高容量血液滤过治疗颅脑损伤后急性高钠血症的临床应用王俊霞肖雄.doc

高容量血液滤过治疗颅脑损伤后急性高钠血症的临床应用 王俊霞 肖雄木 李国辉 周晓丹 河南科技大学第一附属医院血液净化科 洛阳市 471003 摘要 目的 观察高容量血液滤过（HVHF）治疗重症颅脑损伤后急性高钠血症的效果，探讨其实用性和安全性。 方法 回顾性分析了21例重症颅脑损伤后急性高钠血症患者应用HVHF治疗的临床资料，观察治疗前后患者血钠及其纠正速度以及临床症状改善程度，并与同期11例未进行HVHF治疗的高钠血症患者对比。结果 采用HVHF治疗4小时后血钠开始逐步下降，在40-48小时时血钠降至正常范围，HVHF治疗后APACHEII评分显著降低，临床症状改善明显，HVHF治疗组的死亡率明显低于对照组。 结论 HVHF治疗可以缓慢安全地降低重症颅脑损伤后急性高钠血症患者的血钠，降低其死亡率，是重症颅脑损伤后急性高钠血症患者的良好选择。 关键词：重症颅脑损伤、高容量血液滤过、高钠血症 The clinical application of High volume hemofiltration on acute hypernatremia caused by brain injury WANG Jun-xia, XIAO Xiong-mu, LI Guo-hui, ZHOU Xiao-dan, Department of Blood Purification, First Affiliated Hospital of Henan university of Science and Technology, Luoyang 471003, Henan Province, China ABSTRACT Objective To observe the effect of high-volume hemofiltration (HVHF) on acute hypernatremia caused by Severe craniocerebral injury and investigate the practicality and safety of this treatment . Methods 21 patients with hypernatremia caused by severe craniocerebral injury were studied and treated with HVHF ，Retrospective analysis their clinical data such as the serum sodium concentration and its decline speed before and after treatment 、the improvement of clinical symptoms ,In contrast to other 11 patients with hypernatremia caused by severe craniocerebral injury the same period who did not treat by HVHF .Results The serum sodium concentration began to step down after treatment with HVHF for 4 hours , and drop to normal range after 40 -48 hours . APACHEII scores significantly lower and the clinical symptoms improved after treatment. the mortality rate of HVHF treatment group was obviously lower than compared group. Conclusions HVHF treatment can slowly and safely reduce serum sodium concentration in patients with hypernatremia caused by severe craniocerebral injury and decrease their mortality, so it is a good choice for these patients . KEY WORDS severe cranioc