持续缓慢低效透析与常规透析序贯治疗在合并糖尿病的尿毒症患者中的应用

The sequential therapy of sustained low efficiency dialysis and intermittent hemodialysis in uremic patients with diabetes mellitus

目的观察序贯采用持续缓慢低效透析(sustained low effificiency dialysis,SLED)和间歇性血液透析(intermittent hemodialysis,IHD)治疗合并糖尿病的尿毒症患者的疗效,探索更切实可行的血液透析治疗模式。方法在知情同意的基础上纳入西部战区总医院血液净化中心维持性血液透析大于3个月的糖尿病患者,分为序贯治疗组和常规治疗组。序贯治疗组:每周IHD 2次+SLED 1次;常规治疗组:每周IHD 3次。比较2组患者的血压(透析前、透析2小时和透析后血压)、血压变异性、透析脱水量、脑利尿钠肽(brain natriuretic peptide,BNP)、尿素清除指数(Kt/V)、尿素清除率(urea reduction ratio,URR)等指标有无差异。结果序贯治疗组纳入10例患者,常规治疗组纳入24例患者。2组患者透析前收缩压(t=-1.053,P=0.300)、透析前舒张压(t=-1.020,P=0.315)、透析2h收缩压(t=-1.861,P=0.072)、透析2小时舒张压(t=-1.227,P=0.229)、透析后收缩压(t=-1.901,P=0.066)、透析后舒张压(t=-0.945,P=0.354)、透析期间收缩压变异性(t=-1.784,P=0.084)和透析期间舒张压变异性(t=-1.530,P=0.136)比较,差异均无统计学意义;序贯治疗组透析间期(随诊间)收缩压变异性低于常规治疗组(t=-2.166,P=0.038)。序贯治疗组Kt/V(t=2.878,P=0.007)、URR值(t=2.643,P=0.013)高于常规治疗组。结论与常规IHD相比,采用SLED和IHD序贯治疗能更好地控制透析间期血压变异,保证血流动力学的稳定,同时也能改善透析充分性。

Objective To observe the efficacy of the sequential therapy of sustained low efficiency dialysis(SLED)and intermittent hemodialysis(IHD)in uremic patients with diabetes mellitus,and to explore better and practical hemodialysis treatment model.Methods Uremic patients with diabetes mellitus who were undergoing maintenance hemodialysis for more than 3 months were enrolled in this study.The patients were divided into sequential group(IHD twice a week and SLED once a week)and conventional group(IHD3 times a week).Blood pressure,blood pressure variability,dialysis dehydration,BNP,Kt/V and urea reduction ratio(URR)were compared between the two groups.Results There were 10 patients in the sequential group and 24 patients in the conventional group.Systolic blood pressure(SBP)before dialysis(t=-1.053,P=0.300),diastolic blood pressure(DBP)before dialysis(t=-1.020,P=0.315),SBP at 2 hours of dialysis(t=-1.861,P=0.072),DBP at 2 hours of dialysis(t=-1.227,P=0.229),SBP after dialysis(t=-1.901,P=0.066),DBP after dialysis(t=-0.945,P=0.354),systolic blood pressure standard deviation(SBP_SD)between dialysis(t=-1.784,P=0.084),and DBP_SD between dialysis(t=-1.530,P=0.136)showed no statistical significances between the two groups.The variability of systolic blood pressure during follow up period(SBP_SD before dialysis)was significantly lower in the sequential group than in the conventional group(t=-2.166,P=0.038);Kt/V(t=2.878,P=0.007)and URR(t=2.643,P=0.013)were higher in the sequential group than in the conventional group.Conclusion Compared with conventional IHD,the sequential therapy of SLED and IHD can better control the blood pressure variation between dialysis,ensure the stability of hemodynamics,and improve the adequacy of dialysis.