高通量透析在终末期肾病的应用及生活质量影响因素研究

The Application of High Flux Dialysis in End Stage Renal Disease and the Influencing Factors of Quality of Life

目的评价高通量血液透析清除尿毒症患者体内的小中大分子毒素物质,改善患者生活质量的作用。方法选择确诊尿毒症并行维持性透析治疗的患者72例,观察两种方法治疗3个月后空腹血糖、餐后2h血糖、血磷、血清肌酐、甲状旁腺激素、血尿素氮、血钾、血白蛋白、β2-微球蛋白(β2-MG)等指标的变化及治疗过程中的并发症发生情况。同时应用终末期肾脏疾病透析患者调查表(KDQOL-SFTM1.3)对两组患者进行生活质量评价。结果两组患者血液透析治疗3个月治疗后β2-MG含量显著降低,血浆白蛋白含量显著增高,且实验组改善程度优于对照组,差异均有统计学意义(P<0.05)。肌酐和尿素氮含量在治疗前及治疗后组间比较差异无统计学意义(P>0.05),两组病人SF-36的8个维度得分比较,高通量透析组在生理机能、生理职能、躯体疼痛、总体健康、情感职能、精神健康得分明显高于低通量透析组,而活力、社会功能得分在治疗前后两组无明显差异(P>0.05),两组病人KDTA维度得分比较差异均有统计学意义(P<0.05)。结论与低通量透析相比,高通量透析能够改善病人的生活质量,明显提高β2-MG、甲状旁腺激素等中大分子的清除,改善机体营养指标,减少维持性透析病人的远期并发症。

Objective To evaluate the role of high-flux hemodialysis in the removal of large molecular toxins in patients with uremia and to improve the quality of life of patients. Methods Seventy-two patients with diagnosis of uremia and maintenance dialysis were selected,the fasting blood glucose,2 h postprandial blood glucose,serum phosphorus,serum creatinine,parathyroid hormone,blood urea nitrogen,serum potassium,serum albumin,β2-microglobulin（ β2-MG） Changes in indicators and the incidence of complications during treatment 3 months after the two methods were observated. At the same time the quality of life in two groups of patients were assessed with endstage renal disease dialytic questionnaire（ KDQOL-SFTM1. 3）. Results Two groups of hemodialysis patients before treatment β2-MG and albumin,creatinine and urea nitrogen content had no significant difference（ P〈0. 05）,β2-MG group 3 months after treatment decreased significantly,plasma albumin was significantly increased,and the improvement degree of experimental group was better than the control group,the differences were statistically significant（ P〈0. 05）. Creatinine and urea nitrogen content before and after treatment in the treatment group,the difference was not statistically significant（ P〉0. 05）,two groups of patients SF-36 scores were significantly different in low flux dialysis group and HFHD group patients SF-36 score of dimensions in high flux hemodialysis group in physiological function,physiological function,body pain,general health,emotional function and mental health scores were significantly higher than the low flux dialysis group,and the activity and social function scores before and after treatment,no significant difference between the two groups（ P〉0. 05）,at a relatively low flux dialysis group and HFHD group patients KDTA scores in two groups there was statistically significant（ P〈0. 05）. Conclusion Compared with low flux hemodialysis,high flux hemodialysis can improve the patient＇s quality of life,can significantly improve the removal of a beta 2 microglobulin and parathyroid hormone in large molecules,improve the nutritional index,reduce the complications of hemodialysis patients.