血液灌流联合血液透析对尿毒症并发症疗效观察

The Effect of Hemoperfusion Combined with Hemodialysis in Patients with Uremia

目的观察血液灌流联合血液透析对尿毒症并发症的治疗效果。方法选取维持性透析尿毒症患者40例,将灌流器串联于透析器前,血流量150～240ml/min,透析液流量500ml/min,肝素用量首剂16～20mg,追加6～8mg/h或低分子肝素3500～5000U,追加肝素6mg/h。灌流治疗时间为2～2.5h,之后继续血液透析1.5～2h,连续治疗2次(间隔1日)。观察治疗前后患者皮肤瘙痒、骨痛、不安腿综合征、食欲、睡眠及自主感觉等临床症状变化,检测肾功能、电解质、甲状旁腺素(PTH)、β2微球蛋白(β2-MG)及血常规。结果血液灌流联合血液透析治疗后多数患者皮肤瘙痒、骨痛、不安腿综合征症状减轻、食欲增加,睡眠改善,自主感觉良好;尿素、肌酐、血磷、血钾、血PTH、血β2-MG显著降低,无严重的不良反应。结论血液灌流联合血液透析可显著降低尿毒症患者血中PTH、β2-MG等中分子物质,对患者的皮肤瘙痒、骨痛、不安腿综合征等症状疗效显著,并且能够增进食欲、改善睡眠及自主感觉。

Objective To observe the effect of hemoperfusion combined with hemodialysis in patients with uremia. Methods Forty uremia patients were treated with hemoperfusion combined with hemodialysis for 2 -2.5 h then with single hemodialysis for 1.5 - 2 h, which was performed again after one day. The blood flow rate was 150 - 240 ml/min, and dialysate flow 500 ml/min. Anticoagulant was heparin or low molecular weight heparin. The blood urea nitrogen, creatinine, electrolyte, parathyroid hormone （ PTH ）, β2--mioeroglobulin （ β2-MG） ,blood routine and clinical manifestation were observed before and after the treatment. Results The clini- cal manifestations were improved in majority of the patients. The blood urea nitrogen, creatinine, phosphorus, po- tassium, PTH and β2-MG were decreased significantly after treatment（ P 〈 0.05 ）. No serious side-effect was observed. Conclusion The treatment of hemoperfusion combined with hemodialysis can clear the middle molecu- lar substance and improve some of clinical manifestations in uremic patients effectively.