连续性血液净化在重型颅脑损伤并发高钠血症治疗中的应用

目的:探讨连续性血液净化(CBP)在重型颅脑损伤并发高钠血症治疗中的应用价值.方法:32例入住我院ICU的重型颅脑损伤并发高钠血症的患者行CBP治疗,动态监测血清钠以调整置换液钠浓度,观察实施CBP治疗前后血清钠浓度及纠正速度、血流动力学指标、肌酐、血渗透压及急性生理学与慢性健康状况评分Ⅱ(APPECHEⅡ)等的变化....     

连续性血液净化治疗颅脑疾病合并高钠血症疗效分析

目的 探讨连续性血液净化(CBP)对颅脑疾病合并高钠血症患者的疗效.方法 颅脑疾病且血钠浓度>160 mmol/L的患者38例,将12例行CBP治疗的患者设为治疗组,26例仅行一般治疗的患者设为对照组.观察2组患者血钠水平及预后.结果 治疗组12例患者48 h后血钠均降至正常,7 d存活率为83.33%,与对照组比较差异有统计学意义(P<0.05或0.01);2组出院存活率比较差异无统计学意义.结论 CBP治疗能有效迅速地降低颅脑疾病合并高钠血症患者的血钠浓度,延长患者的生存时间,但对急性颅脑疾病合并高钠血症患者预后的影响仍较难定论.     

连续性血液净化在危重病合并高钠血症治疗中的应用

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（2～10 d）,每日14h（12～22 h）,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.     

重型颅脑外伤并发高钠血症

重型颅脑外伤是神经外科和1CU的急危症，病死率高，而高钠血症是重型颅脑外伤常见且严重的并发症，对原发疾病的预后产生极其不利的影响。现将本院2003年1月至2005年10月ICU救治的资料完整的重型颅脑外伤72例，其中并发高钠血症28例，分析报道如下。     

经连续性血液净化治疗危重病合并高钠血症患者的临床价值分析

探究分析经连续性血液净化治疗危重病合并高钠血症患者的临床价值,旨在更好的服务临床。选取在本院2014年1月~2016年6月接受治疗的危重病合并高钠血症患者86例,应用回顾性分析的方法,对危重病合并高钠血症患者运用连续性血液净化进行治疗,并对比治疗前后,相关指标的变化情况。对危重病合并高钠血症患者进行治疗后,死亡31,比例36%,存活55例,比率64%。患者在治疗前以及治疗后4、8、12、24h,置换液钠浓度、血钠浓度、血浆渗透压水平均出现下降,与治疗前相比,差异有统计学意义(P0.05)。连续性血液净化治疗危重病合并高钠血症患者的临床疗效显著,具有重要的临床价值。     

连续性血液净化治疗对危重患者药物清除率影响的研究进展

本文通过查阅文献,了解药物本身药理学及连续性血液净化治疗（ CBP）的滤过膜材料、面积、孔径大小,透析液／超滤液流速,过滤器使用时间,血液滤过模式及滤过原理等对药物清除率的影响,总结连续性血液滤过治疗对各类药物清除率的研究进展。为临床医师调整治疗方案,更好地进行个体化治疗提供参考,同时为药物清除率的进一步研究开拓思路。     

无肝素持续血液净化治疗脑损伤后高钠血症的初步研究

目的评价无肝素持续血液净化治疗对脑损伤后高钠血症的疗效.方法 2001年1月～2003年12月收治的45例重型脑损伤合并高钠血症患者,5例行无肝素前置稀释法持续血液净化治疗.结果 5例病人48h后血钠均降至正常.死亡3例.结论 CBP能有效迅速地降低脑损伤后高钠血症患者的血钠浓度.同时能够改善严重高钠血症病人的预后.对于合并轻度高钠血症病人的预后,尚难以定论.     

连续性血液净化治疗对危重患者药物清除率影响的研究进展北大核心CSCD

本文通过查阅文献,了解药物本身药理学及连续性血液净化治疗（ CBP）的滤过膜材料、面积、孔径大小,透析液／超滤液流速,过滤器使用时间,血液滤过模式及滤过原理等对药物清除率的影响,总结连续性血液滤过治疗对各类药物清除率的研究进展。为临床医师调整治疗方案,更好地进行个体化治疗提供参考,同时为药物清除率的进一步研究开拓思路。     

1例重型颅脑外伤术后并发高钠血症病人的护理

<正>重型颅脑外伤通常是由于病人的颅脑在外部暴力重物作用下导致的损伤,随着我国交通事业和建筑业的快速发展,颅脑外伤的发生率也逐年增高,其致残率和致死率均在50%以上~[1],重型颅脑损伤伤情十分严重,病人受伤后出现各种神经症状,出现意识障碍、引起脑出血,诱发脑组织缺氧缺血、脑血管痉挛、脑水肿甚至脑死亡等症状。可见重型颅脑损伤病人伤情十分严重,病情变化凶险,因此术后治疗和护理显得尤为重要。我科2018年3月7日收治1例重型颅脑损伤病人,术后通过镇     

连续性肾脏替代疗法治疗高钠血症1例

患者女性,47岁,因"头痛、头晕1天,呼吸心跳骤停、心肺复苏术后10小时"入院.入院前1天无诱因自觉头痛、头晕,次日行头颅CT检查未见异常,而后症状加剧并出现呼吸心跳停止,心肺复苏术后3分钟恢复自主心跳,无自主呼吸,行气管插管、呼吸机辅助呼吸.     

Continuous renal replacement therapy: an overview

Continuous renal replacement therapy is a treatment option that is especially suited to the critical care setting. Greater hemodynamic stability, the ongoing ability to optimize fluid balance, and the potential for clearing inflammatory mediators are among the frequently cited advantages continuous veno-venous dialysis modalities offer over traditional intermittent therapies. The concept is simple: blood is pumped from the patient, anticoagulated, and passed through a porous filter where, depending on the desired goal, fluid and/or solutes are removed. The blood is then returned to the patient, without large fluctuations in electrolyte and acid-base balance or renal hypoperfusion. This article includes a review of acute renal failure, a discussion of the indications for continuous renal replacement therapy, the mechanisms of action of this therapy, and the nursing considerations.     

连续性肾脏替代疗法在脑出血合并高钠血症患者中的应用效果

目的分析连续性肾脏替代疗法在脑出血合并高钠血症患者中的应用效果。方法选择2017年5月至2018年12月在本院接受治疗的40例脑出血合并高钠血症患者,根据患者所接受的治疗方案将其分为对照组与观察组,每组20例。对照组给予保守内科疗法,观察组在此基础上给予连续性肾脏替代疗法。比较两组临床疗效。结果治疗后,两组患者的心率、平均动脉压、血清钠离子、尿素氮、肌酐水平均明显降低,且观察组低于对照组(P<0.05);观察组患者的治疗总有效率明显高于对照组(P<0.05)。结论连续性肾脏替代疗法用于脑出血合并高钠血症的临床疗效显著,可纠正患者机体电解质紊乱情况,促进肾功能和预后地改善。     

Continuous renal replacement therapy circuit failure after antidote administration

A 73-year-old man was transferred to the emergency department (ED). He was found unconscious in his house along with an empty 200-mL bottle of Basta^?, a herbicide containing 18% glufosinate. He was comatose with a Glasgow Coma Scale score of 3. As his blood pressure dropped to 60/30 mmHg despite fluids and norepinephrine, 20% intravenous fat emulsion product was injected. He experienced repeated cardiopulmonary arrests during his first 4 h in the ED. When the arrests occurred, standard cardiopulmonary resuscitation was performed, and boluses of fat emulsion were given. He was given a total of 1500 mL of 20% fat emulsion. In an attempt to correct the acidosis, continuous renal replacement therapy (CRRT) was started. Within 5 min of starting CRRT, the transmembrane pressure increased sharply and the machine stopped.     

Continuous versus intermittent renal replacement therapy: a meta-analysis

OBJECTIVE: Patients with critical illness commonly develop acute renal failure requiring mechanical support in the form of either continuous renal replacement therapy (CRRT) or intermittent hemodialysis (IRRT). As controversy exists regarding which modality should be used for most patients with critically illness, we sought to determine whether CRRT or IRRT is associated with better survival. DESIGN: We performed a meta-analysis of all prior randomized and observational studies that compared CRRT with IRRT. Studies were identified through a MEDLINE search, the authors' files, bibliographies of review articles, abstracts and proceedings of scientific meetings. Studies were assessed for baseline characteristics, intervention, outcome and overall quality through blinded review. The primary end-point was hospital mortality, assessed by cumulative relative risk (RR). MEASUREMENTS AND RESULTS: We identified 13 studies ( n=1400), only three of which were randomized. Overall there was no difference in mortality (RR 0.93 (0.79-1.09), p=0.29). However, study quality was poor and only six studies compared groups of equal severity of illness at baseline (time of enrollment). Adjusting for study quality and severity of illness, mortality was lower in patients treated with CRRT (RR 0.72 (0.60-0.87), p<0.01). In the six studies with similar baseline severity, unadjusted mortality was also lower with CRRT (RR 0.48 (0.34 -0.69), p<0.0005). CONCLUSIONS: Current evidence is insufficient to draw strong conclusions regarding the mode of replacement therapy for acute renal failure in the critically ill. However, the life-saving potential with CRRT suggested in our secondary analyses warrants further investigation by a large, randomized trial.     

Choice of renal replacement therapy in patients with complicated uremia

Fourteen patients with complicated uremia and multiple organ dysfunction syndrome were treated by renal replacement therapy (RRT), by hemodialysis and hemodiafiltration. Control group consisted of 14 age-matched convalescents without clinical and laboratory signs of uremia and systemic inflammatory response syndrome. The potentialities of Integral Diagnostic Expert Analytical System (IDEAS) based on the spectrophotokinetic (SPK) technique (ECOTEST, Russia; Thermo Labsystems, Finland) were evaluated on the basis of objective evaluation of clinical condition of end-stage renal disease patients. SPK technology proved to be a highly informative method of automated diagnosis, which allows monitoring the dialysis efficiency, detecting combined diseases and poor system's biocompatibility, which, in turn, permits correction of the treatment and realization of a differentiated approach to the choice of RRT method.     

血液滤过治疗急性肾功能衰竭伴多脏器功能衰竭的疗效观察

目的探讨CRRT用于急性肾功能衰竭(ARF)伴多脏器功能障碍综合征(MODS)患者的治疗方法和疗效.方法利用全身感染相关器官功能衰竭评分(SOFA),对两年来ARF伴多脏器功能障碍综合征(MODS)行CRRT治疗的12例死亡患者和8例存活患者资料进行回顾分析.结果入ICU时APACHE-Ⅱ分值存活组低于死亡组(P=0.04).CRRT开始时存活组SOFA分值低于死亡组(P=0.04).存活组循环SOFA分值由(1.80±1.30)降至(0.50±0.58)(P=0.028),明显低于死亡组72小时分值(P=0.016).总SO-FA分值治疗前后死亡组未见显著变化,存活组则降至(6.60±3.36)(P=0.021).死亡组患者SOFA持续在较高水平,CRRT开始时SOFA分值为(14.09±3.59),与存活组有明显差异(P=0.018).与治疗前比较,治疗后SOFA分值存活组明显下降,死亡组未见此变化.比较入ICU到开始血液净化时间,存活组(1.43±0.78)明显早于死亡组(4.91±5.38)(P=0.030).结论肾脏以外器官功能损害较重可能是患者死亡的主要原因,如果能够尽早开始CRRT治疗,有可能改善患者的预后.     

Continuous renal replacement therapy: the treatment of choice for acute renal failure

The health care issues facing society today are complex. Access to care, quality of life, relative value scales, diagnosis related groups, and cost containment demands have had an impact on the decision-making processes of health care professionals. The availability of alternative therapeutic treatment modalities adds additional considerations when prescribing medical therapy. This is especially true when a patient is diagnosed with renal failure. In the past, either peritoneal dialysis or hemodialysis have been the only therapies for supporting patients with acute renal failure. This article explores continuous renal replacement therapy for the management of acute renal failure: what it is, when and where it should be used, and the responsibilities of nephrology and critical care nurses and physicians.