不同透析模式对尿毒症皮肤瘙痒的临床疗效  

Clinical effect of different dialysis modes on uremic pruritus

作　　者：李俊 石清 霍桢[1] 冀婵娟 LI Jun;SHI Qing;HUO Zhen;JI Chan-juan(Xi＇an Central Hospital,Xi＇an 710043,China)

机构地区：[1]西安市中心医院,陕西西安710043

出　　处：《临床医学研究与实践》2018年第27期65-66,69,共3页Clinical Research and Practice

摘　　要：目的比较常规血液透析、高通血液透析联合血液透析滤过及血液灌流,与腹膜透析对尿毒症皮肤瘙痒的临床疗效。方法选取2015年1月至2017年1月我院收治的尿毒症皮肤瘙痒血液透析患者44例,随机分为2组,每组22例。1组行常规血液透析,2组行高通血液透析联合血液透析滤过及血液灌流,另外以院外随访的22例行血液透析转腹膜透析的尿毒症皮肤瘙痒患者为第3组。比较三组患者治疗前、后β_2微球蛋白(β_2-MG)、全段甲状旁腺激素(iPTH)及血磷(P3-)水平、瘙痒程度及尿毒症皮肤瘙痒症状。结果治疗后,1组患者的β_2-MG、iPTH、P3-水平及VAS评分与治疗前相比无明显变化(P>0.05);2、3组患者的β_2-MG、iPTH、P3-水平及VAS评分与治疗前相比均显著降低(P<0.05);且2、3组治疗后的β_2-MG、iPTH、P3-水平及VAS评分均明显低于1组(P<0.05);治疗后,3组的轻度、重度瘙痒比例显著优于治疗前(P<0.05);2、3组的轻度瘙痒比例均明显高于1组(P<0.05)。结论高通量血液透析联合血液透析滤过及血液灌流和腹膜透析可以有效清除尿毒症患者体内的β_2-MG、iPTH、P3-等中分子毒素,降低尿毒症皮肤瘙痒程度,值得临床推广应用。Objective To compare the clinical effect of routine hemodialysis, high-flux hemodialysis combined withhemodiafiltration＋hemoperfusion and peritoneal dialysis on uremic pruritus Methods A total of 44 patients with uremicpruritus undergoing hemodialysis in our hospital from January 2015 to January 2017 were selected and randomly dividedinto two groups, with 22 cases in each group. Routine hemodialysis was performed in the group1 and high -fluxhemodialysis combined with hemodiafiltration ＋hemoperfusion was performed in the group 2. In addition, 22 uremicpruritus patients undergoing peritoneal dialysis were selected as group 3. The levels of β2-microglobulin （β2-MG）, intactparathyroid hormone （iPTH） and serum phosphorus （P3-）, the degree of pruritus and the symptom of uremic pruritus werecompared among the three groups before and after treatment. Results After treatment, there were no significantdifferences in the levels of β2-MG, iPTH,P3-and VAS scores of the group 1 compared with those before treatment（P〉0.05）. After treatment, the levels of β2-MG, iPTH,P3-and VAS scores in the group 2 and3 significantly decreased, andthose in the group2 and3 were significantly lower than those in the group 1（P〈0.05）. After treatment, the proportions ofmild and severe pruritus in the group 3 were significantly better than those before treatment（P〈0.05）. The proportions ofmild pruritus in the group2 and3 were significantly higher than that in the group1 （P〈0.05）. Conclusion High-fluxhemodialysis combined with hemodiafiltration ＋hemoperfusion and peritoneal dialysis can effectively remove middlemolecule toxins such as β2-MG, iPTH,P3-in uremic patients, reduce the degree of uremic pruritus, which is worthy ofclinical promotion and application.

关 键 词：血液透析 血液透析滤过 血液灌流 腹膜透析 尿毒症皮肤瘙痒 

分 类 号：R692.5[医药卫生—泌尿科学]