 4 (2-10) days and 14 (12-22) hours per day. The fluid amount used for exchange was 4.3L/hour. Serum sodium decreased 14.6mmol/L per day and the rate of the serum sodium change was -0.97mmol/L per hour. After CBP therapy, all patients showed decrease of serum sodium and serum osmolarity and improvement of APACHE II score. During CBP there was no hemodynamic changes (P＜0.01) and the disease condition was stable. Conclusion CBP is a safe and effective measure for the treatment of critical patients with hypernatremia. It must be applied as quickly as possible, especially in craniocerebral disease with hypernatremia.

Key words: Hypernatremia, Critical illness, APACHE II scores

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