不同的较低血透剂量对维持性血透患者矿物质骨代谢及并发症的影响

Effects of different lower hemodialysis doses on mineral bone metabolism and complications in maintenance hemodialysis patients

目的采取不同血液透析的剂量为维持性血液透析患者进行治疗,了解不同血透治疗的剂量对维持性血液透析患者钙磷、甲状旁腺激素及并发症的影响。方法采用回顾性研究,选择2019年1月~2021年1月在四川省人民医院和金牛区人民医院进行维持性血液透析且符合条件的患者共60例。将其分为标准血透剂量组A组(3×4小时/周),低频率血透剂量组B组(2×4小时/周),低透析时间血透剂量组C组(3×3小时/周)3个组,研究观察时间1年,分别于治疗前、治疗2月、治疗6月、治疗12月检测各项血生化指标,即血肌酐(Scr)、尿素氮(BUN)、白蛋白(Alb)、血钙、血磷、甲状旁腺激素(PTH)等,并分别于治疗后1、6、12个月时记录并发症发生的例数,最后进行统计学分析得出结论。结果研究前3组透析患者血清钙磷及PTH水平无明显差异(P>0.05),研究结束时标准血透剂量组血清钙磷水平达标率最高(P<0.05),低频率血透剂量组血清钙磷水平达标率最低(P<0.05),但3组PTH并无明显差异(P>0.05)。研究前3组各项并发症(消化道症状、神经系统症状、皮肤症状、低血压事件、急性心血管事件)并无明显差异(P>0.05),研究结束时,3组消化道症状无明显差异(P>0.05),其他症状比较标准血透剂量组均优于其他两组(P<0.05),同时低透析时间血透剂量组优于低频率血透剂量组(P<0.05)。结论血液透析患者维持标准血透剂量有利于维持正常的钙磷代谢及降低并发症。在无法达到标准血透剂量时,采取标准透析频率减少透析时间的血透剂量优于仅维持每次标准血透时间减少透析频率的血透剂量,但各组对PTH及消化道症状的影响并不明显。

Objective Different doses of hemodialysis were adopted for maintenance hemodialysis patients to understand the effects of different doses of hemodialysis treatment on calcium and phosphorus,parathyroid hormone and complications in maintenance hemodialysis patients.Methods A retrospective study was used to select a total of 60 patients who underwent maintenance hemodialysis at Sichuan Provincial People's Hospital and Jinniu District People's Hospital from January 2019 to January 2021 and were eligible.They were divided into three groups:standard hemodialysis dose group A(3×4 hours/week),low frequency hemodialysis dose group B(2×4 hours/week),and low dialysis time hemodialysis dose group C(3×3 hours/week).The study duration was 1 year,and the blood biochemical parameters,namely blood creatinine(Scr),urea nitrogen(BUN),albumin(Alb),blood calcium,blood phosphorus,and parathyroid hormone(PTH),were measured before,at 2 months,at 6 months,and at 12 months after treatment,and the number of complications was recorded at 1 month,6 months,and 12 months after treatment,respectively,and the final statistical analysis was performed to draw conclusions.Results There was no significant difference in serum calcium and phosphorus and PTH levels among the three dialysis groups before the study(P>0.05),and at the end of the study the standard calcium and phosphorus levels were highest in the standard hemodialysis dose group(P<0.05)and lowest in the low-frequency hemodialysis dose group(P<0.05),but there was no significant difference in PTH among the three groups(P>0.05).There was no significant difference in all complications(gastrointestinal symptoms,neurological symptoms,skin symptoms,hypotensive events,and acute cardiovascular events)among the three groups before the study(P>0.05),and at the end of the study,there was no significant difference in gastrointestinal symptoms among the three groups(P>0.05),and all other symptoms were better in the standard hemodialysis dose group compared with the other two groups(P<0.05),while the low dialysis time hemodialysis dose group was better than the low The frequency hemodialysis dose group was better than the low frequency hemodialysis dose group(P<0.05).Conclusion Maintaining the standard hemodialysis dose in hemodialysis patients is beneficial for maintaining normal calcium and phosphorus metabolism and reducing complications.When the standard hemodialysis dose could not be achieved,the hemodialysis dose with reduced dialysis time by taking the standard dialysis frequency was better than the hemodialysis dose with reduced dialysis frequency by maintaining only the standard hemodialysis time each time,but the effects on PTH and digestive symptoms were not significant in each group.