超滤量及透析液钙浓度对透析前后血钙的影响

Effect of ultrafiltration volume and dialysate calcium concentration on serum calcium in pre-and post-hemodialysis

目的:观察不同超滤量及透析液钙浓度对透析前后血钙的影响。方法:将92名血液透析患者按照使用透析液的Ca2+浓度分为Ca-1.25组和Ca-1.5组,每组再按照透析超滤量分为两个亚组,Ca-1.25组分为A,B组,Ca-1.5组分为C,D组,A组、C组超滤量<3 kg,B组、D组超滤量≥3 kg。检测透析前后各组血清总钙、血磷、透前甲状旁腺激素(plasma parathyroid hormone,PTH)浓度并进行相关分析。结果:各组透析后血钙浓度较透析前升高,差异具有统计学意义(P<0.01),B组、D组透析前后血钙变化分别较A组、C组明显,差异具有统计学意义(P<0.01),Ca-1.5组血钙较Ca-1.25组高,两组透析前后血钙变化差异无统计学意义。A,B组及C,D组中血磷及PTH均无差异,Ca-1.25组血磷及PTH均高于Ca-1.5组,差异具有统计学意义(P<0.05)。结论:使用1.25和1.5 mmol/L的Ca^(2+)透析液均会使钙向体内转运,超滤量与钙转运量成正比,与血磷变化无关,且使用1.5 mmol/L的Ca^(2+)透析液的患者血钙更易达到正常水平,不刺激PTH分泌。

Objective：To investigate the effect of different ultrafiltration volume and dialysate calcium concentration on serum calcium in pre-and post-hemodialysis in maintenance hemodialysis patients.Methods：Ninety-two patients were divided into Ca-1.25 group and Ca-1.5 group according to their dialysate calcium concentration,and they were divided into subgroups according to ultrafiltration volume respectively,A,B subgroups belong to Ca-1.25 group,and C,D subgroups belong to Ca-1.5 group,patients with ultrafiltration volume less than 3.0 kg were as subgroup A in Ca-1.25 group and subgroup C in Ca-1.5 group,patients with ultrafiltration volume equal or greater than 3.0 kg were as subgroup B in Ca-1.25 group and subgroup D in Ca-1.5 group.To measure serum calcium,serum phosphate and plasma parathyroid hormone（PTH） concentrations in pre-and post-hemodialysis respectively were detected and analyzed.Results：Serum calcium concentrations were higher in post-than that in pre-hemodialysis,the difference was statistically significant（P〈0.01）,variations of them were more obvious in B and D subgroups than those in A and C subgroups,the difference was statistically significant（P〈0.01）,and there were no significant differences in Ca-1.25 group and Ca-1.5 group,and in Ca-1.5 group they were higher than in Ca-1.25 group.Serum phosphate and PTH were no differences in A and B subgroups,C and D subgroups,and were higher in Ca-1.25 group than in Ca-1.5 group,P〈0.05.Conclusion：Calcium mass transfers from dialysate to blood during the hemodialysis using dialysate containing 1.25 mmol/L or 1.5 mmol/L calcium,ultrafiltration volumes are positively related with variations of serum calcium concentrations,but no relation with variations of serum plasma concentrations,and using dialysate containing 1.5 mmol/L calcium make patients more healthy.