不同血流量血液灌流联合血液透析治疗尿毒症的临床疗效观察  

Clinical experience of different blood flow hemoperfusion combined with hemodialysis in the treatment of uremic patients

作　　者：卢光娅[1] 谭若芸[2] 

机构地区：[1]首都医科大学附属北京潞河医院血透科,北京101100 [2]南京医科大学血透科,江苏南京210029

出　　处：《临床和实验医学杂志》2016年第1期6-8,共3页Journal of Clinical and Experimental Medicine

基　　金：国家自然科学基金资助项目(编号：81100532)

摘　　要：目的探讨不同血流量血液灌流(HP)联合血液透析(HD)治疗尿毒症的临床疗效。方法选择2013年8月至2014年8月尿毒症患者85例,将其随机分为A组46例、B组39例,两组患者均采取HP+HD,A组血流量设定为200 ml/min,B组血流量设定为250 ml/min,比较两组患者治疗三个月后生化指标变化情况、尿素清除指数(Kt/V)、甲状旁腺激素(PTH)清除率以及凝血发生情况。结果治疗前两组患者肌酐(Cr)、β2-微球蛋白(MMS)、尿素氮(BUN)以及全段PTH水平均无显著差异(P>0.05),治疗后两组患者各生化指标均较治疗前显著降低(P<0.05),治疗后两组患者各生化指标之间均无显著差异(P>0.05);两组患者Kt/V以及PTH清除率比较,差异亦无统计学显著性意义(P>0.05);A组患者发生I级凝血8例,凝血发生率为17.39%,B组患者无凝血发生,凝血发生率为0,A组凝血发生率明显高于B组,差异具有统计学意义(P<0.05)。结论尿毒症HP联合HD治疗中,其HP血流量200 ml/min与250 ml/min对于机体毒素的清除作用无显著差异,而较高的血流量可降低透析器凝血的发生率。Objective To investigate the clinical effect of different blood flow hemoperfusion combined with hemodialysis for the treatment of uremia. Methods Eighty- five uremic patients treated from August 2013 to August 2014 were randomly divided into group A（ n = 46） and group B（ n = 39）. Both groups of patients received hemoperfusion and hemodialysis; the blood flow was set to 200 ml / min in group A,the blood flow was set to 250 ml / min in group B. Biochemical indexes,urea clearance index（ Kt / V）,parathyroid hormone（ PTH） clearance rate and the incidence of coagulation were compared between two groups three months after the treatment. Results Before the treatment there were no significant differences in the levels of creatinine,β2- microglobulin,BUN and PTH between two groups（ P〈0. 05）; after treatment biochemical indexes were significantly lower than those before treatment in both groups（ P〈0. 05）,and no significant difference between the two groups（ P〈0. 05）. No difference was found in Kt / V and PTH removal rate between two groups（ P〈0. 05）. Blood coagulation occurred in 8 cases in group A（ 17. 39%）,no blood clotting occurred in group B,the difference was statistically significant（ P〈0. 05）. Conclusion During the treatment of uremia with the combination of hemoperfusion and hemodialysis,no difference in removing waste products from the blood of the patients between200 ml / min and 250 ml / min blood flow,but higher blood flow can reduce the incidence of dialyzer coagulation.

关 键 词：尿毒症 血液灌流 血液透析 血流量 

分 类 号：R692.5[医药卫生—泌尿科学]