血液透析和血液滤过对慢性肾功能衰竭患者心血管稳定性的影响  

Study of the Effects of Hemodialysis and Hemofiltration on Cardiovascular Stability in Patients with Chronic Renal Failure

作　　者：王知音[1] 何敏[1] 万俊 WANG Zhiyin;HE Min;WAN Jun(The Central Hospital of Bazhong, Sichuan Bazhong 636000, China)

机构地区：[1]四川省巴中市中心医院肾内科血液透析中心,四川巴中636000

出　　处：《河北医学》2020年第9期1522-1527,共6页Hebei Medicine

基　　金：四川省成都市卫生局科学研究基金,(编号:20140776)。

摘　　要：目的:研究血液透析(HD)和血液滤过(HF)对慢性肾功能衰竭(CRF)患者心血管稳定性的影响。方法:选取2018年8月至2019年8月我院接受血液净化治疗的CRF患者104例为研究对象,采用简单随机化法均分为CVVH组和HD组各52例,两组均给予常规对症支持治疗,CVVH组在此基础上进行CVVH治疗,HD组则实施MHD,两组疗程均为3个月,比较两组透析效果、炎症因子表达水平、血流动力学指标及预后情况。结果:治疗3个月时,两组GFR、Kt/V、nPCR以及TACU未见明显差异(P>0.05);两组血清Scr和BUN水平明显降低(P<0.05),CVVH组血清PTH和β2-MG水平明显降低(P<0.05),且CVVH组PTH和β2-MG低于对照组,差异有统计学意义(P<0.05);两组血清IL-10水平明显升高(P<0.05),血清CRP和IL-6水平明显降低(P<0.05),且CVVH组IL-10高于HD组,CRP和IL-6低于HD组,差异有统计学意义(P<0.05);两组GEDVI、ITBVI及EVLWI明显降低(P<0.05),且CVVH组GEDVI、ITBVI及EVLWI低于HD组,差异有统计学意义(P<0.05);随访2年结果显示,CVVH组和HD组患者CVD发生率分别为32.69%和53.85%(P<0.05),心源性死亡率分别为15.38%和28.85%(P>0.05)。结论:HD和CVVH治疗CRF患者均可有效促进小分子毒素清除,且CVVH对中大分子毒素也具有良好清除效果,有利于改善机体微炎症状态并维持心血管稳定,从而降低CVD和心源性死亡等不良事件发生风险。Objective:To study the effects of hemodialysis(HD)and hemofiltration(HF)on cardiovascular stability in patients with chronic renal failure(CRF).Methods:A total of 104 CRF patients who underwent blood purification treatment from August 2018 to August 2019 were selected for the study and were randomly divided into CVVH group and HD group(each n=52).The two groups were given routine symptomatic support,and CVVH group was given CVVH on this basis,and HD group was given MHD,and the two groups were treated for 3 months.The dialysis effects,expression levels of inflammatory factors,hemodynamic indexes and prognosis were compared between the two groups.Results:After 3 months treatment,there were no significant differences in the GFR,Kt/V,nPCR and TACU between the two groups(P>0.05).Serum Scr and BUN levels were significantly decreased in the two groups(P<0.05),and the levels of serum PTH andβ2-MG were significantly decreased in CVVH group(P<0.05),and the levels of PTH andβ2-MG in CVVH group were lower than those in HD group(P<0.05).The serum IL-10 level in the two groups was significantly increased(P<0.05)while the levels of serum CRP and IL-6 levels were significantly decreased(P<0.05),and the level of IL-10 in CVVH group was higher than that in HD group while the levels of CRP and IL-6 were lower than those in HD group(P<0.05).The GEDVI The ITBVI and EVLWI were significantly decreased in the two groups(P<0.05),and the GVVI,ITBVI and EVLWI in CVVH group were lower than those in HD group(P<0.05).Results of 3 years follow-up showed that the incidence rates of CVD in CVVH group and HD group were 32.69%and 53.85%(P<0.05),and the cardiogenic death rates were 15.38%and 28.85%respectively(P>0.05).Conclusion:HD and CVVH can effectively promote the clearance of small molecule toxins in CRF patients,and CVVH has a good scavenging effect on medium macromolecular toxins,and it is beneficial to improve the body microinflammation states and maintain cardiovascular stability,thereby reducing the risk of adverse events such as CVD an

关 键 词：慢性肾功能衰竭 血液透析 血液滤过 心血管稳定性 

分 类 号：R692.5[医药卫生—泌尿科学]