日间延长血液透析滤过治疗难治性水肿的体会

[目的]探讨日间延长的Online-HDF（血液透析滤过）用于难治性性水肿的临床价值。[方法]6例患者，其中男性4例，女性2例，平均年龄55岁（28-74）。Online-HDF治疗3～9次，平均5次。6例患者均为深静脉单针双腔临时留置导管为血管通路，颈内静脉或股静脉插管，有一例后因维持性HD改用带Cuff的导管。Gambro AK-100S机器，U2000过滤Online补液，血流量200-250ml／分，血滤器东丽BS～1．3U，时间6～10h，UF1200～8600不等，补液20～42L，普通肝素钠或低分子肝素抗凝。[结果]6例病人3例因水肿引起的临床症状消退，1例肾功能不能恢复，进入维持性HD治疗，1例因经济原因自动出院，1例并发呼吸衰竭转入ICU接受机械通气治疗。[结论]日间延长的Online-HDF对难治性水肿的治疗效果确切，尤其对于因顽固性水肿导致呼吸困难，胸闷气促等症状有很好的效果。

Comprehension of Daytime Prolonged Online-HDF on the Treatment of Refractory Edema

[Objective] To evaluate the clinical efficiency of refratory edema based on daytime prelonged Online-HDF.[Methods] Six patients include four females and two males whose age ranging from 28 to 74 years old and average 55 years old.Online-HDF treatment for 3-9 times,vascular access was percutaneous femoral or internal jugular catheterization.One patient's temporary access was changed to permanent access because who needed continous hemodialysis.The machine version was Ganbro AK-100S.To filter by u2000 and replace fluid online for 6-10 hous,blood flow was 200-250ml/min,uf 1200-8600,the total fluid used for replacement was 20-42 liter,during the process,regular heparin or low molecular was used for anticoagulation.[Results]Three patients' clinical symptoms resulted from edema resolved,one patient accepted continous hemodialysis treatment for inpaired kidney function,one patient left hospital for expensive medical cost,one patient accepted ventilation treatment for respiratory failure in ICU.[Conclusion]Daytime prelonged Online-HDF is effective on the trentment of refratory edema,especially effective on dyspnea,tachypnea,chest distress that resulted from edema.