提高血流量及透析液流量对血液透析充分性的影响

Effects of enhancing blood flow rate and dialysate flow rate on dialysis adequacy

目的探讨提高血流量及透析液流量对血液透析充分性的影响,以期为临床透析治疗提供参考。方法选择2009年12月～2011年12月本院收治的行稳定透析的尿毒症患者20例。血透透析液流量定于500 mL/min,血流量定于250 mL/min时,行2个月透析治疗后,将血透透析液流量定于800 mL/min,血流量定于300 mL/min。比较提高血流量及透析液流量前后尿素氮清除效率(Kt/V)、尿素下降率(URR)、血清清蛋白(ALB)、血红蛋白(Hb)、血肌酐(SCr)、C反应蛋白(CRP)水平及充分透析患者所占百分率情况。结果血透透析液流量为800 mL/min,血流量为300 mL/min时可提高Kt/V及URR,与500 mL/min透析液流量及250 mL/min血流量比较差异有统计学意义(P<0.05),而ALB、Hb、SCr、CRP水平差异无统计学意义(P>0.05);提高血流量及透析液流量后充分透析患者所占百分率为90%,显著高于提高前(70%,P<0.05)。结论 800 mL/min透析液流量及300 mL/min血流量的维持性血液透析可选择性用于常规透析不充分的患者,值得临床推广使用。

Objective To discuss the effects of enhancing blood flow rate （Qb） and dialysate flow rate （Qd） on dialysis adequacy, in order to provide reference for clinical dialysis treatment. Methods Twenty cases of uremia patients who were treated with stable dialysis in our hospital from December 2009 to Deeember 2011 in our hospital were seleeted. The hemodialysis was performed at Qbs of 250 mL/min and Qds of 500 mL/min for two months, then the hemodialysis was performed at Qbs of 300 mL/min and Qds of 800 mL/min for three months. The Kt/V, URR, ALB, Hb, SCr, CRP level and the percentage of fully dialysis patients were eompared before and after the enhancement of Qb and Qd. Results Compared with 500 mL/min Qd and 250 mL/min Qb, the Kt/V and URR were enhanced with 800 mL/min Qd and 300 mL/min Qb of hemodialysis, the differences were statistically significant （P 〈 0.05）, but the levels of ALB, Hb, SCr, CRP had no significant differences （P 〉 0.05）. After enhancement of Qb and Qd, the percentage of fully dialysis patients was 90%, which was significantly higher than that of before enhancement （70%, P 〈 0.05）. Conclusion The hemodialysis with Qd of 800 mL/min and Qb of 300 mUmin may be considered in selected patients not achieving fully dialysis, which is worthy of clinieal applieation.