伴晚期肝硬化终末期肾脏病患者不同透析治疗的临床效果比较

Clinical effects of hemodialysis versus peritoneal dialysis in end-stage renal disease patients with advanced cirrhosis

目的: 探讨血液透析和腹膜透析在终末期肾病伴晚期肝硬化患者透析治疗中的临床效果. 方法: 选取我院收治的终末期肾病伴肝硬化患者作为研究对象, 并随机分为对照组和观察组. 对照组患者采用血液透析, 中心静脉插管, 流量500 mL/L, 每周透析2-3次, 每次持续4 h; 观察组患者接受腹膜透析, 每日透析3-4次. 结果: 治疗后, 观察组患者血压、血浆总蛋白、白蛋白水平显著低于对照组, 且尿素氮(blood urea nitrogen, BUN)、血肌酐(serum creatinine, SCr)高于对照组, 差异有统计学意义(P<0.05), 但两组患者血钙、血氨、血红蛋白水平差异无统计学意义(P>0.05); 观察组患者不良反应发生率(51.6%)明显低于对照组(74.2%), 生存率(91.9%)高于对照组(74.2%),差异有统计学意义(P<0.05); 但两组患者死亡原因间差异无统计学意义(P>0.05); 观察组患者平均月透析费用低于对照组, 差异有统计学意义(P<0.05). 观察者患者身体疼痛度和情感职能评分显著高于对照组, 而社会功能评分则显著低于对照组, 差异有统计学意义(P<0.05). 结论:血液透析和腹膜透析均能有效治疗终末期肾病伴晚期肝硬化, 但腹膜透析治疗生存率更高, 不良反应更少, 是既经济又有效的手段.

AIM： To compare the clinical effects of hemodialysis and peritoneal dialysis in end-stage renal disease（ESRD） patients with advanced cirrhosis. METHODS： ESRD patients with cirrhosis who were treated at our hospital were randomly divided into either a control group or an observation group. The control group was treated by hemodialysis 2 to 3 times a week, while the observation group was treated by peritoneal dialysis 3 to 4 times daily. RESULTS： After treatment, blood pressure, plasma total protein, albumin levels were significantly lower, and BUN and SCr were significant-ly higher in the observation group than in the control group（P〈0.05 for all）, but serum calcium, ammonia and hemoglobin levels showed no significant difference between the two groups（P〈0.05 for all）. The incidence of adverse reactions（51.6% vs 74.2%） was significantly lower and the survival rate（91.9% vs 74.2%） was significantly higher in the observation group than in the control group（P〈0.05 for both）. The observation group had significantly lower average monthly cost than the control group（P〈0.05）. CONCLUSION： Hemodialysis and peritoneal dialysis are both effective in ESRD patients with advanced cirrhosis, with the latter being associated with a higher survival rate, fewer side effects, and less cost.