老年透析患者难治性高血压的治疗

The therapeutic effect of elderly dialysis patients with refractory hypertension

目的 探讨老年透析患者难治性高血压的治疗.方法 将66例老年难治性高血压透析患者按随机数字表法分为A组和B组,每组33例.A组患者每周3次常规血液透析加2周1次血液灌流;B组患者每周2次常规血液透析加每周1次血液透析滤过加2周1次血液灌流治疗,治疗后观察两组患者血压、血浆内皮素（ET）、血管紧张素Ⅱ（ATⅡ）、肾素（RA）、甲状旁腺素（PTH）水平.结果 A组治疗前后：血压（183.42±16.20）/ （109.15 ±7.69）、（151.45±3.31）/（88.71 ±4.95） mmHg（1 mmHg =0.133 kPa）,ET （173.45 ±41.25）、（160.38 ±25.31） ng/L,ATⅡ（69.21±18.47）、（57.25±23.34） ng/L,RA （1.21 ±0.15）、（0.87 ±0.14） μg/L,PTH （530.27 ±43.28）、（272.43±34.19） ng/L;B组治疗前后：血压（185.34±12.26）/ （112.38 ±6.24）、（141.59±4.15）/（80.39±2.73） mmHg,ET （178.21±34.35）、（149.12 ±21.34） ng/L,ATⅡ （68.38 ± 23.57）、（47.17±15.61） ng/L,RA （1.19 ±0.29）、（0.69±0.41） μg/L,PTH （528.62±42.53）、（253.15±31.62）ng/L,治疗后均降低,与治疗前比较差异有统计学意义（P＜0.05）,治疗后组间比较差异有统计学意义（P＜ 0.05）.结论 联合血液灌流治疗老年透析患者难治性高血压效果显著,值得推广.

Objective To investigate the treatment of elderly dialysis patients with refractory hypertension.Methods Sixty-six patients were randomly divided into two groups of A group and B group,with 33 cases in each group.Patients in A group were treated by routine hemodialysis 3 times per week and hemoperfusion 1 time every 2 weeks.Patients in B group were treated by routine hemodialysis 2 times per week and hemodiafiltration 1 time per week plus hemoperfusion 1 time every 2 weeks.The levels of blood pressure,plasma endothelin （ET）,angiotensin-Ⅱ （AT Ⅱ）,renin （RA）,parathyroid hormone （PTH） in two groups before and after treatment were compared.Results Before and after treatment,the levels of blood pressure,ET,AT Ⅱ,RA and PTH in A group were （183.42 ± 16.20）/（109.15 ± 7.69） and （151.45 ± 3.31）/（88.71 ±4.95） mmHg（1 mmHg =0.133 kPa）,（173.45 ±41.25） and （160.38 ±25.31） ng/L,（69.21 ± 18.47）and（57.25 ± 23.34） ng/L,（1.21 ± 0.15） and （0.87 ± 0.14） μ g/L,（530.27 ± 43.28） and （272.43 ± 34.19） ng/Lrespectively.Before and after treatment,the levels of blood pressure,ET,AT Ⅱ,RA and PTH in B group were （185.34 ± 12.26）/ （112.38 ± 6.24） and （141.59 ± 4.15）/ （80.39 ± 2.73） mmHg,（178.21 ± 34.35） and （149.12 ±21.34） ng/L,（68.38 ±23.57） and （47.17 ± 15.61） ng/L,（1.19 ±0.29） and （0.69 ±0.41） μg/L,（528.62 ± 42.53） and （253.15 ± 31.62） ng/L respectively.The levels of blood pressure,ET,AT Ⅱ,RA and PTH in two groups after treatment were significantly decreased compared with those before treatment （P 〈0.05）,and there were significant differences between two groups （P 〈 0.05）.Conclusion Combined with hemoperfusion in the treatment of elderly hemodialysis patients with refractory hypertension,the effect of combined hemodiafiltration is significant,and it is worthy of promotion.