腹膜透析联合血液透析治疗慢性肾衰竭合并难治性高血压的疗效观察

Observation of peritoneal dialysis combined with hemodialysis in the treatment of chronic renal failure patients with refractory hypertension

目的观察腹膜透析联合血液透析(peritoneal and hemodialysis dialysis,PHD)治疗慢性肾衰竭合并难治性高血压的疗效。方法对16例患者进行观察,比较联合治疗前及联合治疗后6个月的相关指标,包括:24h动态血压、超声心动图、脑钠肽(brain natriuretic peptide,BNP)、溶质清除率等。结果联合治疗后平均服用降压药物种类由4.2种减少为2.8种,24h平均收缩压(t=15.602,P=0.000)、24h平均舒张压(t=12.358,P=0.000)、日间平均收缩压(t=19.457,P=0.000)、日间平均舒张压(t=49.694,P=0.000)、夜间平均收缩压(t=31.379,P=0.000)、夜间平均舒张压(t=17.777,P=0.000)较前均显著降低,BNP(t=-2.172,P=0.030)及左心室质量指数(t=10.429,P=0.000)较前有明显下降,总Kt/V联合治疗后较前增加(t=-16.801,P=0.000)。结论 PHD治疗可以提高透析的充分性,有效的降低血压,改善左心室肥厚。

Objective To observe the curative effect of peritoneal dialysis combined with hemodialysis in the treatment of chronic renal failure associated with refractory hypertension. Method Sixteen patients were enrolled in this study. 24-hour ambulatory blood pressure monitoring, echocardiography, brain natriuret- ic peptide （BNP）, and solute clearance rates were compared before the combination therapy and after the thera- py for 6 months. Results After the combination therapy for 6 months, average number of antihypertensive drugs reduced from 4.2 to 2.8; average systolic pressure in 24 hours （t=15.602, P=0.000）, average diastolic pressure in 24 hours （t =12.358, P=0.000）, average systolic pressure in daytime （t =19.457, P=0.000）, aver- age diastolic pressure in daytime （t =49.694, P=O.O00）, average systolic pressure in night time （t =31.379, P= 0.000）, and average diastolic pressure in night time （t =17.777, P =0.000） were lower than those before the combined therapy; BNP （t=-2.172, P=-0.030） and mass index of left ventricle （t=10.429, P=0.000） were also lower than those before the therapy; total Kt/V was higher （t=- 16.801, P=-0.000） than that before the therapy. Conclusion Peritoneal dialysis combined with hemodialysis can increase dialysis adequacy, reduce blood pressure, and improve left ventricle hypertrophy.