不同血液净化方式对尿毒症患者疗效及预后影响

Comparison of effects of different modes of blood purification in patients with uremia

目的探讨不同血液净化方式对尿毒症患者疗效及预后影响。方法将收治透析1～4年的96例尿毒症患者分别予以HD、HF以及HFHD进行治疗,透析前和治疗6个月后分别常规检测Cr、P,放射免疫法测定β2-MG、血总胆固醇、甘油三酯和低密度脂蛋白,采用QOL-C30进行健康状况调查1次。结果三组患者在透析前,血液各项指标均无统计学差异(P>0.05),具有可比性;透析6个月后,三组患者的Cr、P变化不明显,无统计学差异(P>0.05),HFHD组的β2-MG、血总胆固醇、甘油三酯和低密度脂蛋白下降较HD组显著(P<0.05,P<0.01),HF组的甘油三酯和低密度脂蛋白下降较HD组均有统计学差异(P<0.01)。与透析前比较,透析治疗后患者在躯体功能、认知功能上改善显著(P<0.01),在社会功能、整体健康状况上改善明显(P<0.05);透析6个月后组间比较,HFHD组的各项健康因子较HD组有统计学差异(P<0.05),HF组与HD组未见明显差异(P>0.05)。结论三种血液透析方法均能改善酸碱平衡及电解质紊乱,但高通量血液透析组在提高治疗效果和改善患者生存质量方面的作用优于血液透析滤过组和血液透析组。

Objective To compare the effects of different modes of blood purification in patients with uremia. Methods From our hospital from 1 - 4 years of dialysis in 96 cases of uremic patients underwent HD, HF and HFHD treatment, hemodialysis before and 6 months after treatment respectively, routine testing of Cr, P, radioimmunoassay beta 2 - MG, se- rum total cholesterol, triglyceride and low density lipoprotein, using QOL - C30 health survey. Results The three groups of patients in the predialysis, indexes of blood were not statistically different （ P 〉 0. 05 ） , dialysis 6 months later, in three groups of patients with Cr, P had no obvious change, no statistical difference （ P 〉 0. 05 ）, group HFHD beta 2 - MG, ser- um total cholesterol, triglyceride and low density lipoprotein decreased more than that in HD group was significantly （ P 〈0. 05 ,P 〈 0. 01 ）, HF group of triglyceride and low density lipoprotein decreased than those in group HD had statistical difference （P 〈 0. 01 ）. And before dialysis, dialysis patients in physical function, cognitive function improved significant- ly （ P 〈 0.01 ） , the social function, overall health status improved significantly （ P 〈 0. 05 ） ; Dialysis 6 months after com- parison between groups, group HFHD than in group HD the health factor has statistical difference （ P 〈 0.05 ）, HF group and HD group were no significant difference （ P 〉 0. 05 ）. Conclusion Three kinds of method for blood dialysis can im- prove the acid -base and electrolyte disorders, but high flux hemodialysis group in improving therapeutic effect and im- prove the life quality of the patients and the role of superior hemodiafihration and hemodialysis group.