不同血液净化方式对慢性肾功能衰竭尿毒症的治疗效果

Efficacy of Different Blood Purification Methods in the Treatment of Chronic Renal Failure Uremia Patients

目的:探讨不同血液净化方式对慢性肾功能衰竭尿毒症的治疗效果。方法:114例行维持性血液净化治疗的慢性肾功能衰竭尿毒症患者,分别采用普通血液透析(普通组,34例)、普通血液透析联合血液透析滤过(滤过组,40例)及普通血液透析联合血液灌流(灌流组,40例)治疗,观察3组患者治疗6个月时的治疗效果,比较3组患者透析治疗期间并发症(包括缺血性心脏病变、高血压、感染、皮肤瘙痒、尿毒症脑病)及死亡的发生率,比较3组患者透析前及透析6个月时外周血血肌酐(SCr)、血尿素氮(BUN)、甲状旁腺激素(PTH)、血钙(Ca)、血磷(P)、β2-微球蛋白(β2-MG)、血红蛋白(Hb)、血清白蛋白(ALB)含量及尿素清除指数(KT/V)变化。结果:治疗前,3组患者BUN、SCr、β2-MG、KT/V、Ca、P、PTH、ALB及Hb比较,差异无统计学意义(P>0.05);治疗后,3组患者BUN、SCr、β2-MG、P及PTH水平均显著低于治疗前(P<0.05),KT/V、Ca、ALB及Hb水平水平均显著高于治疗前(P<0.05),滤过组、灌流组患者BUN、SCr、β2-MG、P及PTH水平均显著低于普通组,KT/V、Ca、ALB、Hb水平显著高于普通组(P<0.05);灌流组患者β2-MG、P、PTH水平显著低于滤过组,KT/V值显著高于滤过组(P<0.05);灌流组治疗总有效率显著高于滤过组与普通组(P<0.05),灌流组、滤过组缺血性心脏病变、皮肤瘙痒发生率均显著低于普通组,灌流组的皮肤瘙痒、感染发生率均显著低于滤过组(P<0.05)。结论:普通血液透析联合血液滤过或血液灌流对慢性肾功能衰竭尿毒症治疗效果优于单一普通血液透析,血液灌流对中大分子毒素的清除作用及治疗效果更佳。

Objective: To investigate the clinical efficacy of different blood purification methods in the treatment of chronic renal failure uremia. Methods: 114 patients with chronic renal failure who underwent maintenance blood purification were divided into three groups: the general group ( n =34,treated with general hemodialysis),the filtration group ( n =40,treated with general hemodialysis + hemodiafiltration),and the perfusion group ( n =40,treated with general hemodialysis + hemoperfusion).Observing the therapeutic effect,the incidence rate of uremic complications (including cardiac abnormalities,hypertension,infection,skin itch,uremic encephalopathy and death),comparing indicators before and 6m after dialysis (including SCr,BUN,PTH,Ca,P,β2-MG,Hb,ALB,KT/V). Results: Compared with before treatment,BUN,SCr,β2-MG,KT/V,Ca,P,PTH,ALB and Hb levels in the three groups showed no statistical significance ( P >0.05);while Ca,ALB,Hb and KT/V levels were significantly higher ( P <0.05).After treatment,the levels of BUN,SCr,β2-MG,P and PTH of three groups were significantly lower than before treatment ( P <0.05),the levels of KT/V,Ca,ALB and Hb were significantly higher than before treatment ( P <0.05).The levels of BUN,SCr,β2-MG,P and PTH in filtration group and perfusion group were obviously lower than that of general group,KT/V,Ca,ALB and Hb levels were obviously higher than general group ( P <0.05);levels of β2-MG,P and PTH in perfusion group was obviously lower than that of filtration group,KT/V value was significantly higher than that of filtration group ( P <0.05).The total effective rate of perfusion group was significantly higher than that of filtration group and normal group ( P <0.05).The incidence rate of ischemic heart disease and skin pruritus in perfusion group and filtration group were significantly lower than that in normal group,and the incidence rate of skin pruritus and infection in perfusion group was significantly lower than that in filtration group (P <0.05). Conclusion: General hemodialysis combined with hemodiafiltration or hemoperfusion can effectively improve the adequacy of hemodialysis.The hemoperfusion has better clearance effect on macromolecule toxins.