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目的 观察连续性静脉 静脉血液滤过 (CVVH)治疗急性严重低钠血症的疗效。方法急性严重低钠血症 6例 ,基础病变分别为慢性肾功能衰竭 3例 ,急性肾功能衰竭、妊娠子痫及骨科手术后各 1例。所有患者血钠均低于 115mmol/L ,均为 4 8h内发生。采用中心静脉留置导管建立血管通路行CVVH。滤器为AN6 9及AV6 0 0各 2例 ,HF12 0 0及FH6 6各 1例 ,每 2 4h更换 1次 ,低分子肝素抗凝。结果 CVVH平均治疗时间为 5 9 7h。CVVH治疗中 ,患者血流动力学稳定 ,6例意识模糊者 ,5例治疗 12h后意识有所好转 ;3例嗜睡及谵妄者治疗 2 4h后症状消失 ;1例抽搐者治疗 2 4h后症状消失 ;1例昏迷者治疗 96h后神志完全恢复正常。CVVH治疗后 4 8h血钠上升至 (14 0 3± 1 6 )mmol/L ,纠正速度为 (0 82± 0 10 )mmol·L-1·h-1;血渗量水平为 (2 95 0± 4 2 )mOsm/kgH2 O ,纠正速度为 (1 6 3± 0 2 0 )mOsm·kgH2 O-1·h-1。CVVH开始置换液钠比血钠高 (16 0± 6 0 )mmol/L。CVVH治疗 4 8h后Glasgow评分较治疗前有显著升高 (P <0 0 5 ) ,APACHEⅡ评分较治疗前有显著降低 (P <0 0 5 )。 6例患者全部存活 ,3例转为维持性血液透析 ,3例完全康复。结论 CVVH治疗严重急性低钠血症是有效的 ,为严重急性低钠血症的救治提供了新的治疗?
Objective To observe the curative effect of continuous intravenous venous hemofiltration (CVVH) on acute severe hyponatremia. Methods Six cases of acute severe hyponatremia were included. The basic diseases were chronic renal failure in 3 cases, acute renal failure, pregnancy eclampsia and 1 case after orthopedic surgery. All patients with serum sodium were less than 115mmol / L, were occurred within 48h. The central venous catheter was used to establish the vascular access line CVVH. Filter for the AN6 9 and AV6 0 2 in each case, HF12 0 0 and FH6 6 in 1 case, every 2 4h replacement 1, low molecular weight heparin anticoagulation. Results The average CVVH treatment time was 597 hours. In CVVH treatment, hemodynamics were stable in 6 patients with ambiguity, and consciousness improved after 5 hours of treatment in 12 cases. Symptoms disappeared in 3 cases of drowsiness and delirium after treatment for 24 hours. Symptoms disappeared after 1 case of convulsion in 24 hours One case of coma returned to normal after 96 hours of treatment. Serum sodium rose to (14 0 3 ± 1 6) mmol / L at 48 h after CVVH treatment, and the rate of correction was (0 82 ± 0 10) mmol·L-1 · h-1; ± 4 2) mOsm / kgH2O, and the corrected speed was (163 ± 0 2 0) mOsm · kgH2O-1 · h-1. CVVH began to replace liquid sodium sodium (16 0 ± 60) mmol / L higher than sodium. The Glasgow score of 48 h after CVVH treatment was significantly higher than that before treatment (P <0.05), and APACHE Ⅱ score was significantly lower than that before treatment (P <0.05). Six patients survived, three were switched to maintenance hemodialysis and three were fully recovered. Conclusions CVVH is effective in treating severe acute hyponatremia and provides new treatment for severe acute hyponatremia.