探析左卡尼汀辅助血液灌流联合血液透析对尿毒症患者心功能及骨代谢的影响  

The effects of L-carnitine assisted hemoperfusion combined with hemodialysis on cardiac function and bone metabolism in patients with uremia

作　　者：高真真[1] 王秀莲 耿明亮[1] 段海玲[1] GAO Zhen-zhen;WANG Xiu-lian;GENG Ming-liang(Department of Nephrology,Binzhou Central Hospital,Binzhou 251700,China)

机构地区：[1]滨州市中心医院肾内科,251700

出　　处：《中国实用医药》2024年第21期17-20,共4页China Practical Medicine

摘　　要：目的 探析左卡尼汀辅助血液灌流联合血液透析对尿毒症患者心功能及骨代谢的影响。方法 80例尿毒症患者,采用随机数字表法分为对照组与观察组,各40例。其中对照组采取低剂量左卡尼汀(3 g/周)辅助血液灌流联合血液透析治疗,观察组患者则实施高剂量左卡尼汀(4 g/周)辅助血液灌流联合血液透析治疗。对比两组患者的钙磷指标(血钙、血磷)、心功能指标[左心室射血分数(LVEF)、左心室短轴缩短率(Fs)、每搏输出量(SV)以及二尖瓣舒张早期与舒张末期最大血流速度比值(E/A)]、骨代谢指标及血脂指标[甲状旁腺激素(PTH)、碱性磷酸酶(ALP)和总胆固醇(TC)]及不良反应发生率。结果 治疗后,观察组血磷(1.60±0.45)mmol/L低于对照组的(1.81±0.42)mmol/L,血钙(2.25±0.40)mmol/L高于对照组的(2.05±0.37)mmol/L(P<0.05)。治疗后,观察组LVEF(54.24±1.58)%、Fs(39.05±0.81)%、SV(60.84±1.57)ml、E/A(1.64±0.21)均高于对照组的(50.35±1.25)%、(37.84±1.45)%、(59.64±1.76)ml、(0.85±0.14)(P<0.05)。治疗后,观察组ALP(151.54±5.94)U/L、PTH(320.75±8.58)pg/ml、TC(3.13±1.01)mmol/L低于对照组的(185.64±6.83)U/L、(356.45±9.05)pg/ml、(4.80±1.34)mmol/L(P<0.05)。观察组不良反应发生率与对照组对比无明显差异(P>0.05)。结论 尿毒症患者实施高剂量左卡尼汀(4 g/周)辅助血液灌流联合血液透析进行治疗,能够改善患者的心功能,降低骨代谢异常的发生率,且不良反应未增加,建议推广。Objective To explore the effects of L-carnitine assisted hemoperfusion combined with hemodialysis on cardiac function and bone metabolism in patients with uremia.Methods 80 patients with uremia were divided into a control group and an observation group by random number table method,with 40 cases in each group.The control group was given low-dose L-carnitine(3 g/week)assisted hemoperfusion combined with hemodialysis,and the observation group was given high-dose L-carnitine(4 g/week)assisted hemoperfusion combined with hemodialysis.Patients in both groups were compared in terms of calcium and phosphorus indexes(blood calcium,blood phosphorus),cardiac function indicators[left ventricular ejection fraction(LVEF),fractional shortening(Fs),stroke volume(SV),ratio of early transmitral flow velocity to later transmitral flow velocity(E/A)],bone metabolism indicators and lipid indicators[parathyroid hormone(PTH),alkaline phosphatase(ALP),total cholesterol(TC),and the incidence of adverse reactions.Results After treatment,the observation group had lower blood phosphorus of(1.60±0.45)mmol/L than(1.81±0.42)mmol/L in the control group,and higher blood calcium of(2.25±0.40)mmol/L than(2.05±0.37)mmol/L in the control group(P<0.05).After treatment,the observation group had LVEF of(54.24±1.58)%,Fs of(39.05±0.81)%,SV of(60.84±1.57)ml,and E/A of(1.64±0.21),which were higher than(50.35±1.25)%,(37.84±1.45)%,(59.64±1.76)ml,and(0.85±0.14)in the control group(P<0.05).After treatment,the observation group had ALP of(151.54±5.94)U/L,PTH of(320.75±8.58)pg/ml,and TC of(3.13±1.01)mmol/L,which were lower than(185.64±6.83)U/L,(356.45±9.05)pg/ml,and(4.80±1.34)mmol/L in the control group(P<0.05).There was no significant difference in the incidence of adverse reactions between the observation group and the control group(P>0.05).Conclusion The implementation of high-dose L-carnitine(4 g/week)assisted hemoperfusion combined with hemodialysis in patients with uremia can improve the cardiac function of patients and reduce the incide

关 键 词：左卡尼汀 血液灌流 血液透析 尿毒症 心功能 骨代谢 

分 类 号：R692.5[医药卫生—泌尿科学]