透析机自产回输液行血液透析滤过On-line HDF的临床研究

Clinical study of on-line hemodiafiltration

目的探讨On-lineHDF的安全性、病人耐受性及临床疗效。方法设置On-lineHDF治疗组(I组)和常规HD对照组(II组),观察治疗前、中、后病人状况,溶质变化和溶质下降率,包括Cr、BUN、β2-MG、PTH、KT/V。结果HDF治疗中、治疗后病人无发热,6例顽固性血压易于控制,5例在HD中易出现低血压症状好转,3例皮肤瘙痒严重者明显好转,HDF组治疗前后Cr,β2-MG,PTH显著下降;HD组治疗前后β2-MG、PTH相差不显著。治疗前及2月后溶质变化,两组Cr,β2-MG相差不显著;HDF组PTH前后有显著性差异;KT/V值比较,HDF为1.68±0.34,HD为1.21±0.23,两组有显著性差异(P<0.05)。结论On-lineHDF较传统HDF操作简单,自产回输液安全,病人有较好的耐受性和心血管稳定性,其对小分子、中分子物质的清除能力优于常规HD。

Objective To study the safety, patient's tolerance and clinical effects of on-line HDF. Methods Patients were divided in two groups. Group I was treated with conventional hemodialysis (HD) and on-line hemodiafiltration (HDF) each a week respectively, while group II was treated with HD twice a week. Patient's condition was observed and serum creatinine (Cr), Urea, β2-microglobulin (β2-MG), parathyroid hormone (PTH) were monitored before and after treatment. KT/Vurea was calculated after each HDF or HD. Results No patient has a fever during and after treatment with HDF. The blood pressure of six patients with stubborn hypertension became to be easily controlled after HDF. Five patients who had hypotension during conventional HD did not have hypotension in HDF. Severe uremic pruritus of three patients alleviated markedly after HDF. The levels of serum Cr,β2-MG,PTH decreased significantly after HDF, whereas the levels of β2-MG and PTH were not significantly different after HD. The levels of Cr andβ2-MG of both group patients did not significantly decrease after two months treatment, but the PTH levels of group I significantly decreased. KT/Vurea of HDF (1.68±0.34) was higher than that of HD (1.21±0.23). Conclusion On-line HDF, as compared with conventional HD, offers a better cardiovascular stability, clearance of PTH, clinical improvement and treatment tolerance. On-line prepared substitution fluid is safe.