尿毒出血之診斷與治療新進展

Update of Diagnosis and Treatment in Uremic Bleeding

葉時孟(Shih-Meng Yeh) ； 洪啓智(Chi-Chih Hung) ； 陳鴻鈞(Hung-Chun Chen)

《內科學誌》 22卷1期 (2011/02) Pp. 40-47

https://doi.org/10.6314/JIMT.2011.22(1).05

摘要

當腎臟功能惡化進展到尿毒症，通常影響的是全身性的問題，出血傾向是其中的一環，統稱爲尿毒出血，其背後的原因是多元的，包括尿毒素的堆積、繼發於腎功能不良的貧血等，主要影響的是血小板的功能。傳統測定尿毒出血傾向的方法是出血時間，較具侵襲性且再現性低。現今已有多種新的測定血小板功能的方法，已部分嘗試於此方面的評估。現有的治療包括透析、校正貧血、抗利尿激素使用等，皆基於實驗室數據的改善，尚缺乏直接的證據，有賴更進一步的臨床研究。

關鍵字

慢性腎臟病 ； 血小板功能異常 ； 尿毒症 ； 尿毒出血

並列摘要

As renal function deteriorates to uremic stage, the whole body involved. Influence on hemostasis is just a part, called uremic bleeding, likely to be multifactorial, including accumulation of uremic toxins and anemia secondary to ineffective erythropoiesis, eventually result in platelet dysfunction. The traditional way for evaluating bleeding tendency in uremic patients is bleeding time, which is much invasive and has poor reproducibility. New methods are developed for investigation of platelet function, partially applied to evaluation of uremic bleeding. Present treatment of uremic bleeding includes dialysis, correction of anemia and desmopressin therapy. It is primarily based on improvement of laboratory data, but lacks direct impact on outcome. Further clinical trials are needed to prove.

並列關鍵字

Chronic kidney disease ； Platelet dysfunction ； Uremia ； Uremic bleeding