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目的探讨应用日间连续性肾脏替代疗法(CRRT)急性严重低钠血症的疗效。方法选择大连医科大学附属第一医院2006年12月至2008年12月急性严重低钠血症13例患者,治疗前血钠均低于115mmol/L,使用BaxterBM25血滤机行日间CRRT,滤器为HF1200,低分子肝素钠抗凝,前稀释方式补充置换液,流速4L/h,每天治疗8h。结果CRRT平均治疗(3.1±1.0)d。所有患者均顺利完成治疗,其中12例患者存活,1例最终死于成人呼吸窘迫综合征。治疗后血钠由(112.5±2.4)mmol/L升至(139.6±2.8)mmol/L,血浆渗透浓度随着血钠的纠正逐步恢复正常。患者意识状态逐渐转为清醒,Glasgow评分逐渐恢复接近正常,无严重神经系统并发症发生。结论日间CRRT治疗急性严重低钠血症疗效确切,并发症少,值得临床借鉴。
Objective To investigate the effect of continuous daytime renal replacement therapy (CRRT) on acute severe hyponatremia. Methods Thirteen patients with acute severe hyponatremia who were admitted to the First Affiliated Hospital of Dalian Medical University from December 2006 to December 2008 were all treated with BaxterBM25 hemofiltration. For HF1200, low molecular weight heparin anticoagulant, pre-dilution replacement fluid replacement, flow 4L / h, daily treatment 8h. Results The mean CRRT was (3.1 ± 1.0) days. All patients successfully completed the treatment, of which 12 patients survived, one case eventually died of adult respiratory distress syndrome. Serum sodium rose from (112.5 ± 2.4) mmol / L to (139.6 ± 2.8) mmol / L after treatment, and the plasma osmolality gradually returned to normal with the correction of serum sodium. Patient awareness gradually turned to awake, Glasgow score gradually returned to normal, no serious neurological complications occurred. Conclusion CRRT treatment of acute severe hyponatremia during the day is effective and has few complications. It is worthy of clinical reference.