高通量透析不同超滤量对溶质清除的影响  

Effect of highflux dialysis with different ultrafiltration volume on solute clearance in uremic patients

作　　者：毕学青[1] 姜埃利[1] 魏芳[1] 王喆[1] 张瑞宁[1] 

机构地区：[1]天津医科大学第二医院肾脏病血液净化科,天津300211

出　　处：《中国血液净化》2014年第10期713-716,共4页Chinese Journal of Blood Purification

摘　　要：目的观察高通量透析在不同超滤量情况下对维持性血液透析患者体内毒素清除效率及皮肤瘙痒程度的影响。方法选择维持性血液透析患者80例随机分成治疗组及对照组,均进行高通量透析治疗但治疗组超滤量大于对照组,2组患者均每周血液透析治疗3次,每次4 h,共观察6个月;在观察的0、6个月时分别检测两组患者的透析前后血肌酐(Cr)、血磷(p)、β2-微球蛋白(β2-MG)浓度,计算单次透析溶质清除率,取两次结果均值比较;应用改良Duo评分系统评估治疗前后瘙痒程度变化;比较两组患者跨膜压及不良反应的发生情况。以上结果均行t检验或χ2检验。结果经过上述治疗后两组患者血肌酐下降率差异无统计学意义(t=1.094,P=0.277,P>0.05);治疗组p、β2-MG的下降率均大于对照组(t值分别为-2.138和-12.815,P值分别为0.036和0.01,P<0.05);治疗组患者皮肤瘙痒降低程度大于对照组(t=-3.556,P=0.01,P<0.05);治疗组跨膜压高于对照组(t值10.22,P值0.001,P<0.01);两组不良反应发生率无统计学差异(χ2=值分别为0.346、0.157和0.125,P值分别为0.556、0.692和0.723,P>0.05)。结论高通量透析时增加超滤量在保证对小分子毒素充分清除的基础上,增加了大、中分子毒素的清除,可以明显减轻维持性血液透析患者顽固性皮肤瘙痒症状,可更大程度的发挥高通量透析的优势,不增加不良反应发生。Objective To investigate the effect of highflux dialysis with different ultrafiltration volume on the clearance of uremia toxins and the uremic pruritus in uremic patients.Methods Eighty patients were randomly divided into high ultrafiltration volume group and routine ultrafiltration volume group.All patients underwent highflux dialysis thrice weekly and were followed up for six months.The levels of blood creatinine （Cr）,phosphate,β2-microglobulin,and parathyroid hormone （PTH） were tested,and solute clearance was calculated before and after the dialysis.Skin itch degree was evaluated by the improved Duo scale system.Transmembrane pressure and adverse events were monitored during the treatment.Results There was no significant difference in the decrease of Cr between high ultrafiltration volume group and routine ultrafiltration volume group （t=1.094,P=0.277）,but the decreases of phosphate and β2-microglobulin were more prominent in high ultrafiltration volume group than in routine ultrafiltration volume group （t=-2.138 and-12.815,respectively; P=0.036 and 0.01,respectively）.Skin itch improved more in high ultrafiltration volume group than in routine ultrafiltration volume group （t=-3.556,P=0.010）.The prevalence of adverse events was statistically insignificant between the two groups （χ^2=0.346,0.157 and 0.125,respectively; P=0.556,0.692 and 0.723,respectively）,but the transmembrane pressure was higher in high ultrafiltration volume group than in routine ultrafiltration volume group （t=10.22,P=0.001）.Conclusion Highflux dialysis with higher ultrafiltration volume increased the clearance of macro and middle molecule toxins,while uremic pruritus was also alleviated significantly.

关 键 词：高通量透析 清除率 中分子物质 瘙痒症 

分 类 号：R459.5[医药卫生—治疗学]