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连续性血液透析治疗糖尿病肾病酮症酸中毒合并急性肾损伤的作用 张远鹏 广东省佛山市高明区人民医院内六科 528500 【摘要】 目的：探讨连续性血液透析（CBP）对糖尿病肾病酮症酸中毒（DKA）合并急性肾损伤血液动力学的影响。 方法：回顾性分析2011年6月~2015年5月间收治的102例经普通血液透析IHD（44例）或CBP（58例）治疗的DKA合并急性肾损伤患者的血液动力学变化指标，利用Student’s t或卡方检验比较两组间各指标的差异。 结果：经血液透析治疗后，两组的中心静脉压（CVP）、心排血量（CO）、外周血管阻力（SVR）、心脏指数（CI）、胸腔液体量（TFC）均显著降低（P均 0.05），且CBP组的CVP、SVR、CI和TFC显著低于IHD组（P均 0.01CBP组的MAP、CVP和SVR的恢复率也显著高于IHD组（P均 0.05）。 结论：CBP可使DKA合并急性肾损伤的血液动力学指标趋于正常，且效果优于IHD。 【关键词】 糖尿病肾病酮症酸中毒；急性肾损伤；连续性血液透析；血液动力学 The effect of continuous blood purification on patients with diabetic ketoacidosis and acute kidney injury Zhang yuanpeng Peoples Hospital of Foshan City 528500 【Abstract】 Object: To explore the effect of continuous blood purification CBP on hemodynamic in patients with diabetic ketoacidosis and acute kidney injury DKI . Method: A retrospective analysis of hemodynamic data in 102 patients with DKI 44 were treat by ordinary blood purification, IHD, and 58 by CBP during June 2012 to May 2015, then Students t and chi-square test were used to compare these data between the two groups. Results: After blood purification, the central venous pressure CVP , cardiac output CO , systemic vascular resistance SVR , cardiac index CI , and thoracic fluid volume TFC in the two groups were significantly reduced P 0.05 , and CVP t 3.97, P 0.01 , SVR t 12.54, P 0.01 , CI t 7.16, P 0.01 and TFC t 3.83, P 0.01 were significantly lower in CBP than IHD group, while recover rate of MAP X2 7.54, P 0.01 , CVP X2 8.63, P 0.01 and SVR X2 7.32, P 0.01 in CBP were significantly higher in CBP than IHD group. Conclusion: CBP can significantly reduce hemodynamic in patients with DKI, and the recover effect of that indicators in CBP were better than IHD. 【Keywords】 diabetic ketoacidosis; acute kidney injury; continuous blood purification; hemodynamic 糖尿病肾病酮症酸中毒（DKA）是内科常见的急危重症，临床中常并发急性肾损伤，及时有效地处理DKA合并急性肾损伤对患者的预后尤为重要[1]。血液透析已成功用于急性肾损伤患者的治疗中 [2]。随着医疗技术的发展，连续性血液透析（CBP）也被应用于危重患者的治疗中，与普通血液透析（IHD）相比，CBP可以有效地改善DKA合并急性肾损伤患者的血清学指标，可能