高压氧治疗对维持性血液透析尿毒症患者认知功能的影响

Effect of hyperbaric oxygen therapy on the cognitive function in uremic patients with maintenance hemodialysis

目的探讨高压氧(HBO)治疗对尿毒症维持性血液透析患者认知功能的影响。方法选取2020年1月至12月在闸北中心医院肾内科进行维持性血液透析的尿毒症患者143例作为研究对象, 采用中文版蒙特利尔认知评估量表(MoCA)进行认知功能评估, 根据患者受教育时间和MoCA总分筛选出有认知功能障碍的82例患者, 按照随机数字表法分为HBO组和对照组, 每组41例。对照组患者给予纠正水电解质紊乱、营养支持和血液透析等治疗, HBO组患者在此基础上给予HBO治疗。比较2组患者的体内毒素清除情况、炎症因子水平、认知功能和生存质量。结果治疗后, HBO组患者的MoCA总分及各因子得分、肾病与透析相关生存质量量表(KDTA)总均分及各因子得分均显著高于对照组(P<0.05)。与治疗前相比, 治疗后HBO组患者执行能力、抽象、定向力、语言、命名、注意力评分和MoCA总分均显著升高;而对照组患者仅定向力、注意力评分和MoCA总分显著升高(P<0.05);除对照组患者肾病影响评分升高不明显外, 2组患者其他KDTA各因子及总均分均显著升高(P<0.05)。血肌酐(Cr)、尿素氮(BUN)、甲状旁腺素(PTH)、β2-微球蛋白(β2-MG)和半胱氨酸蛋白酶抑制剂C(CysC)清除率均显著高于对照组(P<0.05)。2组患者的血清C反应蛋白(CRP)、白细胞介素(IL)-6、IL-8、肿瘤坏死因子α(TNF-α)、单核细胞趋化蛋白-1(MCP-1)水平均较治疗前明显下降, 且HBO组患者炎症因子水平明显低于对照组, 差异均有统计学意义(P<0.05)。结论 HBO治疗有助于清除维持性血液透析尿毒症患者体内的毒素, 减轻炎症反应, 对认知功能和生存质量均具有一定的改善作用。

ion,orientation,language,naming,and attention,and the total scores of MoCA after treatment were significantly increased when compared with those before treatment;in the control group,only the scores of orientation and attention and the total scores of MoCA after treatment were significantly increased(P<0.05).All factor scores and total mean scores of KDTA in both groups were increased significantly(P<0.05),except for the score of effects of kidney disease(EKD)in the control group.The clearance rates of blood creatinine(Cr),urea nitrogen(BUN),parathyroid hormone(PTH),β2-microglobulin(β2-MG)and cysteine protease inhibitor C(CysC)in the HBO group were significantly higher than those of the control group(P<0.05).And the levels of serum C-reactive protein(CRP),interleukins(IL-6,IL-8),tumor necrosis factor-α(TNF-α),and monocyte chemotactic protein-1(MCP-1)in both groups after treatment were lower than those before treatment,and levels of inflammatory factors in the HBO group were significantly lower than those in the control group,with statistically significant differences(P<0.05).Conclusion HBO therapy helps remove toxins in uremic patients with maintenance hemodialysis,reduce inflammatory response,and improve the cognitive function and quality of life to a certain extent.