高通量血液透析联合低钙透析液与普通透析对尿毒症病人皮肤瘙痒评分及血生化指标的影响对比

Effect of high flux hemodialysis combined with low calcium dialysis solution and general dialysis on skin pruritus score and blood biochemical indexes in patients with uremia

目的探讨高通量血液透析(HFHD)联合低钙透析液与普通透析对合并皮肤瘙痒尿毒症病人皮肤瘙痒评分及血生化指标的影响。方法选取维持血液透析合并皮肤瘙痒尿毒症病人75例,采用随机抽签法分为观察组A、观察组B和对照组,每组25例;观察组A给予病人HFHD联合低钙透析治疗,观察组B给予病人HFHD治疗,对照组给予病人普通透析治疗;对治疗前和治疗后3个月病人的皮肤瘙痒程度、分布范围、睡眠干扰、血钙、血尿素氮(BUN)、血肌酐(SCr)、血磷、全段甲状旁腺激素(i PTH)、血清白蛋白(ALB)以及超敏C反应蛋白(hs-CRP)进行检测并比较。结果治疗后,观察组A的病人皮肤瘙痒程度(2.43±0.82)分、分布范围(1.32±0.28)分以及睡眠干扰评分(0.34±0.18)分均优于观察组B[(4.56±1.13)分、(1.62±0.22)分、(0.78±0.28)分][检验值分别为F=140.205、33.199、102.357,均P<0.01];观察组A在治疗后病人的皮肤瘙痒程度(t=19.039,P<0.01)、分布范围(t=6.811,P<0.01)、睡眠干扰(t=19.106,P<0.01)较治疗前有明显改善,均差异有统计学意义;观察组B在治疗后病人的皮肤瘙痒程度(t=12.073,P<O.01)、分布范围(t=4.973,P<0.01)、睡眠干扰(t=9.857,P<0.01)较治疗前有明显改善,差异有统计学意义;观察组A和观察组B的病人在治疗3个月后血磷(t=10.811,P<0.01;t=5.569,P<0.01)、钙磷乘积(t=11.327,P<0.01;t=4.956,P<0.01)、i PTH(t=9.103,P<0.01;t=4.721,P<0.01)、hs-CRP(t=6.886,P<0.01;t=7.033,P<0.01)等各项生物化学指标均明显下降,且差异有统计学意义;观察组A和观察组B相比,观察组A的血磷、钙磷乘积、i PTH、hs-CRP、BUN、SCr、ALB均优于观察组B。观察组A、B与对照组治疗后皮肤瘙痒程度、分布范围、睡眠干扰、血磷、钙磷乘积、BUN、SCr、i PTH、hs-CRP、ALB比较,差异有统计学意义(P<0.05)。结论 HFHD联合低钙透析液能有效缓解合并皮肤瘙痒尿毒症病人的皮肤瘙痒程度、分布范围、睡眠干扰,并能降低血磷、i PTH、hs-CRP、BUN、SCr、ALB水平。

Objective To discuss the effect of high flux hemodialysis combined with low calcium dialysis solution and general dialysis on skin pruritus score and blood biochemical indexes in patients with uremia. Methods Seventy-five cases of hemodialysis patients with uremic pruritus and randomly assigned into experimental group A,experimental group B and control group,25 cases in each group.Patients in experimental group A were given HFHD combined with low calcium dialysis treatment,patients in experimental group B were given HFHD treatment,and patients in control group were given regular dialysis treatment. Before treatment and 3 months after treatment patients were detected in skin itching degree,distribution,sleep disturbances,serum calcium,blood urea nitrogen(BUN),serum phosphorus,SCr,i PTH,ALB and hs-CRP and the results were compared. Results Skin itching degree(2. 43 ± 0. 82),distribution range(1. 32 ± 0. 28) and sleep interference score(0. 34 ± 0. 18) in experimental group A were superior to those in experimental group B[(4. 56 ± 1. 13),(1. 62 ± 0. 22),(0. 78 ± 0. 28) respectively; F = 140. 205,33. 199,102. 357,P < 0. 01]. Skin pruritus(t = 19. 039,P < 0. 01),distribution range(t = 6. 811,P < 0. 01),sleep disturbances(t = 19. 106,P < 0. 01) in experimental group A after treatment were significantly improved compared before treatment. Skin itching degree(t = 12. 073,P < 0. 01),distribution range(t =4. 973,P < 0. 01),sleep interference(t = 9. 857,P < 0. 01) in experimental group B after treatment were significantly improved compared before treatment. Experimental group A patients with skin pruritus,distribution range and sleep interference scores than the experimental group B. experimental group A and group B patients in 3 months after treatment Between experimental group A and experimental group B,blood phosphorus(t = 10. 811,P < 0. 01,t = 5. 569,P < 0. 01),calcium phosphorus product(t = 11. 327,P < 0. 01,t =4. 956,P < 0. 01),i PTH(t = 9. 103,P < 0. 01,t = 4. 721,P < 0. 01),hs-CRP(t = 6. 886,P < 0. 01,t = 7. 033,P < 0. 01) decreased significantly 3 months after treatment,and the differences between groups were statistically significant. Blood phosphorus,calcium phosphorus product,i PTH,hs-CRP,BUN,SCr,ALB of experimental group A were better than those of experimental group B. There were statistically significant differences in skin pruritus,distribution range,sleep interference,blood phosphorus,calcium phosphorus product,BUN,SCr,i PTH,hs-CRP,ALB between experimental group A,B and control group(P < 0. 05). Conclusions High flux hemodialysis combined with low calcium dialysis solution can effectively relieve the skin itching degree,distribution range and sleep disturbance in patients with uremic pruritus,and decrease serum phosphorus,i PTH,hs-CRP,BUN,SCr,and ALB.