终末期糖尿病肾衰竭患者的血液透析方式的析因对比研究

A factorial comparison of different modes of hemodialysis among patients with end-stage diabetic nephropathy

目的观察比较血液透析的不同通量不同速度模式,对透析效果的影响。方法按析因设计,通量因素设置高低两个水平,速度因素设置普通血液透析(HD)、缓慢连续透析(SCD)、更缓慢连续透析(MSCD)等3个水平,观测低血压发生情况,进行血液生化指标检测,并比较其中部分指标的清除变化情况。结果血压(收缩压)的比较,以HD模式最差(平均值较低,出现低血事件次数较多);Na等6项血液生化指标,高通量+低速方式更接近正常值;血中AGEs指标,低速方式下下降特别明显,下降变化率竟达60.9%,而HD方式仅为2.1%;此外,严重心、脑血管事件,也是高通量低速模式发生较少。结论高通量和低速度透析模式,各方面的指标都较其它模式为优,建议临床上优先选择。

Objective To compare the effects of different dialysis flux and speed of the hemodialysis on dialysis.Methods Factorial design was applied concerning dialysis flux and speed.The factor of dialysis flux was set at high and low levels,and the factor of dialysis speed was set at HD,SCD and MSCD modes.Then the incidence of hypotension and related blood biochemical indexes were monitored. The changes of indexes were compared.Results The blood pressure (systolic pressure)was the worst at HD mode.The six blood bio-chemical indexes including Na were closer to normal value at high dialysis flux and low speed modes.The index of AGEs declined markedly at low speed mode,which was 60.9% compared with only 2.1% at HD mode.In addition,the occurrence of severe cardiovas-cular and cerebrovascular events was less at high dialysis flux and low speed modes.Conclusion High dialysis flux and low speed modes were optimal,which was suggested as clinical priorities.