摘要
目的探讨血液灌流(HP)联合维持性血液透析(MHD)在改善慢性肾衰竭患者并发症中的临床应用价值。方法选取2016年2月至2019年1月在我院透析中心治疗的慢性肾衰竭患者160例,根据随机数表法将入组患者分为联合组(84例)和对照组(76例)。联合组给予HP联合MHD进行血液净化治疗,对照组仅采用MHD治疗。酶联免疫吸附试验法监测2组患者不同时间血清生化指标变化,记录2组透析过程中不良反应情况,随访24个月分析2组患者并发症发生情况。结果治疗后不同时间,2组间血清B型钠尿肽(BNP)、肌酐、尿素氮水平差异无统计学意义(P>0.05);2组间同型半胱氨酸(Hcy)、甲状旁腺素(PTH)、β2-微球蛋白(MG)、血磷、血钙、血红蛋白和白蛋白水平比较,差异有统计学意义(P<0.05)。治疗后1个月,各生化指标组间比较,差异均无统计学意义(P>0.05);治疗后6、12个月,2组间各生化指标水平差异均有统计学意义(P<0.05),其中联合组中Hcy、PTH、β2-MG、血磷、血红蛋白和白蛋白水平较对照组降低,联合组血钙水平较对照组升高。透析过程中2组患者痛性痉挛、心律失常及发热等不良反应发生率差异无统计学意义(P>0.05);联合组低血压、贫血、低蛋白血症和透析失衡综合征发生率高于对照组(P<0.05)。随访结果显示,联合组皮肤瘙痒、肾性骨病、心脑血管病、高磷血症和透析相关性淀粉样变等并发症发生率均低于对照组(P<0.05)。联合组无并发症平均时间为(20±5)个月,对照组为(15±5)个月,2组间差异有统计学意义(P<0.05)。结论血液灌流联合维持性血液透析可通过有效清除机体内中大毒素分子,降低慢性肾衰竭患者并发症风险。
Objective To explore the clinical value of hemoperfusion(HP)combined with maintenance hemodialysis(MHD)in improving the complications of chronic renal failure.Methods From February 2016 to January 2019,160 patients with chronic renal failure who were treated in dialysis center of our hospital were selected and divided into the combined group(n=84)and the control group(n=76)according to random number table method.The combined group was treated with HP and MHD for blood purification,while the control group was only treated with MHD.Enzyme-linked immunosorbent assay was used to monitor the changes of serum biochemical indexes in two groups at different times.Adverse reactions during dialysis were recorded and follow up for 24 months to analyze the complications of the two groups.Result There was no significant difference in serum BNP,creatinine and urea nitrogen between the two groups at different time after treatment(P>0.05).There were significant differences in Hcy,PTH,β2-MG,P,Ca,Hb and albumin between the two groups(P<0.05).One month after treatment,there was no significant difference in biochemical indexes between the two groups(P>0.05);6 and 12 months after treatment,there was significant difference in biochemical indexes between the two groups(P<0.05).The levels of Hcy,PTH,β2-MG,blood phosphorus,hemoglobin and albumin in the combined group were lower than those in the control group,while the level of blood calcium in the combined group was higher than that in the control group.There was no significant difference in the incidence of adverse reactions such as painful spasm,arrhythmia and fever between the two groups(P>0.05);the incidence of hypotension,anemia,hypoproteinemia and dialysis imbalance syndrome in the combined group was higher than that in the control group(P<0.05).The follow-up results showed that the incidence of skin pruritus,renal osteopathy,cardio cerebrovascular disease,hyperphosphatemia and dialysis related amyloidosis in the combined group were lower than those in the control group(P<0.05).
作者
杨清柏
陈志忠
陈红
Yang Qingbai;Chen Zhizhong;Chen Hong(Department of Nephrology,Putian Medical District of the 900th Hospital of the PLA,Fujian 351100,China)
出处
《山西医药杂志》
CAS
2020年第17期2272-2275,共4页
Shanxi Medical Journal
