联机血液透析滤过抢救急性脑血管病并发高渗性非酮症糖尿病昏迷

目的 评估联机血液透析滤过抢救ACVD并发HNDc的疗效及安全性.方法 前瞻性选取荆门市第一人民医院2006年1月至2007年6月收治的11例ACVD并发HNDc患者,行治疗前后的对照研究.确诊后1 h行联机血液透析滤过抢救,时间为90 min,采用德国Fressnius 4008S型的双泵血透机,F60的血滤器和管道,血流量150～180 ml/min,置换液后稀释方式输入50～60ml/min,碳酸氢盐透析液流量500 ml/min,在治疗前1 h及治疗后6 h取血测定血钠、血钾、血糖、血尿素氮和血浆渗透压;评估治疗中有无脑水肿或心功能不全加重;观察治疗后24 h的神志改变及不良反应.结果 所有患者在治疗中无脑水肿及心功能不全的加重;治疗后6 h血糖、血钠、血尿素氮及血浆渗透压均有明显下降,与治疗前比较差异具有统计学意义(P<0.01);8例患者于治疗后24 h意识障碍明显好转,3例死亡,抢救成功率为73%.结论 联机血液透析滤过抢救ACVD并发HNDC的患者,效果显著,并发症少,安全性高,可缩短病程,降低病死率,是抢救此类患者的有效方法.

The evaluation of on-line hemodiafiltration in acute cerebrovascular disease patients complicated with hyperosmolar nonketotic diabetic coma

Objective To access evaluate the efficacy and safety of on-line hemodiafiltration for treating a-cute cerebrovascular disease (ACVD) patients complicated with hyperosmolar nonketotie diabetic coma (HNDC).Method Totally 11 patients of ACVD complicated with HNDC were observed for this prospective control study.All of them underwent on-line hemodiafiltrafion for 90 minutes using Fressnius 4008S Hemodialysis Machine withONLILNEplus TM and F60 one hour after final diagnosis was made. The bicarbonate ultrafiltrate rate was set at 500ml/min and blood flow at 150 ～ 180 ml/min; and the substitute fluid were infused with post-dilution at 50 ～ 60ml/min. The symptom of brain edema and cardiac insufficiency during the same course of treatment was observed.Blood were taken from the patients to detect serum kalium, serum glucose, serum natrium, BUN and plasma os-motic pressure at one hour before treatment and six hours after treatment, respectively. The change of in conscious-ness and adverse effects were evaluated at 24 hours after treatment. Results All patients were treated successful-ly. The blood glucose, serum natrium, serum kalium, BUN and plasma osmotic pressure were decreased after on-line hemodiafiltration. Among the 11 patients, consciousness was improved obviously in 8 patients, 3 patientsdied, accounting for 73% of successful effectiveness. Conclusions The on-line hemodiafiltration was effectiveand safe for treating ACVD patients complicated with HNDC.