| Objective:This study intends to explore the risk factors of cerebral hemorrhage in uremic patients undergoing hemodialysis and the advantages of sodium citrate anticoagulant continuous renal replacement therapy(CRRT)in the treatment of uremic cerebral hemorrhage.Methods:A total of 44 uremic patients with cerebral hemorrhage treated in the affiliated Hospital of Qingdao University and its surrounding hospitals from January 2012 to June2020 were analyzed retrospectively.224 uremic patients without cerebral hemorrhage matched with age and sex in the same period were randomly selected for control.The risk factors of cerebral hemorrhage in hemodialysis patients from the aspects of past history,primary disease,dialysis mode,selection of anticoagulants,blood pressure and biochemical indexes,etc were explored.The patients with uremic cerebral hemorrhage were divided into two groups according to whether they were treated with sodium citrate anticoagulant CRRT or not,and the advantages of sodium citrate anticoagulant CRRT in the treatment of uremic cerebral hemorrhage were compared and analyzed.Independent sample t-test,χ2 test,Mann-Whitney U test and logistic regression analysis were used to process the data.A line map of risk factors was drew,and a clinical prediction model was established.Results:1.There were significant differences in previous cerebrovascular events,hypertension,daily systolic blood pressure during dialysis,systolic blood pressure before cerebral hemorrhage,serum sodium,serum calcium,B-type natriuretic peptide(BNP),triglyceride,D-dimer,C-reactive protein,white blood cell count,polycystic kidney disease and daily use of warfarin between the two groups with or without cerebral hemorrhage.Based on the multivariate regression analysis of the above influencing factors,it was found that low serum sodium,high serum calcium,high white blood cell count,high systolic blood pressure during daily dialysis,pre-event systolic blood pressure of cerebral hemorrhage,past history of hypertension,previous history of cerebrovascular events,primary disease of polycystic kidney and daily use of warfarin were closely related to cerebral hemorrhage events.The above results further show the influence of various factors on the occurrence of cerebral hemorrhage.2.17 patients were treated with sodium citrate anticoagulant CRRT among the 44 patients with cerebral hemorrhage.All of them survived and the survival rate was 100%.In 27 patients without sodium citrate anticoagulant treatment,17 patients survived and 10 died after heparin-free hemodialysis,and the survival rate was only 63.0%.The difference was statistically significant(χ2=8.148,P=0.004).Before treatment,there was no significant difference in serum calcium,serum sodium,serum potassium,CRP,D-dimer,white blood cell count,platelet count and triglyceride levels between the two groups(P >0.05).BNP in the sodium citrate anticoagulation group was significantly higher than that in the heparin-free group(P < 0.05).After treatment,serum calcium,CRP,D-dimer,serum potassium,white blood cell count and triglyceride in sodium citrate anticoagulation group were significantly lower than those in heparin-free group(P < 0.05),serum sodium level and platelet count were significantly higher than those in heparin-free group(P <0.05),There was no significant difference in BNP between the two groups after treatment(P > 0.05).3.The patients with cerebral hemorrhage were divided into survival group and death group.It was found that the serum BNP,serum calcium,CRP,D-dimer,serum phosphorus and leukocyte count in the survival group were significantly lower than those in the death group.However,the serum albumin,serum sodium and platelet count in the survival group were significantly higher than those in the death group.Conclusion:1.It was found that history of hypertension,high systolic blood pressure before cerebral hemorrhage,high systolic blood pressure during daily dialysis,previous history of cerebrovascular events,primary disease of polycystic kidney,daily use of warfarin,hypercalcemia,hyponatremia,high BNP,high triglyceride,high white blood cell count and high CRP,were risk factors for cerebral hemorrhage in uremic hemodialysis patients.The above risk factors were introduced into the multifactor model to construct a prediction model including low serum sodium,high serum calcium,high white blood cell count,high systolic blood pressure during daily dialysis,systolic blood pressure before cerebral hemorrhage,past history of hypertension,previous cerebrovascular events,polycystic kidney disease and daily use of warfarin,showing the degree of influence of various factors on cerebral hemorrhage events.This model can be referred to predict the risk of cerebral hemorrhage in hemodialysis patients with uremia and actively prevent it.2.Sodium citrate anticoagulation has obvious advantages over heparin-free anticoagulation,which is the core technology for the successful treatment of cerebral hemorrhage in uremic hemodialysis patients.The mechanism of reducing the death of patients with cerebral hemorrhage is not only to ensure the non-coagulation of extracorporeal blood and filter,full dialysis,reduce sodium and water retention,lower blood pressure,but also improve the hyponatremia and hypercalcemia state of uremic patients with cerebral hemorrhage through its own components.In addition,it can reduce inflammatory reaction,and ensure the success rate of treatment,highlighting the advantage of sodium citrate anticoagulation in the treatment of patients.3.It was found that most of the risk factors of cerebral hemorrhage,including hypercalcemia,hyponatremia,high white blood cell count and high CRP,could be effectively corrected by sodium citrate anticoagulant CRRT treatment by comparing the laboratory data of survival and death patients after treatment. |
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