维持性血液透析联合血液灌流治疗尿毒症的临床研究

Clinical Analysis of Maintenance Hemodialysis Combined with Hemoperfusion for Treatment of Uremic Patients

目的探讨观察血液透析(HD)和血液灌流(HP)联合治疗维持性血液透析(MHD)尿毒症患者的临床疗效。方法67例MHD尿毒症患者随机被分为观察组(34例)和对照组(33例)。观察组采用HD和HP联合治疗,对照组采用单纯HD治疗。比较治疗后两组生存率、死亡原因、β2-微球蛋白(β2-MG)、甲状腺激素(PTH),并观测患者皮肤瘙痒改善情况。结果①观察组1年和3年生存率高于对照组,病死率低于对照组,但差异均无统计学意义(P>0.05);观察组5年生存率为82.4%,高于对照组(75.8%)(P<0.05);病死率17.6%,低于对照组(24.2%)(P<0.05)。②观察组PTH、β2-MG指标降低,与治疗前和对照组比较差异均有统计学意义(P<0.05)。对照组治疗前后PTH、β2-MG检测结果差异无统计学意义(P>0.05)。③观察组皮肤瘙痒临床症状明显改善,临床症状总有效率为94.1%,高于对照组(24.2%)(P<0.05)。结论HD+HP联合治疗能有效提高MHD患者的生存率,降低病死率,弥补单纯HD的不足,减轻瘙痒症状,值得临床推广应用。

Objective To discuss the clinical efficacy of maintenance hemodialysis （HD） combined with hemoperfusion （HP） for treatment of uremic patients. Methods Sixty- seven maintenance hemodialysis （MHD） patients of uremia were randomly divided into observation group （n = 34） and control group （n = 33）. The patients in observation group were received maintenance hemodialysis combined with hemoperfusion （HD ＋ HP）, while the patients in control group were given simple HD. After treatment, the survival rate, the cause of death, β2 -microglebulin （β2 MG）, thyroid hormone （PTH）, and pruri- tus were compared between the two groups. Results The 1 - year and 3 - year survival rates were higher in observation group than those in control group, the mortality rate was lower in observation group than that in control group, but no statisti- cally significant difference was found between the two groups （P 〉 0.05）. The 5 - year survival rate of observation group （82.4%） was higher than that of control group （75.8%） （P〈0.05）, while the mortality rate of observation group （17.6%） was lower than that of control group （24.2 % ） （P〈 0.05）. As compared with before treatment and control group, PTH and -MG of observation group were decreased, there were statistically significant differences among them （P〈 0.05）. There was no statistically significant difference in PTH and β2 - MG of control group before and after treatment （P〉0.05）. Clinical symptom of pruritus of observation group was significantly improved; the total effective rate of clinical symptoms was 94.1%, which was higher than that of control group （24.2 % ） （P〈 0.0.5）. Conclusion Combination therapy of HD ＋ HP can ef- fectively improve the survival rate of MHD patients, lower mortality, make up for the lack of pure HD, and reduce the clinical symptom of pruritus; it is worthy of clinical application.