Clinical Observation On Continuous Veno-venous Hemoifltration Treatment Of Severe Uremia Encephalopathy

BackgroundAccording to statistics from the international society of Nephrology released in2006shows, there are about five hundred million people worldwide (approximately10%of the population) in chronic kidney disease in different degree, because ofend-stage renal disease requiring dialysis patients is as high as one million fivehundred thousand, and in the tendency of increase year by year, and the complicationsand mortality of patients in this part a higher level. Swiss study showed: the averagesurvival period of uremia patients was4.25years, survival rate of1years,3years,5years were88%,68%,46%. How to improve the survival rate, control of seriouscomplications, improve the prognosis becomes the research hotspot in recent years.Through continuous veno-venous hemofiltration and hemodialysis+hemoperfusionclinical efficacy in patients with uremic encephalopathy and laboratory analysis andcomparison of indicators to provide a basis for future clinical reasonable and effectivetreatment for patients with uremic encephalopathy.Chronic kidney disease (Chronic kidney disease, CKD) refers to the kidneydamage or glomerular filtration rate (glomerular filtration rate, GFR60ml/min) is lessthan1.73square meters, lasted3months, the renal injury including blood, urinecomposition abnormalities or abnormal imaging findings. USA National KidneyFoundation (National Kidney, fundation, NKF) for K/DOQI (kidney disease outcomequality initiative) guidelines, CKD should be divided into5stages (see Table1). Andrenal failure (chronic renal failur, CRF), end-stage renal disease (end-stage renaldisease, ESRD CKD) as the main outcome, patients had to rely on renal replacementtherapy (renal replacement therapy, RRT) sustain life.When the renal GFR <15ml/min1.73㎡, now often with symptoms and signsof uremia, or need to start giving renal replacement therapy (dialysis ortransplantation) to treat GFR reduce complications, all kinds of advanced kidneydisease, renal function due to a slowly progressive decline, eventually to metaboliteretention, water, electrolyte disorder, acid-base imbalance and clinical systemicsymptoms as the main performance of the syndrome. CKD often progresses toend-stage renal disease (end-stage renal disease, ESRD). Symptoms and signs of a serious decline in the GFR after become uremia (uremia), or uremic syndrome.Uremic toxin concentration fluid in uremic patients was significantly higher than thatof normal people, and can cause metabolic disorders, body water electrolysis alkali,acid metabolism, protein, carbohydrate, fat and vitamins. According to the uremictoxin molecular size is divided into: small molecules (molecular weight&lt;500D) such as potassium, phosphorus, urea, creatinine, uric acid, middle molecularsubstances (molecular weight500~10000D) such as: parathyroid hormone, largemolecules (molecular weight&gt;10000D): such as: cysteine proteinaseinhibitor C. Because of the variety of metabolites accumulate in the body for longterm, lead to a change in uremia patients with cardiovascular system, respiratorysystem, digestive system, blood system, nervous system and skeletal muscle. Whenpatients with uremic encephalopathy, severe pulmonary heart failure and severeinfection, severity of illness, the conventional hemodialysis, hemofiltrationhemoperfusion and etc. because time is short, clear toxins Co., hemodynamicinstability and other factors, cause patients can’t withstand the dialysis mode, itscondition deteriorated again, cause the crisis of life.ObjectiveBy contrast hemodialysis+hemoperfusion (IHD+HP) and continuous veno-venous hemofiltration (CVVH) treatment of uremic encephalopathy efficacy analysis,a clear continuous veno-venous hemofiltration to more efficiently remove the bodyof uremia toxins, so full of dialysis patients achieve better clinical, rapid remission ofdisease and prolong survival time of patients and improve their quality of life.MethodSelect the2011-01~2014-03in our hospital for hemodialysis treatment ofchronic renal failure-uremia47patients for the study, including26males and21females, mean age (61.2±7.6) years. Inclusion criteria were: the frequency of dialysisthree times a week, duration of dialysis were more than six months, associated withencephalopathy patients as research subjects, and the exclusion of cerebrovascularaccident, hypertensive encephalopathy, hepatic encephalopathy, pulmonaryencephalopathy, dialysis disequilibrium syndrome neuropsychiatric symptoms ofother diseases caused by aluminum poisoning. Primary disease was chronicglomerulonephritis (CGN)18cases of hypertensive nephropathy (HAN)15cases ofdiabetic nephropathy (DN)12cases, one case of polycystic kidney disease, chronic pyelonephritis one case.47cases were divided into hemodialysis+hemoperfusiongroup (control group, n=15) and continuous veno-venous hemofiltration (CVVH)group (observation group, n=32), two sets of clinical data, gender and agedifferences in other aspects of the non-significant, comparable. All patients providedwritten informed consent therapy, given conventional ECG, blood pressure, oxygen,respiratory monitoring.Research Methods1. Experimental Methods: Eligible patients in two different ways dialysis:hemodialysis+hemoperfusion and continuous veno-venous hemofiltration, beforetreatment, the laboratory indicators and vital signs after contrast.2. Dialysis Methods: Continuous veno-venous hemofiltration group(observation group) underwent CVVH treatment mode. CVVH models for theGerman Feisenyousi multi Filtrat, filter selection Ultraflux AV600s (Fresenius,polysulfone membrane, the membrane area of1.4m2). Blood flow150~200ml/min. Replacement fluid before and after dilution are entered as a replacement rate of4000ml/h, duration12~24h/d, according to the patient’s condition remissionadministered once or twice CVVH treatment, follow-up given to conventionalhemodialysis three times a week, observe the time limit of two weeks.Hemodialysis+hemoperfusion group (control group) Feisenyousi4008Bhemodialysis machine Germany, FreseniusFX80polysulfone membrane dialyzer(membrane area1.8㎡), hemoperfusion for Franc Kin HA sail a130(resin). Theperfusion series before dialysis, hemoperfusion time of2hours, blood flow180~220mL/min,2hours after application of saline back to the blood and removehemoperfusion continue hemodialysis. Blood flow to200~250/min, carbonatesdialysate, dialysate flow rate500mL/min, each time four hours of dialysis, threetimes a week. Observe the time limit of two weeks.3. Determination3.1The evaluation standard①cured: clinical symptoms disappeared completelyconscious, no convulsions and seizures;②remission: partial remission of clinicalsymptoms;③invalid: clinical symptoms were not relieved. Observation: remissionrate:(number of cases cured+number of cases remission)/total number of cases. 3.2blood sample specimens: Two groups of patients before and after treatment,the record heart rate (HR), oxygen, blood pressure. Laboratory indicators: beforetreatment and testing routine coagulation, serum creatinine (Scr), blood urea nitrogen(BUN), serum potassium concentrations after treatment (K+), serum sodiumconcentration (Na+) parathyroid hormone (PTH), β2-microglobulin (β2-MG),bicarbonate (HCO3-) and other indicators; before and after treatment, treatment,patient records every30minutes breathing, blood pressure, heart rate and other vitalsigns, observe the spirit of neurological signs in patients.3.3Determination of blood samples Lab: Application SYSMEX XE-2100analyzer blood cell count, hemoglobin, white blood cell count, neutrophilpercentage, coagulation analysis, application Beckman Coulter ACCESS2analyzerparathyroid hormone, application OLYMPUS AU2700analyzer blood urea,creatinine, uric acid, potassium, phosphorus, carbon, β2-microglobulinconcentration.Result1. Treatment: the state of consciousness of patients, laboratory indicators beforeand after treatment in varying degrees of improvement, clinical assessment of efficacythan before treatment improved after two weeks of treatment, but CVVH group(observation group) index the degree of improvement is more ideal, compared withthe control group was statistically significant.2. Monitoring indicators: After treatment, serum creatinine (Scr), blood ureanitrogen (BUN), serum potassium (K+), parathyroid hormone (PTH), β2-microglobulin (β2-MG) compared with treatment before improvement (decline indexP <0.05); but CVVH group (observation group) much improved these indicators,compared with the control group was statistically significant. After treatment, thepatient’s heart rate after treatment, serum sodium concentration (Na+), mean arterialpressure (MAP), prothrombin time (PT), international normalized ratio (INR),thrombin time (TT), activated partial thromboplastin original time (APTT) index didnot change significantly, the difference was not statistically significant (P>0.05).Conclusion1. The present study is an analysis that CVVH safe and effective method oftreatment of uremic encephalopathy, significantly better than hemodialysis+hemoperfusion; 2.CVVH clear serum creatinine (Scr), parathyroid hormone (PTH), β2-microglobulin (β2-MG) and blood urea nitrogen (BUN) the ability to hemodialysis+hemoperfusion; Efficacy and advantages related to the treatment of uremicencephalopathy;3.CVVH confirmed the efficacy of CVVH worthy of recognition in the bloodbefore and after treatment of water, electrolyte levels more stable, and the dynamicchanges in a controlled coagulation safe range.