腹膜透析联合血液透析对透析不充分终末期肾病患者的疗效分析  

Efficacy analysis of peritoneal dialysis combined with hemodialysis in patients with inadequate dialysis end-stage renal disease

作　　者：贺发贵[1] 刘丹颖 张琳[3] 郑艳宇 张志强[4] 赵鹏飞 He Fagui;Liu Danying;Zhang Lin;Zheng Yanyu;Zhang Zhiqiang;Zhao Pengfei

机构地区：[1]中国人民解放军联勤保障部队第981医院肾脏病科,067032 [2]中国人民解放军联勤保障部队北戴河康复疗养中心综合内科,066100 [3]中国人民解放军联勤保障部队第981医院卫勤处,067032 [4]中国人民解放军联勤保障部队第981医院院部,067032

出　　处：《中国疗养医学》2022年第10期1106-1109,共4页Chinese Journal of Convalescent Medicine

基　　金：战、创伤中急性肾损伤早期预警及修复关键技术研究(CWSJ12J065)。

摘　　要：目的分析腹膜透析(PD)联合血液透析(HD)对血透不充分终末期肾病(ESRD)患者的治疗效果。方法回顾性分析北戴河康复疗养中心全军肾病中西结合治疗中心15例PD与HD联合治疗(PHD)3个月后患者的临床资料,对比其PHD前与PHD3个月后(PHD3)的主要临床表现、营养症状及化验指标。结果通过PHD3患者焦虑、抑郁、失眠、乏力、食欲不振症状明显好转(P<0.05),PHD前、PHD3其发生情况为:焦虑由86.7%(13例)降至13.3%(2例),抑郁由73.3%(11例)降至20.0%(3例),失眠由60.0%(9例)降至6.6%(1例),乏力由80.0%(12例)降至33.3%(5例),食欲不振由73.3%(11例)降至26.7%(4例);营养症状有所改善,但营养良好率升高差异无统计学意义(P>0.05),PHD前、PHD3其发生情况为:营养良好由26.67%(4例)升至66.66%(10例);主要检验[如血尿素氮(BUN)、血肌酐(Scr)、C反应蛋白(CRP)、血红蛋白(Hb)、血浆白蛋白、尿素清除指数(Kt/V)、血钙、血磷、甲状旁腺激素(PTH)、血钠、血钾、二氧化碳结合力(CO_(2)CP)]明显改善(P<0.01),PHD前、PHD3其结果为:血BUN(28.12±6.05)mmol/L降至(21.62±5.34)mmol/L,Bcr(1148.63±105.42)μmol/L降至(1016.28±101.81)μmol/L,CRP(61.66±25.90)mg/L降至(28.42±11.78)mg/L,Hb(89.27±5.21)g/L升至(115.32±4.86)g/L,血浆白蛋白(36.05±3.14)g/L升至(41.38±3.67)g/L,Kt/V值(1.48±0.16)升至(1.91±0.13),血钙(2.03±0.22)mmol/L升至(2.35±0.24)mmol/L,血磷(1.96±0.18)mmol/L降至(1.47±0.17)mmol/L,PTH(384.37±37.64)ng/L降至(198.65±20.35)ng/L,血钠(131.66±2.25)mmol/L升至(140.81±1.43)mmol/L,血钾(6.16±0.54)mmol/L降至(4.46±0.65)mmol/L,CO_(2)CP(14.42±1.27)mmol/L升至(22.56±1.68)mmol/L。结论对于单纯PD或者HD已不能满足肾替代治疗的患者,可选择PHD。Objective To analyze the efficacy of peritoneal dialysis(PD)combined with hemodialysis(HD)in the treatment of patients with inadequate hemodialysis end-stage renal disease(ESRD).Methods The clinical data of 15 patients with PD and HD combined treatment in our hospital were retrospectively analyzed.The main clinical manifestations,nutritional symptoms and laboratory indicators before and after combined treatment were compared.Results The symptoms of anxiety,depression,insomnia and loss of appetite in PHD3 patients were significantly improved(P<0.05).The occurrence of PHD3 before PHD was as follows:Anxiety(13 cases),fell to 13.3%from 86.7%(2 cases),depression(11 cases)fell to 20.0%from 73.3%(3 cases),insomnia(9 cases)from 60.0%to 6.6%(1 case),fatigue(12 cases)fell to 33.3%from 80.0%(5 cases),loss of appetite(11 cases)fell to 26.7%from 73.3%(4 cases);Nutritional symptoms improved,but there was no significant difference in the rate of good nutrition(P>0.05).Before PHD and PHD3,the incidence of good nutrition increased from 26.67%(4 cases)to 66.66%(10 cases).The main tests[such as blood urea nitrogen(BUN),creatinine(Scr),C-reactive protein(CRP),hemoglobin(Hb),plasma albumin,urea clearance index(Kt/V),blood calcium,phosphorus,parathyroid hormone(PTH),sodium,potassium,carbon dioxide binding ability(CO_(2)CP)]were significantly improved(P<0.01).The results of pre-PHD and PHD3 are:Blood BUN(28.12±6.05)mmol/L decreased to(21.62±5.34)mmol/L,Bcr(1148.63±105.42)μmol/L decreased to(1016.28±101.81)μmol/L,CRP(61.66±25.90)mg/L to(28.42±11.78)mg/L,Hb(89.27±5.21)g/L to(115.32±4.86)g/L,plasma albumin(36.05±3.14)g/L to(41.38±3.67)g/L,Kt/V value(1.48±0.16)to(1.91±0.13),blood calcium(2.03±0.22)mmol/L tendency to(2.35±0.24)mmol/L tendency for L,blood phosphorus(1.96±0.18)mmol/L tendency/L fell to 1.47(0.17 mm)mmol/L,PTH(384.37±37.64)ng/L decreased to(198.65±20.35)ng/L,serum sodium(131.66±2.25)mmol/L increased to(140.81±1.43)mmol/L,potassium(6.16±0.54)mmol/L decreased to(4.46±0.65)mmol/L,and CO_(2)CP increased to(2

关 键 词：腹膜透析 血液透析 终末期肾病 治疗 

分 类 号：R692.5[医药卫生—泌尿科学]