不同透析方法治疗尿毒症难治性高血压疗效观察

The clinical effect observation of different blood purification methods on uremic patients with resistant hypertension

目的对比观察尿毒症难治性高血压患者应用血液透析滤过(HDF)联合规律血液透析(HD)和持续不卧床腹膜透析(CAPD)两种治疗方法的临床疗效。方法将68例尿毒症伴难治性高血压患者随机分为HDF/HD组和CAPD组各34例。HDF/HD组每周采用2次血液透析加上1次血液透析滤过治疗;CAPD组进行持续不卧床腹膜透析,每天腹透液总量8000ml,晚上留腹2000ml,均连续观察治疗3个月。比较2组患者治疗前后血尿素氮(BUN)、肌酐(Cr)及平均动脉压的变化。结果治疗后,2组患者血清BUN及Cr均降低(P<0.05),组间比较差异无统计学意义(P>0.05)。2组患者治疗后平均动脉压均低于治疗前,且CAPD组降低幅度大于HDF/HD组,差异均有统计学意义(P<0.05)。结论尿毒症伴难治性高血压患者采用CAPD治疗,血压控制效果更好,但HDF/HD临床效果也较满意,可针对不同患者选择性应用。

Objective To compare the clinical efficacy of hemodialysis（ HD） combined with regular hemodialysis（ HDF） and continuous ambulatory peritoneal dialysis（ CAPD） in the treatment of uremic patients with resistant hypertension.Methods 68 uremic patients with resistant hypertension were randomly divided into two groups with 34 cases of each. One group was received hemodiafiltration and hemodialysis which was named HDF / HD group. The other group received continuous ambulatory peritoneal dialysis which was named CAPD group. Patient in HDF / HD group underwent hemodialysis twice and hemodiafiltration once every week for 3 months. The volume dose of peritoneal dialysis fluid for CAPD group was 8000 ml,which contained 2000 ml remaining at night. BUN,Cr,mean arterial pressure（ MAP） were observed and compared before and after the course of treatment. Results After treatment,serum BUN and Cr of two groups were both decreased,and there was no significant difference between the two groups（ P 0. 05）. After treatment,the mean arterial pressure of two groups were decreased（ P 0. 05）,but the CAPD group reduce more significantly,and the difference with HDF/HD group was statistically significant（ P 0. 05）. Conclusion The effect of CAPD on the treatment of uremic patients with resistant hypertension is better,but the clinical effect of HDF / HD is satisfactory. It can be used for different patients with selective application.