Objective To investigate the effects of different dialysis modes (intermittent and continuous) on the hemodynamics of patients with end-stage renal disease complicated with cerebral hemorrhage.Methods A total of 36 patients with end-stage renal disease complicated with cerebral hemorrhage were selected from January 2010 to December 2016,and were randomly divided into intermittent dialysis group and continuous dialysis group.The hemodynamics indexes,changes of intracranial pressure,changes of vasoactive peptides,oxidative and inflammatory factors were analyzed and compared between the two groups.Results There were no significant differences in the degree of brain damage and clinical manifestation between the two groups.There was no significant difference in mean blood pressure between the two dialysis models.The increase of cardiac output during intermittent dialysis and continuous dialysis was 5.2%±1.8%,4.9%±1.2%,heart index was 3.2%±1.4%,2.6%±1.3%,respectively.The difference in stroke volume and stroke volume was not found in different dialysis models.However,stroke volume in patients receiving intermittent dialysis was significantly higher than that in continuous dialysis (P=0.028);mean 3 hours after dialysis (P=0.015) but was not found in patients with intermittent dialysis.Other biochemical markers were analyzed and analyzed.No significant difference was found between the two dialysis modes (P<0.05),and the level of serum endothelin-1 was significantly increased after continuous dialysis.Conclusion We initially demonstrate that there is no significant difference in the use of intermittent and continuous hemodialysis in patients with acute renal hemodynamics for end-stage renal disease with cerebral hemorrhage;continuous dialysis can significantly increase vasoactive peptide levels and the fluid reactivity is low,intermittent dialysis had the effective removal of small molecule toxins advantage.%目的 探讨不同透析模式下(间歇性与连续性)对终末期肾病合并脑出血患者的血流动力学的影响.方法 选择2010-01-2016-12至我院血液净化中心治疗的明确诊断为终末期肾病合并脑出血患者36例,随机分为间歇性透析组与连续性透析组,分别进行透析治疗,比较透析期间患者的心脏指数、每搏量等血流动力学指标,颅内压的变化及血管活性肽、氧化及炎症因子变化情况.结果 透析前通过神经功能评估结果显示,2组脑损伤程度及临床表现无显著性差异;两种透析模式下患者的平均血压无显著性差异;透析期间间歇性透析与连续性透析的心脏输出增加分别为(5.2±1.8)%、(4.9±1.2)%,心脏指数分别为(3.2±1.4)%、(2.6±1.3)%.不同透析模式下未观察到每搏量与每搏量指数的显著差异,然而接受间歇性透析患者的每搏量变异显著高于连续性透析组(P=0.028);透析后3 h出现平均颅内压水平显著增加,患者神经损害临床症状随之加重,间断性透析患者尤其明显;血清内皮素-1水平在连续性透析后显著升高(P=0.015),但未见于间歇性透析组患者.结论 对于终末期肾病合并脑出血患者,使用间歇性及连续性血液透析对血流动力学的影响无显著性差异;连续性透析能够显著增加血管活性肽的水平,流体反应性较低,间歇性透析具备有效清除小分子毒素的优势.
展开▼
