血液透析联合血液灌流治疗尿毒症继发性甲状旁腺功能亢进症的疗效观察及护理

Hemodialysis and hemoperfusion for uremic secondary hyperparathyroidism and its nursing care

目的 观察血液透析联合血液灌流及护理干预对尿毒症继发甲状旁腺功能亢进的治疗效果.方法 将50例尿毒症继发甲状旁腺功能亢进患者随机分为常规血液透析组（A组）、血液透析联合血液灌流组（B组）;两组均予一系列护理干预,A组予常规透析每周2～3次,B组在常规透析基础上,每周予血液灌流1次,比较两组患者治疗前及治疗30周后血清钙（Ca）、磷（P）和血清全段反应性甲状旁腺激素（iPTH）的浓度;观察两组患者皮肤瘙痒、重症肌无力等症状的改善.结果 B组血清iPTH、血磷的下降较A组差异有统计学意义（P＜0.01）;血钙显著上升（P＜0.01）;皮肤瘙痒、重症肌无力等症状明显改善.结论 血液透析联合血液灌流及护理干预可显著降低患者iPTH水平,改善尿毒症继发甲状旁腺功能亢进引起临床症状.

Objective To observe the efficacy of hemodialysis and hemoperfusion and nursing intervention for uremic secondary hyperparathyroidism.Methods 50 uremic patients with secondary hyperparathyroidism were collected and randomly divided into a hemodialysis group （group A） and a hemodialysis and hemoperfusion group （group B）.Both groups were treated with a series of nursing interventions.Group A were treated with dialysis 2 to 3 times per week,group B with dialysis and hemoperfusion once a week.Serum calcium phosphorus （P） and serum parathyroid hormone reactivity whole paragraph （iPTH） concentration are compared before and after the treatment.Improvements were observed in patients with skin itching and myasthenia gravis.Results Serum iPTH and serum phosphate decreased more significantly（P 〈0.01）,calcium increased more significantly （P 〈0.01）,and skin itching and myasthenia gravis symptoms improved more significantly in group B than in group A.Conclusions Hemodialysis and hemoperfusion and nursing intervention can significantly reduce iPTH levels in patients with secondary hyperparathyroidism and improve the clinical symptoms caused by uremia.