维持性HD老年患者应用三种不同血液净化方式对皮肤瘙痒的疗效分析

Three different methods of blood purification on skin pruritus in elderly maintenance hemodi- alysis patients

目的:探讨不同血液净化方式对维持性血液透析(HD)老年患者皮肤瘙痒的疗效。方法:维持性HD且伴有皮肤瘙痒的老年患者63例随机分为(HD)组、血液透析滤过+血液透析(HDF+HD)组和高通量透析(HPD)组,每组各21例,观察临床皮肤瘙痒差异性。结果:3组患者透析前及透析6个月后血尿素氮(BUN)﹑肌酐(Cr)﹑钙和尿素清除指数(Kt/V)比较,差异无统计学意义(P>0.05);而HDF+HD组和HPD组治疗后患者体内血清甲状旁腺激素(PTH)和β2-微球蛋白(β2-MG)水平明显降低,差异具有统计学意义(P<0.05),患者的视觉模拟评分法(VAS)评分指数也显示患者对皮肤瘙痒的主观感受明显提高,差异具有统计学意义(P<0.05)。结论:HDF+HD和HPD均减低患者血浆的血磷水平,有效清除PTH和β2-MG大中分子毒物,有效缓解患者的皮肤瘙痒症状。

Objective= To explore the effect of different methods of blood purification on itchy skin of the elderly patients with maintenance hemodialysis （HD）. Methods= Maintenance HD complicated with pruritus in 63 elderly patients were randomly divided into （HD） group, hemodiafiltration and hemodialysis （HDF-FHD） group and high flux hemodialysis （HPD） group with 21 cases in each group, then difference in skin itching were observed and compared. Results： The level of BUN, Cr, blood calcium and Kt/V val- ue in three groups showed no remarkable change before and after six-month blood dialysis （P0.05）. While the level of PTH and 132-MG in HDFq-HD and HPD groups were significantly decreased （P 0.05）. The VAS score index indicated that the subjective feelings of itchy skin were greatly improved （P 0.05）. Conclusion： HDF＋HD and HPD significantly decreased serum phosphorus levels in plasma, effec- tively removed PTH and 132-MG and medium molecular substances, thus to alleviate the patient＇s skin itch- ing.