低钠血液透析联合血液灌流在慢性肾衰竭合并顽固型高血压治疗中的应用

Application of Hyponatremia Hemodialysis Combined with Hemoperfusion in the Treatment of Chronic Renal Failure Complicated with Refractory Hypertension

目的:研究低钠血液透析(HD)联合血液灌流(HP)在慢性肾衰竭(CRF)合并顽固性高血压(RH)治疗的临床效果。方法:选取2018年7月—2020年7月南阳市中心医院收治的73例CRF合并RH患者作为研究对象,按随机数表法分为对照组36例和观察组37例。对照组患者给予低钠HD治疗,观察组患者在对照组患者基础上联合使用HP进行治疗。观察比较治疗前和治疗3个月后两组患者血压[收缩压(SBP)、舒张压(DBP)]、血管相关指标[血浆内皮素(ET)、血浆肾素(RA)、血管紧张素Ⅱ(ATⅡ)]、肾功能指标[尿素氮(BUN)、血磷、β2-微球蛋白(β2-MG)、同型半胱氨酸(Hcy)、甲状腺旁素(PTH)、血肌酐(Scr)]、炎症因子水平[C反应蛋白(CRP)、肿瘤坏死因子(TNF-α)、干扰素(IFN-γ)]、生活质量[慢性肾衰竭生命质量量表(QLICD-CRF2.0)]变化。结果:治疗3个月后,两组患者的SBP、DBP、ET、RA、ATⅡ、BUN、血磷、β2-MG、Hcy、PTH、Scr、CRP、TNF-α水平较治疗前均有明显降低,且观察组患者低于同一时间对照组患者,差异有统计学意义(t=2.744、4.058、2.706、2.678、2.731、2.793、3.031、3.141、2.869、3.409、2.995、3.356、3.527,P<0.05);两组患者IFN-γ水平、QLICD-CRF2.0评分较治疗前均有显著提高,且观察组患者高于同一时间对照组患者,差异有统计学意义(t=3.320、3.456、2.703、3.007、2.758,P<0.05)。结论:低钠HD联合HP治疗CRF合并RH患者能有效降低患者血压,促进毒素代谢排出,从而改善患者生活质量。

Objective: To study the clinical effect of low sodium hemodialysis(HD) combined with hemoperfusion(HP) in the treatment of chronic renal failure(CRF) complicated with resistant hypertension(RH). Methods: A total of 73 patients with CRF and RH who were admitted to the hospital from July 2018 to July 2020 were selected and randomly divided into the control group with 36 cases and the observation group with 37 cases. The control group was treated with low sodium HD. The patients in the control group were treated with low sodium HD, and the patients in the observation group were treated with HP on the basis of the patients in the control group. The blood pressure(systolic blood pressure [SBP], diastolic blood pressure [DBP]), blood vesselrelated indexes(plasma endothelin [ET], plasma renin [RA], angiotensin II [ATⅡ]), the renal function indexes of the two groups of patients(urea nitrogen [BUN], serum phosphorus, β2-microglobulin [β2-MG], homocysteine [Hcy], parathyroid hormone [PTH],serum creatinine [Scr]), the levels of inflammatory factors(C-reactive protein [CRP], tumor necrosis factor [TNF-α], interferon[IFN-γ]), quality of life(chronic renal failure quality of life scales [QLICD-CRF2.0]) in the two groups of patients changes before treatment and after 3 months of treatment were observed and compared. Results: After 3 months of treatment, the levels of SBP,DBP, ET, RA, ATⅡ, BUN, serum phosphorus, β2-MG, Hcy, PTH, Scr, CRP and TNF-α in the two groups were significantly lower than those before treatment, and the patients in the observation group were lower than the patients in the control group at the same time, the difference was statistically significant(t=2.744, 4.058, 2.706, 2.678, 2.731, 2.793, 3.031, 3.141, 2.869, 3.409,2.995, 3.356, 3.527, P<0.05). The IFN-γ levels and QLICD-CRF2.0 scores of the two groups were significantly improved compared with those before treatment, and the patients in the observation group were higher than those in the control group at the same time, and the difference was statistically significant(t=3.320, 3.007, 2.758, P<0.05). Conclusion: Low sodium HD combined with HP in the treatment of CRF and RH patients effectively reduces blood pressure, promotes the metabolism and excretion of toxins, and improves the quality of life of patients.