目的 观察无肝素序贯血液透析对尿毒症合并脑出血患者的临床效果。方法 慢性肾衰竭尿毒症患者40例随机分为无肝素序贯血液透析组(A组)、单纯无肝素血液透析组(B组);分别于发病24 h内,发病后第3、7、14 天测定并比较两组基质金属蛋白酶-9(matrix metalloproteininase-9,MMP-9)、白介素-8(Interleukin-8,IL-8)、白介素-10(Interleukin-10,IL-10);行头颅CT观察血肿及水肿体积,分析脑出血的预后。结果 两组发病后第7、14天与发病24 h内MMP-9、IL-8、IL-10、血肿及水肿体积比较,差异均有统计学意义(P＜0.05);B组与A组发病后第7、14天上述指标比较,差异均有统计学意义(P＜0.05);心律失常、心力衰竭、肺部感染影响脑出血的预后。结论 尿毒症合并脑出血采用无肝素序贯血液透析治疗安全有效,值得推广。

Objective To investigate clinical effect of sequential hemodialysis without heparine in treatment and prevention of intracerebral hemorrhage in uremic patients. Methods From this hospital we recruited 40 patients with chronic renal failure and uremia who were randomly divided into 2 groups. Group A underwent sequential hemodialysis without heparin; groups B recieived traditional hemodialysis without heparin. Comparative analysis was made of the correlation among different indexes at 24 hours, 3 days,7 days,and 14 days by detecting matrix metalloproteininase-9(MMP-9),interleukin-8(IL-8), interleukin-10(IL-10). The CT of head was serially performed to calculate the volume of hemorrhage and perihematomal hypodensity; multivariate logistic regression analysis of prognosis on intracerebral hemorrhage was conducted. Results Comparing group A and group B at 7 days and 14 days,there were statistically significant differences in MMP-9, IL-8, IL-10,hemorrhage and perihematomal hypodensity(P<0.05). Multivariate logistic regression analysis showed that heart failure, arrhythmia,and pulmonary infection are the effects of prognosis on intracerebral hemorrhage. Conclusions Treatment of intracerebral hemorrhage in uremic patients using sequential hemodialysis without heparine is safe, effective, and worthy of clinical application.