透析液钙浓度对血液透析患者透析过程中不良反应发生风险影响的随机对照试验  

Randomized controlled trial of dialysate calcium concentrations on risks of adverse reactions in hemodialysis patients during dialysis

作　　者：陈彬 张萍 陈江华 Chert Bin;Zhang Ping;Chen Jianghua(Department of Nephrology,Zhenhai People＇s Hospital of Ningbo City,Zhejiang Province,Zhenjiang 315200,China;Kidney Disease Center,the First Affiliated Hospital,Zhejiang University,Hangzhou 310058,Chin)

机构地区：[1]宁波市镇海区人民医院肾内科,315200 [2]浙江大学附属第一医院肾脏病中心,杭州310058

出　　处：《药物不良反应杂志》2018年第3期181-186,共6页Adverse Drug Reactions Journal

基　　金：国家自然科学基金（81170691）

摘　　要：目的探讨透析液钙浓度（DCC）对维持性血液透析患者透析过程中不良反应发生风险的影响。方法研究对象为2016年6—10月在浙江大学附属第一医院肾脏病中心行维持性透析治疗的稳定终末期肾病患者。按照DCC将患者随机分为3组（1.25 mmol/L组、1.35 mmol/L组、1.50 mmol/L组），观察时间为12周。比较3组患者尿素清除指数Kt/V和尿素下降率（URR），透析前后平均动脉压，透析前后血钙、血磷、全段甲状旁腺激素（iPTH）及碱性磷酸酶（ALP）水平，以及肌肉痉挛、恶心呕吐、头痛、胸闷、心律失常等不良反应发生情况。结果纳入研究的患者为273例，男性159例，女性114例；年龄25-83岁，平均（52±9）岁；1.25 mmol/L、1.35 mmol/L和1.50 mmol/L组各91例，3组患者的基线资料差异无统计学意义（P〉0.05）。12周血液透析后，3组患者Kt/V和URR比较差异均无统计学意义（均P〉0.05）；1.25 mmol/L组和1.35 mmol/L组患者平均动脉压［分别为（102±9） mmHg、（103±11） mmHg］均无明显变化（均P〉0.0.5），1.50 mmol/L组患者平均动脉压明显高于透析前［（120±12） mmHg比（103±9） mmHg，P〈0.01］且明显高于1.25 mmol/L组和1.35 mmol/L组（均P〈0.01）；1.25 mmol/L组患者血钙水平低于透析前［（1.94±0.31） mmol/L比（2.24±0.18）mmol/L，P〈0.01］，1.50 mmol/L组血钙水平高于透析前［（2.54±0.18）mmol/L比（2.24±0.17）mmol/L，P〈0.01］；1.25 mmol/L组iPTH和ALP水平均明显高于透析前［（356±68）ng/L比（291±49）ng/L，（443±45）U/L比（343±58）U/L，均P〈0.01］。1.35 mmol/L组患者透析12周后血钙、血磷、iPTH、ALP水平均无明显变化（均P〉0.05）。透析过程中，1.25 mmol/L组肌肉痉挛发生率明显高于1.35 mmol/L组和1.50 mmol/L组［14.28%（13/91）比5.49%（5/91）、4.39%（4/91）, 均P〈0.05］；1.50 mmol/L组头痛发生率明显高于1.25 mmol/L组和1.35 mmol/L组［14.28%Objective To explore the effects of dialysate calcium concentrations （DCC） on risks of adverse reactions occurred in maintenance hemodialysis patients during dialysis.MethodsThe subjects were end-stage renal disease （ESRD） patients in stable condition who were treated with maintenance dialysis in the First Affiliated Hospital, Zhejiang University from June to October 2016. According to the DCC, the patients were randomly divided into 3 groups, the 1.25 mmol/L group, the 1.35 mmol/L group, and the 1.50 mmol/L group; the observation time was 12 weeks. The urea clearance index Kt/V, urea reduction rate （URR）, mean arterial pressure before and after dialysis, the serum calcium, serum phosphorus, intact parathyroid hormone （iPTH）, and alkaline phosphatase （ALP） levels before and after dialysis, and the incidence of muscle spasm, nausea and vomiting, headache, chest tightness, and arrhythmia in hemodialysis patients in the 3 groups were compared.ResultsA total of 273 patients entered the study, including 159 males and 114 females with ages from 25 to 83 years and average age of （52±9） years. Each of the 1.25 mmol/L, 1.35 mmol/L, and 1. 50 mmol/L groups comprised 91 patients. The differences of baseline data in patients in the 3 groups were not statistically significant （P〉0.05）. After 12 weeks of hemodialysis, the differences of Kt/V and URR in patients in the 3 groups were not statistically significant （all P〉0.05）;the differences of the mean arterial pressures in patients in the 1.25 and 1.35 mmol/L groups [（102±9） and （103±11） mmHg, respectively] were not statistically significant （all P〉0.0.5）; the mean arterial pressure in the patients in the 1.50 mmol/L group was higher than that before hemodialysis [（120±12） mmHg vs. （103±9） mmHg, P〈0.01] and was higher markedly than that in 1.25 and 1.35 mmol/L groups （all P〈0.01）; the serum calcium level in patients in the 1.25 mmol/L group was lower than that before hemodialysis [（1.94±0.31） mmol/L vs

关 键 词：血液透析液 钙 药物相关副作用和不良反应 

分 类 号：R692.5[医药卫生—泌尿科学]