床旁连续血液净化治疗重症脑卒中急性肾脏损害

摘要

Objective To study the effect of continuous blood purification (CBP) at bedside in severe stroke patients with acute kidney injury. Methods The clinical data about 15 severe stroke patients with acute kidney injury admitted to our hospital from January 2006 to August 2011 were retrospectively analyzed. Results All the patients except one who died of thalamus bleeding recovered. The serum levels of creatinine, blood urea nitrogen, potassium, sodium, intracranial pressure, IL-lβ, IL-6, 24 h urinary volume, and Glasgow coma score were significantly higher after CBP treatment than before CBP treatment (230.67±42.34μmol/L vs 75.47±22.54μmol/L, 18.74±4.17 mmol/L vs 5.35±0.66 mmol/L, 6.26±0.38 mmol/L vs 4.16±0.44 mmol/L, 158.07±5.16 mmol/L vs 141.60±3.22 mmol/L, 22.73±2.19 mmHg vs 18.40±1.55 mmHg(1 mmHg=0.133 kPa), 0.95±0.07 ng/ml vs 0.42±0.09 ng/ml, 259.13±24.39 pg/ml vs 216.53±17.61 pg/ml, 506±95 ml vs 1 449.33±244.20 ml, 8.20±1.61 vs 10.33±1.91, P<0.01). Head CT scanning revealed no enlarged hematoma. Conclusion CBP at bedside can clear the cytokines, improve the renal function and reduce the intracranial pressure in severe stroke patients with acute kidney injury.%　　目的探讨床旁连续血液净化治疗重症脑卒中急性肾损害的效果。方法回顾分析2006年1月-2011年8月本院15例重症脑卒中合并急性肾脏损害的患者资料。结果除1例死于丘脑出血，其余病人恢复良好。血液净化治疗前后，血肌酐[(230.67±42.34)μmol/L vs (75.47±22.54)μmol/L]，尿素氮[(18.74±4.17) mmol/L vs (5.35±0.66) mmol/L]，血钾[(6.26±0.38) mmol/L vs (4.16±0.44) mmol/L]，血钠[(158.07±5.16) mmol/L vs (141.60±3.22) mmol/L]，颅内压[(22.73±2.19) mmHg vs (18.40±1.55) mmHg (1 mmHg=0.133 kPa)]，细胞因子IL-1β[(0.95±0.07) ng/ml vs (0.42±0.09) ng/ml]，IL-6[(259.13±24.39) pg/ml vs (216.53±17.61) pg/ml]，24 h尿量[(506±95) ml vs (1449.33±244.20) ml]，格拉斯哥昏迷评分(8.20±1.61 vs 10.33±1.91)。数据变化具统计学意义(P＜0.01)。病人头颅CT检查未见血肿增加。结论对重症脑卒中合并急性肾脏损害患者，床旁连续血液净化治疗能清除细胞因子，恢复肾脏功能，降低颅内压。