论文部分内容阅读
目的:观察血液透析对大量蛋白尿、低蛋白血症、重度营养不良、多浆膜腔积液和心衰的糖尿病肾病(DN)的作用,探讨DN患者的血液透析指征,以选择最佳血液透析时机。方法:收集我院2001-2007年56例糖尿病肾病患者资料,均重度营养不良,血肌肝(Scr)200～400umol/L,内生肌肝清除率(Ccr)血液透析20～40m1/min之间,透析组(n=26)内科综合治疗基础上辅助血液透析,非透析组(n=30)仅内科综合治疗。结果:透析组3M、6M后营养状况改善及明显改善、多浆膜腔积液和心衰缓解病例均优于非透析组,Ccr水平下降不明显。非透析组中Ccr水平下降<15m1/min7人,死亡2人。结论:①重度营养不良、多浆膜腔积液和心衰为决定DN患者血液透析指征,不能过分依赖改Scr、Ccr水平。②提前血液透析可减慢DN走向终末期肾功能衰竭,改善生活质量。
Objective: To observe the effect of hemodialysis on diabetic nephropathy (DN) with massive proteinuria, hypoalbuminemia, severe malnutrition, multiple serous effusions and heart failure, and to investigate the indications of hemodialysis in patients with DN to choose the best Hemodialysis timing. Methods: The data of 56 patients with diabetic nephropathy from 2001 to 2007 in our hospital were collected. All patients were severely malnourished with 200 ~ 400umol / L of Scr and 20 ~ 40m1 / min of endometrial liver clearance (Ccr) Interventional dialysis group (n = 26) based on comprehensive medical treatment hemodialysis, non-dialysis group (n = 30) only medical comprehensive treatment. Results: The nutritional status of the dialysis group was improved and significantly improved after 3M and 6M, and the cases of multiple serous effusion and heart failure were better than the non-dialysis group. The Ccr level did not decrease obviously. Non-dialysis group Ccr levels decreased <15m1 / min7 people, 2 people died. Conclusions: ① Severe malnutrition, multiple serous effusion and heart failure are the indicators of hemodialysis in patients with DN. They should not be over-dependent on the level of Scr and Ccr. ② early hemodialysis can slow DN towards end-stage renal failure, improve quality of life.