硫代硫酸钠对难治性尿毒症皮肤瘙痒症患者的疗效及其对生存质量的影响

Effect of Sodium Thiosulfate on quality of life and clinical efficacy in hemodialysis patients with refractory uremic pruritus

目的探讨硫代硫酸钠在难治性尿毒症皮肤瘙痒症患者中的疗效及其对生存质量的影响。方法选取2020年1月至2022年12月北京市海淀医院和济宁市第一人民医院收治的102例维持性规律血液透析治疗伴有皮肤瘙痒症患者作为研究对象,按随机数字表法分为对照组(51例)和观察组(51例)。对照组针对瘙痒患者保持皮肤湿润,局部冷敷,结合口服抗组胺药物等处理;观察组在每次透析下机前静脉推注硫代硫酸钠。比较两组患者的血肌酐(SCr),尿素氮(BUN),血液透析尿素清除指数(Kt/V),血钙(Ca):血磷(P),甲状旁腺激素(PTH)及皮肤瘙痒视觉模拟评分(VAS),并评价两组疗效,评估两组的生活质量,观察是否出现毒副反应和患者的耐受情况。结果观察组患者在接受硫代硫酸钠治疗8周后,其SCr、BUN、P、PTH均低于对照组,Kt/V、Ca均高于对照组,差异有统计学意义(P<0.05)。治疗8周后,观察组的VAS低于对照组,差异有统计学意义(P<0.05)。观察组的总有效率高于对照组,差异有统计学意义(P<0.05)。观察组的生理机能、生理职能、躯体疼痛、总体健康、活力、情感职能、精神健康、社会功能得分均高于对照组,差异有统计学意义(P<0.05)。两组患者治疗期间均未出现相关毒副反应,患者耐受度良好。结论硫代硫酸钠可有效缓解难治性尿毒症皮肤瘙痒症状,改善患者血肌酐、尿素氮、Kt/V、血钙磷、甲状旁腺激素等指标,对生活质量有显著的积极影响。

Objective To investigate the effect of Sodium Thiosulfate on quality of life and clinical efficacy in hemodialysis patients with refractory uremic pruritus.Methods A total of 102 patients with skin pruritus who were treated with maintenance regular hemodialysis in Beijing Haidian Hospital and Jining No.1 People's Hospital from January 2020 to December 2022 were selected as the research objects.According to the random number table method,they were divided into control group(51 cases)and observation group(51 cases).Patients in the control group were treated with skin moisturization,local cold compress,and oral antihistamine drugs.The observation group received intravenous injection of Sodium Thiosulfate before the completion of dialysis.The serum creatinine(SCr),blood urea nitrogen(BUN),kidney/renal urea clearance multiplied by time divided by volume of distribution of urea(Kt/V),serum calcium(Ca),serum phosphorus(P),parathyroid hormone(PTH)and visual analogue scale(VAS)of skin pruritus were compared between the two groups,and the curative effect was evaluated,the quality of life of the two groups was evaluated,and the side effects and tolerance of the patients were observed.Results After 8 weeks of Sodium Thiosulfate treatment,the SCr,BUN,P and PTH of the observation group were lower than those of the control group,and Kt/V and Ca were higher than those of the control group,and the differences were statistically significant(P<0.05).After 8 weeks of treatment,the VAS of the observation group was lower than that of the control group,and the difference was statistically significant(P<0.05).The total effective rate of the observation group was higher than that of the control group,and the difference was statistically significant(P<0.05).The scores of physical function,role physical,bodily pain,general health,vatality,role emotional,mental health and social function of the observation group were higher than those of the control group,and the differences were statistically significant(P<0.05).There were no related adverse reactions during treatment in the two groups,and the patients were well tolerated.Conclusion Sodium Thiosulfate can effectively relieve the pruritus of refractory uremia,improve the serum creatinine,urea nitrogen,Kt/V,serum calcium and phosphorus,parathyroid hormone and other indicators of patients,and has a significant positive impact on the quality of life.