观察长期使用不同钙浓度透析液对维持性血液透析患者PTH和血压的影响

To observe the long-term use of different calcium concentration dialysate effect on maintenance hemodialysis patients and the blood pressure of PTH

目的 观察长期使用不同钙浓度透析液对维持性血液透析（HD）患者PTH和血压的影响.方法 将36例慢性肾功能衰竭维持性血透（MHD）患者随机分为两组,A组18例患者使用钙浓度为1.5 mmol/L的透析液,B组18例患者使用钙浓度为1.75mmol/L的透析液,观察透析36个月后患者血清离子钙（iCa）、磷（P）、甲状旁腺激素（PTH）及平均动脉压（MAP）的水平和临床表现.结果 B组有3例患者因高血压不能耐受试验退出.长期治疗后A组患者血清离子钙（iCa）、MAP明显降低（P＜0.05）,血P无明显变化（P＞0.05）,血PTH明显升高（P＜0.05）;B组患者血清iCa、MAP明显升高（P分别＜0.001和＜0.01）,血P无明显变化（P＞0.05）、血PTH明显降低（P＜0.05）.两组患者中骨痛发生率A组为55.56％,B组为20％,部位多见于脚后跟和脚底,其次为膝关节;心律失常发生率A组为11.11％,B组为46.67％,心率失常的类型以阵发性房性期前收缩多见,其次为阵发性心房纤颤以及室性期前收缩.结论 维持性血液透析患者长期使用1.5mmol/L钙浓度的透析液后血离子钙明显下降,出现低钙血症,血PTH明显增高,肾性骨痛发病率增加,患者MAP下降;长期使用1.75 mmol/L钙浓度的透析液后血PTH明显下降,血清离子钙和MAP明显升高,骨痛发生率下降,但心律失常的发生率增加.

Objectives To observe the effect of patients with PTH（HD） and blood pressure.Methods 36 cases of chronic renal failure on maintenance hemodialysis（MHD） patients were randomly divided into two groups,A group of 18 patients using calcium concentration of dialysate 1.5mmol/L,B group of 18 patients using calcium concentration of dialysate 1.75mmol/L,observe the dialysis 36 months later serum ionized calcium（iCa）,patients phosphorus（P）,parathyroid hormone （PTH） and mean arterial pressure（MAP） levels and clinical manifestations.Results In group B,3 patients with hypertension can not withstand test exit.Group A patients serum calcium ion after long-term treatment （iCa）,MAP decreased significantly（P 〈0.05）,no significant changes in blood P（P 〉0.05）,serum PTH increased significantly（P 〈0.05） ;B group the serum levels of iCa,MAP increased significantly（P 〈0.001 and 〈0.01 respectively）,blood P no significant change（P 〉0.05）,serum PTH decreased significantly（P 〈0.05）.Two groups of patients with bone pain and the incidence rate was 55.56% in A group,B grrop was 20%,the site is more common in the heel and sole,followed by knee joint; arrhythmia incidence rate was 11.11% in A group,B group was 46.67%,the type of arrhythmia in patients with paroxysmal atrial extrasystoles see more,followed by paroxysmal atrial fibrillation and ventricular extrasystoles.Conclusions The maintenance dialysis solution for the long-term use of 1.5mmol/L calcium concentration in hemodialysis patients after blood ionized calcium decreased significantly,hypocalcemia,PTH significantly increased in blood,kidney pain incidence rate increased,the average artery pressure in patients with long-term use of 1.75mmol/L decreased;the dialysate calcium concentration in blood decreased significantly after PTH,serum calcium ion and 104mean arterial pressure significantly increased pain,decreased the incidence,but the increased incidence of cardiac arrhythmia.