糖尿病肾病血液透析难点分析与对策

Strategies and analysis of difficulties on hemodialysis for diabetic nephropathy

目的应用血液透析方法治疗糖尿病肾病患者肾衰竭,探讨糖尿病肾病患者血液透析的难点及应对策略,旨在加强和提高该类患者的血液透析治疗水平。方法采取患者对照研究,以我院2001年1月～2008年1月间行血液透析的糖尿病肾病患者53例为治疗组,非糖尿病肾病患者50例为对照组,观察两组进行透析时的肌酐、尿素氮和血糖水平及透析并发症的发生情况等。结果两组透析前血糖水平差异有统计学意义,但肌酐、尿素氮情况差异无统计学意义;并发症的发生情况治疗组明显高于对照组,差异有统计学意义;治疗组组内比较,治疗后死亡患者介入透析时肌酐尿素氮水平明显高于生存患者;治疗组血管通路建立难点较大。结论血液透析在糖尿病肾病中应用确切有效,但并发症多、血管通路建立有一定难度,应根据患者情况,采取个体化透析策略和血管通路建立。

Objective Hemodialysis was performed on the patients with chronic renal failure caused by diabetic nephropathy. We discussed the difficulties and strategies on hemodialysis for diabetic nephropathy, in order to improve the quality of the treatment of hemodialysis.Methods By using case-control study, we retrospectively analysised the patients with hemodialysis during 2001,1 - 2008, 1,which was divided into diabetic nephropathy group（53 cases）and non-diabetic nephropathy group（50 cases）. The serum creafinine, serum urea nitrogen, blood glucose and complications of hemodailysis were observed. Results There were no significant differences of the levels of serum creatinine and urea nitrogen between the two groups,but the incidence d complications was obviously higher in diabetic nephropathy group than in non-diabetic nephropathy group（ P 〈 0.05）.In diabetic nephropathy group,the levels of serum creatinine and urea nitrogen after hemodialysis were significantly higher in died patients than survivors. Besides, the establishment of hemodialysis vascular access was more difficult in diabetic nephropathy group. Conclusion Hemodailysis was effective on the treatment of end stage renal failure caused by diabetic nephropaty with more complications and difficulties on the establishment of hemodialysis vascular access than non-diabetic nephropaty,so we should take hemodialysis and establish vascular access by individualization.