血液透析治疗终末期糖尿病肾病.docVIP

血液透析治疗终末期糖尿病肾病【摘要】 目的 观察血液透析(hemodialysis,HD)治疗终末期糖尿病(diabeticnephropathy,DN)的疗效及透析时的并发症。方法 25例终末期糖尿病肾病患者HD前均已经临床确诊为2型糖尿病,平均57.4岁,血肌酐(Sc)为(908.4±142.6)umol/L,血尿素氮(BUN)为(28.7±7.2)mmol/L,合并症主要有高血压、心力衰竭、胸腔积液、腹水、心包积液、上消化道出血、感染和脑梗死。采用Fresenius4008B透析机,进口透析器,碳酸盐或醋酸盐透析液,每周透析2、3次。结果 经透析患者心衰改善,血压控制满意,水、电解质酸碱失衡纠正,上消化道出血控制,大部分患者心包积液、胸腹水减少或消失。HD主要并发症有低血压、心律失常、心力衰竭、高血压、心绞痛和低血糖。死亡13例,转院5例,中止透析或失访6例。死亡原因主要为心血管疾病。结论 HD为治疗终末期糖尿病肾病的有效手段,开始HD时机要早。HD时心血管并发症较多,终末期糖尿病肾病HD病死率相对较高,多死于心脑血管原因,临床上应引起注意。 【关键词】 糖尿病肾病;终末期肾病;血液透析 Hemodialysis treating the end-stage diabetic nephropathy WANG Lun-tao.The People’ Hospital of shangqiu City,Henan 476100,china 【Abstract】 Objective To observe hemodialysis(hemodialysis,HD)for end-stage diabetes(diabeticnephropathy,DN)of the efficacy and complications during dialysis.Methods 25 patients with end-stage HDpatients with diabetic nephropathy have been clinically diagnosed before type 2 diabetes,an average of 57.4 years of age,serum creatinine(Sc) was(908.4 ± 142.6)umol/L,blood urea nitrogen(BUN)was(28.7±7.2)mmol/L,complications,mainly hypertension,heart failure,pleural effusion,ascites,pericardial effusion,upper gastrointestinal bleeding,infection and cerebral infarction.using Fresenius4008B dialysis machines,dialyzers imports,carbonate or acetate dialysate,each week dialysis 2 or 3 times.Results The improvement of heart failure in dialysis patients,satisfactory blood pressure control,water,electrolyte acid-baseimbalancecorrected, control ofupper gastrointestinal bleeding,most patients with pericardial effusion,hydrothorax and reduction or disappearance.HDmajor complications patients with hypotension,arrhythmia,heart failure,high blood pressure,angina,and low blood sugar.13 were dead,5 cases were transferred,suspended or lost six cases of dialysis.The main cause of death was cardiovascular disease.Conclusion HD for the treatment of end-stage diabetic nephropathy effective means of HD time to start early.HD more cardiovascular complications,end sta