老年尿毒症患者血液透析滤过临床疗效

A clinical study on hemodiafiltration in elderly patients with uremia

目的探讨老年尿毒症患者对血液透析滤过（ＨＤＦ）的耐受性及临床疗效。方法回顾性分析２０例老年尿毒症患者１６６例次ＨＤＦ，并与其常规血液透析（ＨＤ）治疗进行比较。结果患者对ＨＤＦ治疗的耐受性显著优于ＨＤ，且ＨＤＦ对小分子及中分子尿毒性物质的清除显著优于ＨＤ，ＨＤＦ治疗前血β２微球蛋白（β２－ＭＧ）值６０．７±１２．９ｍｇ／Ｌ、甲状旁腺素（ＰＴＨ）２．０±１．３ｐｇ／Ｌ，治疗后分别为４９．９±１１．０ｍｇ／Ｌ，及１．１±０．９ｐｇ／Ｌ，治疗前、后差异均有非常显著性（Ｐ＜０．０１及＜０．００１）；而ＨＤ治疗前后β２－ＭＧ分别为５２．８±１２．７及５１．７±１１．９ｍｇ／Ｌ（Ｐ＞０．０５），ＰＴＨ１．９±１．６及１．９±１．８ｐｇ／Ｌ（Ｐ＞０．０５）。结论老年尿毒症患者ＨＤＦ未发生ＨＤ时发生的顽固性高血压、严重的低血压、心律失常、心绞痛、心力衰竭、体腔积液等，提高了对透析治疗的耐受性。

Objective To study the tolerance and clinical effect of hemodiafiltration (HDF) in elderly patients. Methods The clinical tolerance, adequate index of dialysis and clearance of β 2 microglobulin(β 2 MG) and parathyroid hormone (PTH) in 20 cases of elderly uremic patients treated with HDF for 166 times were compared to those when they routinely treated with hemodialysis (HD). Results The clearances of small and middle molecule toxins by HDF were significantly better than that of HD. Before and after the treatment the β 2 MG value and PTH value were significantly different ( P <0 001). But before and after the treatment with HD the β 2 MG value and PTH vlaue were not significantly different ( P >0 05)。 There were no refractory hypertension, serious low blood pressure, arrhythmia, angina pectoris and heart failure occurred in HDF. Conclusions HDF increases the tolerance to dialysis and significantly improve the effect of dialysis in elderly uremic patients.