透析不同时期加入血液灌流治疗尿毒症的疗效评价
Clinical efficacy of hemoperfusion at different stages in the treatment of uremia
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摘要: 目的:比较血液透析联合血液灌流治疗中,在治疗前期和后期分别加入血液灌流的临床疗效。方法:将采用血液透析联合血液灌流治疗的106例尿毒症病人随机分为A、B2组,各53例。A组为在透析治疗前2 h加入血液灌流,B组在透析治疗后2 h加入血液灌流。治疗后3个月,比较2组病人甲状旁腺素(PTH)、血尿素氮(BUN)、肝酐(Cr)及β2-微球蛋白β2-(MG)变化,并观察治疗前后的睡眠、血压、食欲、皮肤瘙痒及肢体疼痛、麻木感、不宁腿综合征神经症状变化情况。结果:2组病人BUN、PTH、Cr和β2-MG的含量经治疗后均明显降低(P<0.05~P<0.01),且B组治疗后降低幅度大于A组(P<0.01)。治疗后2组睡眠障碍、高血压、皮肤瘙痒和趾端疼痛均有改善(P<0.05~P<0.01),食欲差在2组间均没有得到改善(P>0.05),而感觉障碍和麻木感仅在B组得到改善(P<0.01)。结论:治疗后期进行血液灌流联合治疗方式能显著提高尿毒症病人血液中有害物质的清除效率,改善感觉障碍和麻木感的症状。Abstract: Objective:To compare the clinical efficacy of hemoperfusion at early or late stage during the hemodialysis combined with hemoperfusion treatment.Methods:A total of 106 uremia patients who were treated by combination of hemodialysis and hemoperfusion were included and randomly divided into group A and group B(53 cases each group).Blood perfusion was added 2 hours before dialysis in group A, while blood perfusion was added at last 2 hours of dialysis in group B.Three months after treatment, the levels of parathormone(PTH),blood urea nitrogen(BUN),creatinine(Cr),β2-microglobulin (β2-MG) between two groups were compared.The changes of the sleep situation,blood pressure,appetite,skin itching,body pain,numbness and restless leg syndrome before and after treatment were also observed.Results:The levels of BUN,PTH, Cr and β2-MG in two groups significantly decreased after treatment(P<0.05 to P<0.01),while the decreasing degree of these indexes in group B was more than that in group A(P<0.01).After treatment, the sleep disorder, high blood pressure and toe pain in two groups significantly improved(P<0.05 to P<0.01),while the poor appetite in two groups did not improve significantly(P>0.05).The sensory disorder and numbness improved only in group B(P<0.01).Conclusions:The combination of hemoperfusion at late stage of dialysis can significantly increase the clear rate of serum harmful substance, and improve the sensory disorder and numbness symptom.
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Key words:
- uremia /
- hemoperfusion /
- hemodialysis
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[1] GIRNDT M.Clinical issues with uremia[J].Internist(Berl),2012,53(7):817. [2] HADDY FJ,MEYER TW,HOSTETTER TH.Uremia[J].New Engl J Med,2008,358(1):95. [3] TONELLI M,KARUMANCHI SA,THADHANI R.Epidemiology and mechanisms of uremia-related cardiovascular disease[J].Circulation,2016,133(5):518. [4] SUGERMAN HJ,HARVEY J,THOMAS F.Effect of pH on phenobarbital extraction by hemoperfusion over anion exchange resins[J].J Pharmacol Exp Ther,1970,175(1):22. [5] HOLUBEK WJ,HOFFMAN RS,GOLDFARB DS,et al.Use of hemodialysis and hemoperfusion in poisoned patients[J].Kidney Int,2008,74(10):1327. [6] MOROZUMI I,INAGAKI A,SUZUKI S,et al.Successful treatment of high-dose methotrexate-induced oliguric acute renal failure by using a combination of hemodialysis filtration and direct hemoperfusion[J].Gan To Kagaku Ryoho,2015,42(5):609. [7] 徐艳梅,许传文.血液灌流联合血液透析对维持性血液透析患者体内微炎症和营养不良状态的影响[J].中国中西医结合急救杂志,2014,21(1):42. [8] WINCHESTER JF,RONCO C,BRADY JA,et al.Rationale for combined hemoperfusion/hemodialysis in uremia[J].Contrib Nephrol,2001,133(133):174. [9] 于笑霞,王立新,吕增禄,等.血液灌流治疗急性有机磷农药中毒中间综合征的疗效研究[J].中华肾病学杂志,2000,16(3):3. [10] 黄艳春.尿毒症患者瘙痒的发病机制及治疗研究进展[J].中国社区医师,2016,32(29):669. [11] 王海明,孙宏宇,毛丽丹,等.血液灌流技术及护理浅析[J].世界最新医学信息文摘,2013,13(17):407. [12] CHEN SJ,JIANG GR,SHAN JP,et al.Combination of maintenance hemodialysis with hemoperfusion:a safe and effective model of artificial kidney[J].Int J Artif Organs,2011,34(4):339. [13] MIAO LY,ZHU B,HE XZ,et al.Effects of three blood purification methods on serum fibroblast growth factor-23 clearance in patients with hyperphosphatemia undergoing maintenance hemodialysis[J].Exp Ther Med,2014,7(4):947. [14] WINCHESTER JF,RATCLIFFE JG,CARLYLE E,et al.Solute,amino acid,and hormone changes with coated charcoal hemoperfusion in uremia[J].Kidney Int,1978,14(1):74. [15] 刘辉.组合型血液净化治疗尿毒症患者的临床护理[J].国际护理学杂志,2013,32(4):3. [16] 许敏昭,曾洪,吴瑞恩,等.组合型血液净化治疗尿毒症病人的临床护理研究[J].护理研究,2009,23(8):2.
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