摘要
目的探讨高频超滤对抗利尿性肾性水肿的临床疗效。方法选择42例符合肾病综合征诊断标准并伴有重度水肿的患者，其中糖尿病肾脏疾病20例，狼疮肾炎10，难治性原发肾病综合征8例，多发性骨髓瘤肾病4例。所有患者入院后根据不同的原发疾病给予相应的标准治疗3～5d后每日尿量少于800ml，符合利尿剂抵抗的标准，遂给予高频超滤治疗。高频超滤治疗的方案为血流量160-180ml／min，脱水量1500-3000ml／次，超滤率不超过800ml／h，治疗频率每天1次，4．0～5．0h／次，连续治疗5～7d后，改为每周1～3次；对于血压较高、心衰症状较重或出现低血压倾向患者，将微调上述治疗方案。高频超滤期间对原发病进行积极治疗及必要的营养支持治疗，暂停利尿剂的使用。观察比较治疗前后患者24h尿量、水肿程度评分、呼吸困难评分、血肌酐（SCr）、血浆白蛋白（albumin，Alb）、N末端B型脑钠肽前体（Nterminal B type natriuretic peptide precursor，NT-proB—NP）、动脉血气、24h尿蛋白定量。结果水肿评分、24h尿量、呼吸困难评分、SCr、NT-proBNP治疗前及治疗1、2、3周间均有统计学差异（P〈0．05）；Alb、24h尿蛋白定量治疗3周与治疗前、1、2周比较均有差异（P〈0．05），但治疗前及治疗1、2周相互间并无差异（P〉0．05）；血气分析（钾、钠、碳酸氢根和剩余碱）治疗前与治疗1、2、3周比较均有统计学差异（P〈0．05），而治疗1、2、3周相互间并无差异（P〉0．05）。结论高频超滤对抗利尿性肾性水肿的短期疗效显著，能有效改善利尿剂抵抗，为原发病治疗赢得了时间及空间的保障。
Objective To study the clinical curative effectiveness of high frequency ultrafiltration for the renal edema with diuretic resistance. Methods We selected 42 cases of nephrotic syndrome with severe edema. Among them, there were 20 cases of diabetic kidney disease, 10 cases of lupus nephritis, 8 cases of refractory primary nephrotic syndrome, and 4 cases of multiple myeloma nephropathy. All patients were subjected to standard treatment for 3-5 days according to different primary diseases after admission. Their urine was less than 800 mL every day and it met the standard of diuretic resistance. Then the patients were treated with ultrafiltration. The scheme of ultrafiltration treatment was as follows： blood flow rate was 160-180 ml/min, dialysate flow rate was 500 ml/min, dehydrated level was 1500-3 000 mL every time mainly in the single ultrafiltration period, ultrafiltration rate less than 800 ml/h, once every day, 4. 0-5.0 h every time; after continuous treatment for 5-7 days, 1-3 times every week. Treatment plan above was trimmed for the patients with high blood pressure, severer heart failure symptoms or hypotension tendency. Primary diseases were treated actively and necessary nutritional support was given during ultrafiltration, and diuretic was withdrawn. Daily urine volume, edema severity score, dyspnea score, serum creatinine （SCr）, plasma albumin （Alb）, N terminal B type natriuretic peptideprecursor （NT-proBNP）, arterial blood gas, 24-h urine protein were observed and compared before and after treatment. Results The edema scores, daily urine volume, dyspnea score, SCr and NT-proBNP showed significant difference before and 1, 2, 3 weeks after treatment （P〈0. 05）. Alb, and 24-h urine protein showed significant difference 3 weeks after treatment in comparison to those before treatment and 1, 2 weeks after treatment （P〈0. 05）, and there was no significant difference before and 1 and 2 weeks after treatment （P〉0. 05）. Blood gas analysis （potassium, sodium, bicarbonate and bas
出处
《临床肾脏病杂志》
2015年第2期98-101,共4页
Journal Of Clinical Nephrology
关键词
高频超滤
抗利尿性肾性水肿
呼吸困难评分
疗效
High frequency ultrafiltration
Renal edema with diuretic resistance
Dyspnea score
Curative effectiveness
