Eiser A R, Lieber J J, Neff M S
Department of Ambulatory Care, Elmhurst Hospital Center, NY, USA.
Clin Nephrol. 1997 Jan;47(1):47-9.
To assess the efficacy of phlebotomy in the treatment of pulmonary edema in hemodialysis patients.
Maintenance hemodialysis patients presenting to the emergency room in respiratory distress from apparent pulmonary edema were assessed with regard to clinical response, change in blood pressure, change in hematocrit, and interval until the next hemodialysis treatment,
Twenty-one patients underwent phlebotomy and seventeen improved markedly and did not require intubation or emergent dialysis. Hemodialysis was initiated 15.6 +/- 13.6 SD hours later. Four were able to have their treatment 24 or more hours later. Thirteen of 21 (62%) were hypertensive at the time of treatment and blood pressure tended to normalize in this subset. Four of 21 (19%) developed transient hypotension without permanent sequelae. Pre-mean hematocrit = 25.0 + 6.0 and post phlebotomy = 22.6 + 4.6 SD. All patients receiving phlebotomy survived to hospital discharge.
Phlebotomy can often obviate the need for intubation or emergent dialysis in ESRD patients presenting with pulmonary edema.
评估放血疗法对血液透析患者肺水肿的治疗效果。
对因明显肺水肿而出现呼吸窘迫并前往急诊室的维持性血液透析患者，就临床反应、血压变化、血细胞比容变化以及直至下一次血液透析治疗的间隔时间进行评估。
21例患者接受了放血疗法，其中17例明显好转，无需插管或紧急透析。15.6±13.6标准差小时后开始进行血液透析。4例患者能够在24小时或更长时间后接受治疗。21例中有13例（62%）在治疗时患有高血压，该亚组患者的血压趋于正常。21例中有4例（19%）出现短暂性低血压，无永久性后遗症。放血术前平均血细胞比容=25.0+6.0，术后=22.6+4.6标准差。所有接受放血疗法的患者均存活至出院。
对于出现肺水肿的终末期肾病患者，放血疗法通常可避免插管或紧急透析的需要。
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