高通透性血液透析临床应用研究

The Clinical Study of High Permeability Dialysis

目的 研究高通透性血液透析 (HPD)能否有效的清除大、中、小分子尿毒素。比较HPD和常规透析 (CHD)的特点 ,HPD能否可替代CHD。方法 选择 4 8例长期透析患者 ,随机分为两组 ,HPD组 2 6例 ,用高通透性血滤器进行常规血液透析 ;CHD组 2 2例 ,用普通透析器进行常规血液透析 ,分别进行为期 2年的前瞻性临床观察研究 ,定期测血透析前后血液肾功能、电解质、β2 微球蛋白、血氨基酸、蛋白质浓度、内毒素等。结果 HPD组血肌酐、尿素氮、尿酸、β2 球蛋白的清除效果优于CHD组 ;透析前后血氨基酸浓度下降率两组无差异 ,血内毒素浓度无差异 ,透析后蛋白质浓度高于透析前 ,血磷下降率无差异。结论 血滤器行常规血透析保持常规血透析所有优点 ,能消除CHD不能清除的大。

Objective To compare the characteristic of high permeability dialysis(HPD) and conventional hemodialysis(CHD) and to study whether HPD was more effectively in elimination of the macromolecular, medium and small molecule urinary endotoxin in uremia than CHD.Method 48 cases of hemodialysis patients were randomly divided into two groups: HPD group(26 cases)given by high permeability dialysis, and CHD group(22 cases)given by conventional hemodialysis dialyzer. Two groups were observed prospectively for 2 years and renal function , electrolytes, β 2 microglubulin, amino acid, protein concentration, endotoxin in blood serum were detected before and after hemodialysis respectively.Results The clearance rates of blood creatinine, blood urea nitrogen, uric acid , β 2 microglubulin in HPD group were better than that of CHD group. Serum amino acid, endotoxin, serum phosphorum changes were no statistical significance after hemodialysis in two groups. Protein concentration after hemodialysis was higher than that before hemodialysis in two groups. Conclusions High permeability dialysis has all virtues of conventional hemodialysis dialysis and can clear macromolecular and medium molecule endotoxin, but conventional hemodialysis can not do.