高通量血液透析治疗终末期肾衰竭的临床效果分析

Clinical effect of high-flux hemodialysis for the treatment of end-stage renal failure

目的观察高通量血液透析治疗终末期肾衰竭的方法和临床效果,为临床救治提供参考。方法选取2014年6月至2015年6月收治的78例终末期肾衰竭患者,根据患者就诊时间先后,随机将患者分为观察组39例,对照组39例。两组均予以常规饮食及药物治疗,包括低磷、低盐、优质蛋白饮食,给予降压药物、铁剂、钙剂和重组人促红细胞生成素。在常规药物治疗基础上,对照组给予常规血液透析:采用醋酸纤维膜透析器,透析液流量维持在500 ml/min,血流量维持在210~260 ml/min,每周3次;观察组给予高通量血液透析:采用HI PS高通透性透析器,透析液流量、血流量及透析次数与对照组相同。分别于治疗前、治疗12个月后检测患者血清β2-微球蛋白(β2-MG)、血清白蛋白(ALB)、血红蛋白(Hb)、血清磷(PO43-)和甲状旁腺激素(PTH),并观察分析两组患者不良反应发生率。结果观察组终末期肾衰竭患者治疗后β2-MG、PTH、Hb、PO43-和ALB水平均优于治疗前和对照组,差异均有统计学意义(P均<0.05)。观察组不良反应发生率显著低于对照组(10.26%vs 30.77%,χ2=5.032,P<0.05)。结论与常规血液透析比较,高通量血液透析治疗终末期肾衰竭患者具有更高清除有害物质能力和较低的不良发生率,具有较高的临床应用价值。

Objective To observe clinical effect of high-flux hemodialysis（ HFHD） in the treatment of end-stage renal failure. Methods Seventy-eight patients with end-stage renal failure received and cured between June 2014 and June 2015 were selected. According to the patient＇s visit time,the patients were divided into observation group（ n = 39） and control group（ n = 39）. routine diet（ low phosphorus,low salt and high-quality protein） and drug（ antihypertensive drugs,supplements of iron calcium,human recombinant erythropoietin） treatment. On the basis of routine drug treatment,conventional hemodialysis（ using cellulose acetate membrane dialyzer,Keeping the dialysate flow volume in 500 ml/min and blood flow volume in 210 ~ 260 ml/min,three times a week） was given in control group,and HFHD（ using HI PS high-flux dialyzer,same dialysate flow volume,blood flow volume and time of dialysis with conventional hemodialysis） was given in observation group. Serum β2-microglobulin（ β2-MG）,serum albumin（ ALB）,hemoglobin（ Hb）,Serum phosphate anion（ PO43-） and blood parathyroid hormone（ PTH） were detected before treatment and 12 months after treatment,and incidence of adverse reaction was observed. Results Levels of β2-MG,PTH,Hb,PO43-and ALB after treatment were better than those in pretreatment（ all P 0. 05）,and they after treatment in observation group were better than those in control group（ all P 0.05）. The incidence of adverse reaction（ infection） in observation group was significantly lower than that in control group（ 10. 26% vs 30. 77%,χ2= 5. 032,P 0. 05）. Conclusion Compared with conventional hemodialysis,HFHD has higher ability clearing harmful substances and lower incidence of adverse reaction for the treatment of end-stage renal failure,so it has higher clinical applied value.