腹膜透析联合血液透析治疗终末期肾病的临床效果

Clinical effect of peritoneal dialysis combined with hemodialysis in the treatment of end-stage renal disease

目的探讨腹膜透析(PD)联合血液透析(PHD)治疗终末期肾病(ESRD)的临床效果。方法选取2017年1月—2019年10月于徐州市第一人民医院行血液净化治疗的ESRD患者30例,对所有患者进行腹膜平衡实验,根据患者腹膜转运类型及患者意愿分为对照组试和验组,每组15例。对照组采用持续非卧床腹膜透析(CAPD)模式,试验组采用PD联合PHD的形式。比较2组治疗前后一般情况包括尿量、血压(收缩压、舒张压)、干体质量达标率,比较2组治疗前后血肌酐、Kt/V、血红蛋白、血细胞比容(HCT)、平均每周促红素用量、血清中血钙、血磷、甲状旁腺激素水平。比较2组并发症,治疗前后血蛋白水平,主观综合性营养评分(SGA)评分,并比较2组治疗费用。结果治疗前2组尿量、收缩压、舒张压、干体重达标率比较,差异无统计学意义(P>0.05);治疗后试验组收缩压和舒张压低于对照组,干体质量达标率高于对照组(P<0.05);尿量比较,差异无统计学意义(P>0.05)。治疗前2组血肌酐、Kt/V比较,差异无统计学意义(P>0.05);治疗后试验组血肌酐低于对照组,Kt/V高于对照组(P<0.05)。2组治疗前后血红蛋白、HCT、每周促红素用量比较,差异无统计学意义(P>0.05)。治疗前2组血钙、血磷、甲状旁腺激素水平比较,差异无统计学意义(P>0.05);治疗后试验组血磷和甲状旁腺素低于对照组(P<0.05),血钙比较,差异无统计学意义(P>0.05)。试验组感染率、6个月内住院率低于对照组(P<0.05);2组心脑血管事件发生率、低蛋白血症发生率比较,差异无统计学意义(P>0.05)。治疗前2组血清白蛋白、SGA评分A级比例比较,差异无统计学意义(P>0.05);治疗后试验组血清白蛋白高于对照组(P<0.05);SGA评分A级比例比较,差异无统计学意义(P>0.05)。2组治疗前透析剂量、每月平均实际花费比较,差异无统计学意义(P>0.05)。结论 PD联合PHD治疗ESRD的临床效果良好,提高透析充分性,减少并发症,延长患者生存率,减少并发症的发生。

Objective To investigate the clinical effect of peritoneal dialysis(PD)combined with hemodialysis(PHD) in the treatment of end-stage renal disease(ESRD).Methods A total of 30 cases of patients with ESRD who underwent blood purification treatment in Xuzhou First People’s Hospital from January 2017 to October 2019 were selected.All patients underwent peritoneal balance test.According to the types of peritoneal transport and patients’ wishes,they were divided into control group and experimental group,with 15 cases in each group.The control group was treated with continuous ambulatory peritoneal dialysis(CAPD),and the experimental group was treated with PD combined with PHD.The general conditions including urine volume,blood pressure(systolic blood pressure,diastolic blood pressure),dry body weight reaching the standard rate were compared between the two groups before and after treatment.The serum creatinine,Kt/V,hemoglobin,hematocrit(HCT),average weekly erythropoietin dosage,serum calcium,blood phosphorus,parathyroid hormone levels were compared between the two groups before and after treatment.The complications,blood protein levels before and after treatment,and subjective comprehensive nutrition score(SGA)score were compared between the two groups.Results Before treatment,there was no significant difference in urine volume,systolic blood pressure,diastolic blood pressure and dry body weight between the two groups(P>0.05);after treatment,the systolic blood pressure and diastolic blood pressure in the experimental group were lower than those in the control group,and the dry weight compliance rate was higher than that in the control group(P<0.05);there was no significant difference in urine volume between the two groups(P>0.05).Before treatment,there was no significant difference in serum creatinine and Kt/V between the two groups(P>0.05);after treatment,the serum creatinine of the experimental group was lower than that of the control group,and the Kt/V was higher than that of the control group(P<0.05).There was no significant difference in hemoglobin,HCT and weekly erythropoietin consumption between the two groups before and after treatment(P>0.05).Before treatment,there was no significant difference in the levels of serum calcium,phosphorus and parathyroid hormone between the two groups(P>0.05);after treatment,the levels of serum phosphorus and parathyroid hormone in the experimental group were lower than those in the control group(P<0.05),but there was no significant difference in blood calcium(P>0.05).The infection rate and hospitalization rate within 6 months in the experimental group were lower than those in the control group(P<0.05);there was no significant difference in the incidence of cardio cerebrovascular events and hypoproteinemia between the two groups(P>0.05).Before treatment,there was no significant difference in the proportion of serum albumin and SGA score between the two groups(P>0.05);after treatment,the serum albumin in the experimental group was higher than that in the control group(P<0.05);there was no significant difference in the ratio of SGA score a between the two groups(P>0.05).There was no significant difference in dialysis dose and monthly average actual cost between the two groups(P>0.05).Conclusion PD combined with PHD in the treatment of ESRD has good clinical effect,improve dialysis adequacy,reduce complications,prolong the survival rate of patients,and reduce the incidence of complications.