A Comparison On Clinic Efficacy Of Continuous Renal Replacement Therapy And Intermittent Hemodialysis In Patients With Uremic Encephalopathy

backgrounds and objections:uremic encephalopathy refers to the nervous and mental disorders in uremic patients.The complications of the nervous system can be seen usually in patients with uremia,and its serious impact on the quality of lives of those patients with chronic kidney disease, the pathogenesis of uremic encephalopathy is not yet entirely clear. It may be related to uremic toxins,water, electrolyte disturbance and metabolic acidosis and other relevant. Some large and medium molecular substances, such as PTH andβ2-MG may play an important role in pathogenesis of uremic encephalopathy. The clinical manifestations of uremic encephalopathy is various.In the early,th-ere may be mainly manifested that the disturbance of consciousness, fati-gue, insomnia, inability to concentrate, personality changes, depression, memory loss and misjudgments, etc. It may be found that the nystagmus, dysarthria, gait abnormalities, decreased muscle strength, muscle spontaneous contraction, tendon reflex asymmetry during the checkup. Pounce-like tremor is a specific performance of the patients with uremic enceph-alopathy, it is often associated with disturbance of consciousness simul-taneously. In the late, epilepsy and coma may appear. The treatments of uremic encephalopathy include general treatment and dialysis therapy. The most commonly used treatment is hemodialysis. This article aims to observe the continuous renal replacement therapy and intermittent hemo-dialysis in uremic encephalopathy compared to facilitate future treatment of uremic encephalopathy choice.Research Methods:21 patients with uremic encephalopathy were included in this study,who were chosen in the second clinical hospital of Jilin University from March 2009 to December 2009. They are all in line with the diagnostic criteria of uremic encephalopathy, after ruled out other causes of mental illness caused by the nerve.11 patients were received CRRT treatment (groupⅠ),10 patients were received IHD treatment (groupⅡ). Clinical data were recorded from medical records. Including the patients'age, sex, primary diseases and symptoms, signs, blood pressure, blood biochemical screening. Comparing the differences of serum creatinine, blood urea nitrogen and blood pressure before and after the two treatments. Data analysis using statistical methods, qualitative data were presented as the number of cases (percentage) and the quantitative data were presented as mean±standard deviation. t test was used to compare measurement data within and between groups, with P<0.05 defined as a statistically significant difference.Results:(1) 21 patients with uremic encephalopathy,11 patients were received CRRT treatment (group I),10 patients were received IHD treatment (groupⅡ). patients in groupⅠaged 46-79 years, mean age were (65±9) years,2 people with chronic glomerulonephritis,4 people with diabetic nephropathy,2 persons with chronic interstitial nephritis,3 people with hypertensive arteriolar nephrosclerosis, included 6 men and 5 women with the ratio of 6:5. patients in group II aged 50-76 years, mean age were (63±8)years,3 people with chronic glomerulonephritis, diabetic nephropathy 3 people,2 persons with chronic interstitial nephritis, hypertensive arteriolar nephrosclerosis 2 people,6 men and 4 women with the ratio of 6:4. The ages, gender and primary diseases were not significantly different between the two groups' patients.(2) The patients of the two groups with the most common clinical manifestations of consciousness, lethargy, accounting for 47.6%, patients of groupⅠwith major clinical manifestations:1 patient pounce like tremor,1 patient apathy, speech is unclear,5 cases consciousness, lethargy,1 patient developed hallucinations,1 case of a convulsion,2 patients had restless. The main clinical manifestations of groupⅡ:2 patients had lap-like tremor,2 patients had apathy, speech is unclear,5 cases of consciousness, lethargy,1 patient restlessness. The two groups had no significant differences in clinical manifestations.(3) The blood pressure value of patients in group I remained stable during the treatment,No hypotension occurred and changes of systolic blood pressure, mean arterial blood pressure did not differ significantly (p> 0.05) in all time. Systolic blood pressure and mean arterial pressure of the patients in groupⅡin the first 1,2,3-hours decreased significantly compared with those before the treatment, a gradual pick-up happend after the end of the treatment, there are three people appeared low blood pressure, low blood pressure rate was 30%. In which systolic blood pressure in 1,2,3 hours and 10 minutes after the end of the treatment declined which compared with those pre-treatment,The differences were significant (p<0.05), mean arterial pressure in 1,2,3 hours and 10 minutes after the end of the treatment declined when compared with pre-treatment differences also have significance (p<0.05).(4) The two groups before treatment in patients with serum creatinine values were no significant difference (p>0.05), blood urea nitrogen values were no significant difference (p> 0.05). Serum creatinine values after treatment in groupⅠwere Lower than groupⅡ, and differences between the two groups were significant (p<0.05). The urea nitrogen values of groupⅠwere lower than that in groupⅡ, and the differences between the two groups were significant (p<0.05).(5) All patients in groupⅠalleviated symptoms after one week's treatment, with the remission rate of 100%.Dialysis caused imbalances in brain aggravating circumstances did not appeare during the treatment, only three people in patients of groupⅡalleviated the symptoms, remission rate of 30% in one week,9 patients alleviate d the symptoms in 2 weeks, a patient reduced the symptoms slightly, remission rate was 90%. one patient performanced dialysis disequilibrium In the early stage of the treatment in GroupⅡ. the average time in remission of GroupⅠwas (1.25±0.95) days,while the number of groupⅡwas (8.44±3.28) days,The treatment time in groupⅡwas longer than that in groupⅠ, the difference was statistically significant (p<0.05).Conclusions:1.This study suggested that hemodynamic stability of CRRT was better than IHD,blood pressure changed little during CRRT treatment.2.CRRT had a better removal ability of Serum creatinine and blood urea nitrogen than IHD (P<0.05).3.The remission rate of CRRT was higher than IHD, and the time of treatment was shorter (P<0.05). The advantages of CRRT provide more choice for the treatment of uremic encephalopathy.