联机血液透析滤过与高通量血液透析改善尿毒症患者钙磷代谢的效果比较

Comparison of on -line hemodiafiltration and high -flux hemodialysis for correcting calcium and phosphate metabolic disorder in uremia patients

目的：比较联机血液透析滤过（QL-HDF）与高通量血液透析（HFHD）对纠正尿毒症患者钙磷代谢紊乱的效果和对患者生存质量的影响。方法选取90例尿毒症患者，采用数字表法随机分为 QL-HDF组和 HFHD 组，测定透析前后血 Ca^2＋、P^3＋、血清甲状旁腺激素（PTH）水平，采用 KDQOL-SFTM1．3量表评价患者生存质量，统计不良反应发生率，比较两组上述情况的异同。结果透析前后两组 Ca^2＋水平差异无统计学意义（P ＞0．05）；QL-HDF 组治疗后 P^3＋（1．82±0．19）mmol／L、PTH（401．6±16．7）pg／L，显著低于 QL-HDF组[P^3＋（2．14±0．22）mmol／L、PTH（425．0±17．2）pg／L]（t ＝24．256、21．059，均 P ＜0．05）；除肾病对生活的负担（BKD）外，其余十个领域 QL-HDF 组得分均比 HFHD 组高，症状与不适（SPL）、肾病对生活的影响（EKD）、认知功能（CF）、社交质量（QSI）、性功能（SEXF）、睡眠（SLEEP）、患者满意度（PS）等领域得分差异均有统计学意义（均 P ＜0．05），工作状况（WS）、社会支持（SOS）、透析人员的支持（DSF）等领域得分差异无统计学意义（P ＞0．05）；QL-HDF 组不良反应6例（13．33％），HFHD 组不良反应14例（31．11％），两组不良反应发生率差异有统计学意义（χ^2＝5．361，P ＜0．05）。结论两种方法均能改善尿毒症患者钙磷代谢紊乱，QL-HDF 表现出更强的清除能力，患者生存质量更高，值得在临床中推广。

Objective To compare the effect on correcting calcium and phosphate metabolic disorder and the impact on quality of life in uremia patients between on -line hemodiafiltration and high -flux hemodialysis.Methods 90 patients with uremia,digital watches were randomly divided into QL -HDF group and HFHD group,Ca^2＋,P^3＋, serum parathyroid hormone（PTH）level were measured before and after dialysis blood.The survival quality of patients were evaluated by the KDQOL -SFTM1.3 scale.The incidence of adverse reactions were collected.The similarities and differences of two groups were compared.Results The comparison of Ca^2＋ levels in the two groups before and after dialysis showed no significant difference（P 〉0.05）;Of the QL -HDF group after treatment,P^3＋ was （1.82 ± 0.19）mmol/L,PTH was （401.6 ±16.7）pg/L,which were significantly lower than those of QL -HDF group[P^3＋（2.14 ±0.22）mmol/L,PTH（425.0 ±17.2）pg/L]（t =24.256,21.059,all P 〈0.05）in addition to the burden of kidney disease;life（BKD）,the other ten areas scores of the QL -HDF group were higher than those of the HFHD group;The symptoms and discomfort（SPL）and the effect of nephropathy in life（EKD）,cognitive function（CF）, quality（QSI）,social function（SEXF）and sleep（SLEEP）,patient satisfaction（PS）had significant differences in areas such as score（all P 〈0.05）,working condition（WS）and social support（SOS）,dialysis staff support（DSF） and other domain scores had no significant difference （all P 〉0.05 ）;6 cases of adverse reactions was in the QL -HDF group （13.33%）,14 cases of adverse reactions was in the HFHD group（31.11%）,there was significant difference between the two groups（χ^2 =5.361,P 〈0.05）.Conclusion The two methods can improve the metabolic disorders of calcium and phosphorus in patients with uremia,and QL -HDF showed stronger ability to remove the ability,and the quality of life is higher,it is worth promoting in clinical practice.