透析中心夜间血液透析对尿毒症患者血磷代谢的影响  

In-center nocturnal hemodialysis on phosphate metabolism in uremic patients

作　　者：袁艳辉[1,2] 戎殳[1] 张翼翔[1] 陈静[1] 张斌[1] 计雁飞[1] 叶朝阳[1] 梅长林[1] 

机构地区：[1]第二军医大学长征医院肾内科,上海200003 [2]辽宁省葫芦岛市解放军第313医院肾内科

出　　处：《中国血液净化》2014年第3期140-142,160,共4页Chinese Journal of Blood Purification

基　　金：国家自然科学基金资助项目(编号:81200542);上海市重点学科建设项目(编号:B902)

摘　　要：目的 观察透析中心夜间长时血液透析（in-center nocturnal hemodialysis,INHD）模式对尿毒症患者高磷血症的疗效.方法 调查INHD时间6个月以上的56例患者进入INHD前l～3个月及进入INHD至2013年5月透析情况、透析前血磷、血钙、血全段甲状旁腺激素（iPTH）检测值,分析血磷变化趋势,统计患者降磷药物服用情况.结果 患者进入INHD前3个月内平均血磷水平变化无统计学差异,进入INHD后1个月平均血磷水平即显著下降（P＜0.05）,之后持续稳定在＜1.67mmol/L水平；进入INHD后,有15例患者的31次（6.5％）检测出现低磷血症,发生过低磷血症的患者年龄更大、体重指数（BMI）更低、接受NHD时间更长（P＜0.05）：进入INHD后有14例（25％）患者停用降磷药物.结论 INHD能持续、平稳、有效地控制透析患者高磷血症,低磷血症发生率较低.Objective To observe the effect of in-center nocturnal hemodialysis （INHD） on hyperphos- phatemia in uremic patients. Methods Fifty-six patients treated with INHD for more than 6 months were in- vestigated. Serum phosphate, calcium and iPTH before and after entering INHD were collected. The use of phosphate binders was also recorded. Results The average serum phosphate changed insignificantly within the 3 months before 1NHD, but decreased significantly （P 〈0.05） after 1NHD for one month, and maintained less than 1,67 mmol/L thereafter. Hypophosphatemia occurred for 31 times （6.5%） in 15 patients after INHD. Hypophosphatemia was frequently found in patients with older age, lower body mass index, and longer noctur- nal hemodialysis duration （P 〈0.05）. After INHD, phosphate binders were discontinued in 14 patients （25%）. Conclusion 1NHD can effectively and stably control hyperphosphatemia in dialysis patients, with the lower prevalence of hypophosphatemia.

关 键 词：夜间血液透析 尿毒症 高磷血症 低磷血症 

分 类 号：R318.16[医药卫生—生物医学工程]