不同透析方法对尿毒症患者血钙的影响观察

Observation to the Effect on Blood Calcium of Patients with Uremia in Different Dialysis

目的观察不同透析方法对尿毒症患者血钙的影响,为尿毒症临床治疗和预后评估提供实验依据。方法选尿毒症患者58例,分为血液透析(HD,n=26,碳酸氢盐透析液)和腹膜透析(PD,n=32,1.5%及2.5%卡糖乳酸盐透析液)两组,两组对象年龄、患病情况、透析时间有可比性,并分别于透析前后采集静脉血,测定血钙离子浓度及血尿素氮、肌酐、钙、磷和白蛋白等生化指标。结果与讨论1.PD病人存在低血钙,透析后血钙浓度异常仍然存在;2.本组透出液中的钙浓度为(1.56±0.27)mmol/L,较灌入液的钙浓度(1.75mmol/L)低,说明透析液钙浓度较为安全;3.PD者血钙有随PD龄增加而升高趋势,因此,对透龄长者推荐选用低钙腹透液,以降低高钙血症的危险性;4.HD患者透后血钙(2.58±0.32)明显高于透前(2.16±0.21)mmol/L,其高钙血症发生率透后(65.4%)也明显高于透前(7.7%),表明HD较PD更易发生高钙血症,因此,采用HD透析时透析液钙离子浓度应视患者血钙浓度设计个本化方案。

Objective To observe the effect on the blood calcium of patients with uremia in different dialysis methods and provide experimental data for clinical treatment and prognosis evaluation to uremia. Methods Choose 58 cases with uremia and divide into two groups ： hemodialysis group（ HD, n = 26, bicarbonate dialysis liquid system） and peritoneal dialysis liquid）and peritoneal dialysis（ PD, n = 32,1.5% and 2.5% ） bicarbonate dialysis liquid system）. The two groups have comparability in age, sickness status and dialysis time, and collect venous blood before and after dialysis, measure the content of blood calcium and some biochemical indexes such as blood urea nitrogen, ereatinine calcium,phosphorus and albumin. Results and Conclusion 1. The patients with PD has hypocalcemia,and abnormal content of blood calcium after dialysis still exists. 2. The content of peritoneal effluent in this group is （ 1.56 ± 0.27） mmol/L,which is lower than that of inject liquid（ 1.75 mmol/L）. It means the safe calcium content of dialysate. 3. The blood calcium of PD patients has the rising trend with the increase of PD time. Therefore, in order to lower the danger of hypercalcemia the patients should choose peritoneal dialysis solutions with low calcium. 4. The content of HD patients blood calcium（2.58±0.32）mmol/L after dialysis is significantly higher than that before dialysis（2.16 ±0.21 ）mmol/L. And its incidence of hypercalcemia after dialysis （65.4%） is also significantly higher than that（7. 7% ） before it, which means HD is easier to happen hyperccalcemia than PD. Therefore, the content of calcium of dialysate through HD should be designed according to the individualized content of blood calcium.