高通量血液透析和低通量血液透析间断串联血液灌流对尿毒症患者的影响

High-flux Hemodialysis and Low-flux Hemodialysis with Intermittent Series Hemoperfusion the Effect on Patients with Uremia

目的探讨高通量血液透析与低通量血液透析间断串联血液灌流对尿毒症患者自我感觉以及尿毒症毒素的清除、电解质酸碱平衡、贫血和营养等多方面的影响。方法选取2017年1~12月在成都市第十一人民医院肾内科维持性血液透析6个月以上患者106例,随机分成高通量血液透析组和低通量血液透析间断串联血液灌流两组,每组53例。收集年龄、原发病、透析病程、瘙痒、恶心纳差、透析次日尿素氮、肌酐、β2微球蛋白、钠、钾、氯、CO2、钙、磷、甲状旁腺激素、血红蛋白、白蛋白和C反应蛋白,计算校正钙,比较两组指标。结果①高通量血液透析组全身瘙痒、恶心纳差等症状明显低于低通量血液透析间断串联血液灌流组(P<0.05);②高通量血液透析组β2微球蛋白、血钠均明显低于低通量血液透析间断串联血液灌流组(P<0.001);③高通量血液透析组校正血钙、血CO2均明显高于低通量血液透析间断串联血液灌流组(P<0.01);④尿素氮、肌酐、血红蛋白、白蛋白、血小板、血磷和甲状旁腺激素两组均无统计学差异(P>0.05)。结论①高通量血液透析对改善尿毒症患者瘙痒、纳差恶心等症状方面优于低通量血液透析间断串联血液灌流;②高通量血液透析对中大分子物质的清除、对改善CKD-MBD的钙磷代谢方面、对减低透析间期血钠、纠正酸中毒的方面均优于低通量血液透析间断串联血液灌流,没有增加微炎症和白蛋白的丢失。

Objective To investigate the effects of on self-perception,clearance of uremic toxins,maintenance of electrolyte acid-base balance,anemia and nutrition in patients with uremia during high-flux hemodialysis and low-flux hemodialysis interruptedseries connectionhemoperfusion.Methods 106 patients with maintenance hemodialysis over 6 months from January to December 2017 in the Department of Nephrology,Chengdu Eleventh People's Hospital were randomly divided into two groups,high-flux hemodialysis group and low-flux hemodialysis with intermittent series hemoperfusion group,53 in each group.Age,primary disease,course of dialysis,pruritus,nausea,urea nitrogen,creatinine,β2 microglobulin,blood sodium,blood potassium,blood chlorine,carbon dioxide,blood calcium,blood phosphorus,parathyroid hormone,hemoglobin,albumin and C-reactive protein were collected,and corrected calcium was calculated and compared between the two groups.Results①The symptoms of pruritus and nausea in high-flux hemodialysis group were significantly lower than those in low-flux hemodialysis with interruptedseries connectionhemoperfusion group(P<0.05);②The levels of serum beta 2 microglobulin and sodium in high-flux hemodialysis group were significantly lower than those in low-flux hemodialysis with intermittent series hemoperfusion group(P<0.001);③Calcium and CO2 in high-flux hemodialysis group were significantly higher than those in low-flux hemodialysis group(P<0.01);④Urea nitrogen,creatinine,hemoglobin,albumin and platelet.There was no significant difference in blood phosphorus and parathyroid hormone between the two groups(P>0.05).Conclusion①High-flux hemodialysis is superior to low-flux hemodialysis with interruptedseries connectionhemoperfusion in improving itching,nausea and other symptoms;②High-flux hemodialysis is superior to low-flux hemodialysis with intermittent series hemoperfusion in clearing macromolecule substances,improving calcium and phosphorus metabolism of CKD-MBD,reducing blood sodium during dialysis and correcting acidosis.There was no increase in microinflammation and loss of albumin.