组合型人工肾治疗尿毒症性皮肤瘙痒的疗效观察及护理

Efficacy of combined hemoperfusion-hemodialysis on pruritus in patients with uremia and nursing

目的探讨组合型人工肾[血液透析（HD）＋血液灌流（HP）]治疗尿毒症患者皮肤瘙痒的效果及护理。方法选择蚌埠医学院第一附属医院2010年6月—2011年6月进行维持性血液透析合并轻、中度皮肤瘙痒的患者40例，随机分成HD＋HP组（观察组）20例和HD组（对照组）20例，观察组采用HD＋HP治疗及护理干预，开始连续进行3次组合治疗，以后每2周组合治疗1次，另外行单纯HD治疗，每周透析2～3次；对照组采用常规血液透析，每周2～3次，疗程为12周。检测治疗前后PTH水平变化，观察皮肤瘙痒改善情况、重度皮肤瘙痒发生率。结果观察组治疗后甲状旁腺素水平较对照组下降明显（P〈0．01），皮肤瘙痒缓解率（85％）、重度皮肤瘙痒发生率（10％）显著优于对照组。结论组合型人工肾能有效地清除甲状旁腺素，改善患者的皮肤瘙痒症状，干预了维持性血液透析患者轻、中度皮肤瘙痒的进展。重视并加强组合型人工肾治疗前、中、后的综合护理干预措施可以保证治疗的顺利进行。

Objective To investigate the efficacy of a combined hemoperfusion-hemodialysis （ HD ＋ HP） procedure on pruritus in patients with uremia and nursing. Methods From June 2010 to June 2011,40 cases of maintenance hemodial- ysis patients with mild to moderate pruritus were randomly divided into HI） ＋ HP group and HD group. 20 cases in the HD group were treated with hemodialysis twice or three times in a week for 12 weeks ;while the other 20 ones in the HD ＋ HP group were continually treated with hemoperfusion （HD ＋ HP） three times at the beginning, then once in two week, HD was performed as same as the HD group. The level of PTH was monitored;the improvement of pruritus and the incidence of severe pruritus were evaluated before and after the treatment. Results PTH level decreased more obviously in HD ＋ HP group than in HD group（P 〈0.01 ）. The remission rate of pruritus was higher in HD ＋ HP group（85% ） than in HD group（20% ） （P 〈0.01 ） ,and the incidence of severe pruritus in the HD ＋ HP group lower than in the HD group（ P 〈 0.05 ）. Conclusion HD ＋ HP can effectively clear PTH,interfere with the progress of pruritus and relieve pruritus. The comprehensive nursing intervention before, during, and after the HD ＋ HP treatment may promote HD ＋ HP treatment.