不同钙浓度透析液对维持性血液透析患者影响的对照研究

A clinical control study the effects of different calcium dialysate on maintenance hemodialysis patients

目的观察不同钙浓度(1.25mmol/L和1.75mmol/L)透析液治疗6个月对患者血压、钙、磷和甲状旁腺素影响。方法选择中山大学附属第三医院肾内科维持性血液透析患者20例,首先接受钙离子1.75mmol/L(高钙)透析液治疗6个月,而后接受钙离子1.25mmol/L(低钙)透析液治疗6个月,其它治疗不变。检测两种治疗组入组时、后3个月和6个月患者透析前后血压、血清钙、磷、甲状旁腺素、碱性磷酸酶的水平。结果使用低钙透析液单次治疗4h后血压下降(P<0.05),血钙下降7.5%(P>0.05),甲状旁腺素升高(P<0.05);而高钙透析液治疗后血压和血钙均升高(P<0.05),甲状旁腺素有所下降(P>0.05);治疗6个月后,使用低钙透析液,患者血压下降(P>0.05),血钙下降(P>0.05),血磷和钙磷乘积显著下降(P<0.05),甲状旁腺素升高(P>0.05),碱性磷酸酶升高(P<0.05);两种钙离子浓度透析液应用后收缩压、甲状旁腺素和碱性磷酸酶的变化相比差异有显著性(P<0.05)。结论单次应用低钙透析液进行透析,透析后甲状旁腺素升高,血压下降;与使用高钙透析液相比,长期应用(6个月)低钙透析液进行透析,钙负荷减轻,血钙磷乘积和收缩压下降,血清甲状旁腺素和碱性磷酸酶升高。

Objective To investigate the changes of blood pressure, serum calcium, phosphate and parathyroid hormone in hemodialysis patients after being treated with different calcium dialysate （1. 25mmol/L and 1.75mmol/L） for 6 months Methods Twenty patients were enrolled in this study. These patients firstly received high calcium dialysate（1.75mmol/L） for 6 months, then accepted low calcium dialysate （1. 25mmol/L）therapy for 6 months while other therapy remained. Unchanged blood pressure, serum calcium, phosphate, parathyroid hormone and alkaline phosphatase were measured before and after one dialysis session at the beginning, 3 and 6 months later. Results Serum calcium level decreased 7.5 percent（P〉 0.05）, blood pressure decreased （P〈0.05）and parathyroid hormone increased（P〈0.05） in post dialysis compared with pre-dialysis for single low calcium dialysis; While blood pressure and serum calcium increased （P〈0.05） and parathyroid hormone decreased（P〉0.05） in post dialysis for single high calcium dialysis. During 6 months with low calcium dialysate, serum calcium and blood pressure gradually dicreased, while serum parathyroid hormone gradually increased. However these changes didn＇t show statistical difference（P〉 0.05）. But serum alkaline phosphatase increased remarkedly （P〈0.05）,serum phosphate and calcium-phosphate product decreased remarkedly（P〈0.05）. The changes of systolic blood pressure, parathyroid hormone and alkaline phosphatase due to different calcium dialysate showed statistical difference（P 〈0.05）. Condusion Serum parathyroid hormone increased with single low calcium dialysis. Calcium load, systolic blood pressure and serum calcium-phosphate decreased, serum parathy roid hormone increased, serum alkaline phosphatase increased remarkedly after 6 months dialysis with low calcium dialysate contrasted with high calcium dialysate.