不同透析频率在尿毒症血液透析患者中的应用效果  

Application effect of different dialysis frequencies in uremic patients

作　　者：何联义[1] 

机构地区：[1]广西医科大学第三附属医院肾内科,广西南宁530031

出　　处：《临床荟萃》2015年第11期1292-1296,共5页Clinical Focus

摘　　要：目的比较不同透析频率在尿毒症血液透析患者中的应用效果。方法选取2011年1月至2013年12月期间于我院进行血液透析治疗的81例尿毒症患者为研究对象,根据透析频率分为A组(每周透析4次,n=19)、B组(每周透析3次,n=33)、C组(每周透析2次,n=29)。比较3组一般情况、营养状况指标、钙磷代谢状况、微炎症指标、并发症发生率和转归情况。结果开始透析时3组各临床资料比较差异均无统计学意义(P>0.05)。透析1年后,A组血红蛋白(Hb)显著高于B组(P<0.05),A组血清白蛋白(ALB)、前白蛋白(PA)、Hb均显著高于C组,而血肌酐(SCr)和尿素氮(BUN)均显著低于C组(P<0.05),B组的ALB、PA均显著高于C组(P<0.05)。A组的血钙(Ca)显著高于B组和C组,而血磷(P)、甲状旁腺激素(PTH)显著低于B组和C组(P<0.05)。A组的超敏C反应蛋白(hs-CRP)、白细胞介素6(IL-6)水平均显著低于C组(P<0.05)。A组的感染发生率和病死率均显著低于C组(P>0.05)。结论透析频率增加有助于改善营养状况和微炎症状态,降低感染的发生风险,从而改善尿毒症患者的预后,故推荐对每周透析3次的患者增加透析频率,在经济条件允许情况下可采用每周透析4次的高通量透析方案。Objective To compare the application effect of different dialysis frequencies in uremic patients.Methods A total of 81 uremic patients who received dialysis from Jan.2011 to Dec.2013 were enrolled and divided into group A（4times per week,n =19）,group B（3times per week,n =33）and group C（2times per week,n =29）.General condition,nutrition indicators,calcium and phosphorus metabolism,micro-inflammatory indicators,incidence of complications and prognosis were compared among three groups.Results There were no significant difference in all clinical indexes among three groups at the initiation of dialysis（P〈0.05）.One year after dialysis,hemoglobin（Hb）of group A was significantly higher than that of group B（P〈0.05）.Compared with group C,serum albumin（ALB）,pre albumin（PA）and Hb in group A were significantly higher,and serum creatinine（Scr）and blood urea nitrogen（BUN）in group A were significantly lower（P〈0.05）.ALB and PA in group B were significantly higher than those in group C（P〈0.05）.Compared with group B and C,the serum calcium was significantly higher and serum phosphorus（P）and parathyroid hormone（PTH）were significantly lower（P〈0.05）.The high sensitivity C reactive protein（hs-CRP）and interleukin-6（IL-6）in group A were significantly lower than those in group C（P〈0.05）.The incidence of infection and mortality in group A were significantly lower than those in group C（P〈0.05）.Conclusion Increasing dialysis frequency could help improve the nutritional status and microinflammatory state,reduce the risk of infection,and improve the prognosis of uremia patients.It is recommended to increase the dialysis frequency for patients receiving dialysis three times twice weeks,and adopt the high flux dialysis scheme three times a week if economic conditions permit.

关 键 词：尿毒症 透析 营养不良 炎症 

分 类 号：R692.5[医药卫生—泌尿科学]