高通量血液透析与常规血液透析联合血液透析滤过治疗血液透析患者的生活质量评分比较

Comparison of quality of life score in patients with high-flux hemodialysis and those with conventional hemodialysis combining hemodiafiltration

目的比较高通量血液透析(high-flux hemodialysis,HFHD)与常规血液透析(hemodialysis,HD)联合血液透析滤过(hemodiafiltration,HDF)治疗尿毒症患者的生活质量评分。方法选择维持性血液透析患者41例,随机分为试验组(HFHD,3次/周)21例;对照组(HD2次/周+HDF1次/周)20例,平均随访36月,进入试验前1周内(基线期)及试验结束进行生化检测,用简明健康测量量表(short form 36 health survey questionnaire,SF-36)进行生活质量评估。结果试验组和对照组生活质量评分治疗后无明显统计学差异(生理机能:t=1.682,P=0.254;生理职能:t=1.697,P=0.251;躯体疼痛:t=1.682,P=0.234;一般健康状况:t=1.682,P=0.149;精力:t=1.682,P=0.481;社会功能:t=1.682,P=0.497;情感职能:t=1.690,P=0.349;精神健康:t=1.682,P=0.354)。试验组和对照组治疗前后尿素清除指数Kt/V的变化2组间比较无统计学差异(0.05±0.19比0.02±0.20,Z=0.874,P=0.472);试验组和对照组治疗前后尿素下降率(urea reduction ratio,URR)的变化2组间比较无统计学差异[(1.96±0.29)%比(2.02±7.34)%,Z=1.096,P=0.363]。但试验组经治疗后生理机能、生理职能、躯体疼痛、一般健康状况、社会功能、情感职能、精神健康评分均有上升,且上升趋势较对照组明显。结论 2种透析方式的总体疗效和患者的生活质量评分可能是相当的。由于高通量血液透析经济成本较低,护理操作较简单,故可能更有临床推广潜力。

To compare the efficacy and quality of life score in uremic patients with high-flux hemodialysis （HFHD） and those with conventional hemodialysis （HD） combining hemodiafiltration （HDF）. Methods Forty-one maintenance hemodialysis （MHD） patients were randomly divided into experimental group （HFHD 3 times/week） and control group （HD 2 times/week plus HDF one time/week）. They were followed up for an average of 36 months. Kt/V, URR, and the SF-36 scale were measured at baseline and after the treatment for 36 months. Results The SF-36 score （including physical functioning, role-physical, bodily pain, general health, energy, social functioning, role-emotional, mental health scores）, Kt/V1, and URR had no significant differences between the two groups （P〉0.05）. However, physical functioning, role-physical, bodily pain, general health, social functioning, role-emotional, and mental health scores in experimental had an increasing trend compared with the control group. Conclusion The long-term efficacy of the two dialysis patterns may be comparable. HFHD may have more clinical potentials regarding its lower expenses and relatively simple nursing operation.