不同透析液流量对联机血液透析滤过效率的影响

Effects of different dialysate flow rates on efficiency of on-line hemodiafiltration

目的比较不同透析液流量对透析患者血清肌酐(creatinine,CREA)、尿素氮(blood ureanitrogen,BUN)、甲状旁腺激素(parathyroid hormone,PTH)、β2-微球蛋白(β2-microglobulin,β2-MG)清除率的影响。方法选择我科维持性血液透析并且行联机血液透析滤过(Hemodiafiltration,HDF)治疗的患者32例,分别给予550ml/min、650ml/min、750ml/min三种不同透析液流量进行透析,检测不同透析液流量下透析前后CREA、BUN、PTH、β2-MG水平,评估透析效率。结果与透析液流量为550ml/min时比较,透析液流量为650ml/min时,血清CREA、BUN、PTH清除率及尿素清除率(KT/V)均呈增加趋势,但无统计学差异(t分别为0.97,0.95,0.130和1.64,P>0.05),血清β2-MG清除率明显增加,差异具有统计学意义(t=3.45,P<0.05)。与透析液流量为550ml/min时比较,透析液流量为750ml/min时CREA、BUN、PTH、β2-MG清除率及KT/V均显著增加(t分别为3.45,2.79,3.32,4.73和3.04,P<0.05)。但与透析液流量为650ml/min比较,透析液流量为750ml/min时CREA、BUN、PTH、β2-MG清除率及KT/V清除率比较差异无统计学意义(t分别为1.32,1.87,2.01,0.49和1.63,P>0.05)。结论联机HDF治疗时,提高透析液流量对尿毒症患者CREA、BUN、PTH、β2-MG的清除更为有效。

Objective To evaluate the influence of different dialysate flow rates upon dialysis effi- ciency in patients receiving on-line maintenance hemodiafiltration. Methods In this clinical trial different dialysate flow rates （550 ml/min, 650 ml/min and 750 ml/min） were respectively given to 32 patients who were treated by on-line maintenance hemodiafiltration. Plasma creatine （CREA）, blood urea nitrogen （BUN）, parathyroid hormone （PTH） and β2- microglobulin （132-MG） were examined before and after dialysis to evaluate dialysis efficiency. Results When the dialysate flow rate elevated from 550 to 650 ml/min, the clearance rates of CREA, BUN, PTH and KT/V was increased, though the difference was statistically insignificant （t values were 0.97,0.95, 0. 130 and 1.64 respectively, P 〉0.05）. However, the ascending trend of serum [3z -MG clearance rates was statistically significant （t = 3.45, P 〈 0.05）. Statistically significant increased in CREA, BUN, PTH β2- MG clearance rate and KT/V was noted as the dialysate flow rate increased from 550 to 750 ml/min （t values were 3.45, 2.79, 3.32, 4.73 and 3. 04, P〉 0. 05）. Therefore, serum clearance rates of CREA, BUN, PTH, t32 -MG and KT/V were unchanged from 650 ml/min to 750 ml/min （t values were 1.32, 1.87, 2.01, 0.49 and 1.63, P〈 0.05）. Conclusions The present results demonstrate that a faster dialysate flow rate increases the efficiency of clearance of Cr, BUN, PTH and 132- MG from blood to dialysate in on- line hemodiafiltration.