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目的观察连续性静脉-静脉血液滤过(CVVH)治疗在颅脑疾病合并高钠血症患者中的应用价值。方法分析16例行CVVH治疗的颅脑疾病合并高钠血症患者,观察CVVH治疗前后血钠变化及病情转归,血钠浓度及纠正速度、渗透压及急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)的变化。结果 16例高钠血症患者病死率为69%(11/16)。死亡组中血钠水平中重度增高者占73%(8/11),存活组中血钠水平中重度增高者占1/5,死亡组CVVH前血钠水平和高血钠的持续时间及APACHEⅡ评分均较存活组明显升高(P<0.01)。CVVH治疗期间血清钠每日下降10.2mmol/L,血钠纠正速度为0.89mmol.L~(-1).h~(-1)。所有患者经CVVH治疗后血清钠和渗透压明显下降,APACHEⅡ评分改善(P<0.01)。结论颅脑疾病合并高钠血症患者CVVH治疗前血钠水平越高,持续时间越长,则预后越差。CVVH治疗颅脑疾病合并高钠血症安全有效,应尽早实施。
Objective To observe the value of continuous veno-venous hemofiltration (CVVH) in the treatment of patients with craniocerebral disease complicated with hypernatremia. Methods Sixteen patients with craniocerebral disease complicated with hypernatremia who were treated with CVVH were enrolled in this study. The change of serum sodium, the change of serum sodium, the concentration of sodium, the speed of correction, the osmotic pressure and acute physiology and chronic health status Ⅱ (APACHE Ⅱ )The change. Results The mortality of 16 patients with hypernatremia was 69% (11/16). 73% (8/11) were severe moderate increase of serum sodium level in the death group, 1/5 were severe increase of serum sodium level in the survival group, and the duration of pre-CVVH serum sodium level and hypernatremia in the death group and APACHEⅡ The scores were significantly higher than those in survivors (P <0.01). Serum sodium decreased 10.2 mmol / L during CVVH treatment, and the corrected rate of serum sodium was 0.89 mmol.L -1 .h -1. After treatment with CVVH, the serum sodium and osmotic pressure decreased significantly in all patients, APACHE Ⅱ score improved (P <0.01). Conclusions The serum sodium level before CVVH is higher in patients with craniocerebral disease and hypernatremia, the longer the duration, the worse the prognosis. CVVH treatment of brain disease associated with hypernatremia safe and effective, should be implemented as soon as possible.