适应性血液过策略在终期怀孕与末期脏疾病:一个案例报告
Masato Sakai1, Erika Hishida1,2, Manabu Ogura3
1Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke, Japan.
Case reports in nephrology and dialysis
|December 15, 2025
概括
在怀孕期间管理末期病 (ESKD) 需要小心透析. 连续在线血液过 (OL-HDF) 和间歇性HDF (i-HDF) 有效地控制了低蛋白血症和液体平衡,确保了母亲和新生儿的积极结果.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 产科 产科 产科 产科 产科
- 孕产妇和胎儿医学 孕产妇和胎儿医学
背景情况:
- 在透析的末期病患者 (ESKD) 中,怀孕带来了重大挑战.
- 低albuminemia是这些怀孕中对母亲和新生儿不良后果的主要危险因素.
研究的目的:
- 在使用自适应性血液透析策略的ESKD患者中展示成功管理怀孕的案例.
- 突出连续在线血液过 (OL-HDF) 和间歇性血液过 (i-HDF) 在处理复杂病例中的作用.
主要方法:
- 一名27岁的ESKD患者在怀孕30周+5周时因渐进的低albuminemia而从OL-HDF过渡到i-HDF.
- 流体管理利用生物阻抗分析和人类心房 natriuretic (hANP) 水平进行干重调整.
- 在分娩期间叠加的孕前被保守地管理.
主要成果:
- 与OL-HDF相比,间歇性HDF (i-HDF) 显示了减少的白蛋白损失.
- 孕妇的血液动力学稳定,使得39+1周的分娩能够实现.
- 一个体重为2,774克的健康新生儿出生,精确的流体管理实现了6.4公斤的妊娠体重增加.
结论:
- 连续的OL-HDF和i-HDF在治疗ESKD怀孕中低albuminemia和液体不平衡方面是有效的.
- 适应性透析策略有助于成功的母亲和新生儿结局.
- 以生物阻抗分析和hANP为指导的精确流体管理至关重要.
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