高通量血液透析在维持性血液透析患者中的应用价值及感染风险研究  

Study on the application value and infection risk of high-flux hemodialysis in maintenance hemodialysis patients

作　　者：温小楠 邝光华 周宇明[1] WEN Xiao-nan;KUANG Guang-hua;ZHOU Yu-ming(Department of Emergency,Ganzhou People's Hospital,Ganzhou 341000,China)

机构地区：[1]赣州市人民医院急诊科,341000

出　　处：《中国实用医药》2025年第1期45-49,共5页China Practical Medicine

摘　　要：目的研究临床采用高通量血液透析(HFHD)对维持性血液透析患者的应用价值及感染风险。方法选取90例行血液透析治疗>3个月的患者进行前瞻性研究,随机分为A组、B组、C组,各30例。A组患者采用3次/周高通量血液透析治疗,B组患者采用3次/周低通量血液透析(LFHD)治疗,C组患者采用2次/周低通量血液透析+1次/周血液透析滤过(HDF)治疗。观察随访25个月,对比三组患者死亡发生情况、心脑血管事件发生情况、炎性指标水平,检测并分析透析用水重金属与离子及透析器用水内毒素数据。结果A组患者中共计死亡1例,死亡原因为脑出血;B组患者中共计死亡7例,其中脑出血死亡4例,心肌梗死死亡2例,高钾血症死亡1例;C组患者中共计死亡6例,其中癫痫死亡2例,脑出血死亡4例。A组患者的死亡率低于B组和C组,差异有统计学意义(χ^(2)=5.192、4.403,P=0.023、0.044<0.05)。临床观察随访25个月,A组患者发生脑出血2例;B组患者发生脑出血5例、心肌梗死2例、脑梗死2例;C组患者发生脑出血4例、脑梗死1例、心肌梗死3例。A组患者心脑血管事件发生率低于B组与C组,差异具有统计学意义(χ^(2)=5.455、4.320,P=0.020、0.038<0.05);而B组与C组的心脑血管事件发生率对比差异无统计学意义(χ^(2)=0.082,P=0.774>0.05)。三组患者入院后1、2、3个月肿瘤坏死因子-α(TNF-α)、白细胞介素(IL)-1、IL-6、内毒素、超敏C反应蛋白、中性粒细胞百分比、β_(2)-微球蛋白、胱抑素C、甘油三酯对比差异均无统计学意义(P>0.05)。经检测,入院后1、2、3个月透析用水重金属与离子检测结果均符合美国医疗仪器促进协会(AAMI)与美国人工器官学会(ASAIO)的血液透析水质标准。检测透析机水管及水机显示,透析器用水内毒素检测结果均符合我国血液净化标准。结论相较于低通量血液透析和血液透析滤过,高通量血液透析患者生存率更高,心脑血管�Objective To study the application value and infection risk of high-flux hemodialysis(HFHD)in maintenance hemodialysis patients.Methods 90 patients who underwent hemodialysis treatment>3 months were selected for prospective study and randomly divided into A group,B group and C group,with 30 cases in each group.Patients in A group were treated with 3 times/week high flux hemodialysis,patients in B group were treated with 3 times/week low flux hemodialysis(LFHD),and patients in C group were treated with 2 times/week LFHD+1 time/week hemodialysis filtration(HDF).Observational follow-up was conducted for 25 months,the occurrence of death,cardiovascular and cerebrovascular events,and the level of inflammatory indicators were compared among the three groups,and data on heavy metals and ions in dialysis water and endotoxins in dialyzer water were detected and analyzed.Results A group had a total of 1 death,and the cause of death was cerebral hemorrhage;B group had a total of 7 deaths,including 4 deaths from cerebral hemorrhage,2 deaths from myocardial infarction,and 1 death from hyperkalemia;C group had a total of 6 deaths,including 2 deaths from epilepsy and 4 deaths from cerebral hemorrhage.The mortality rate of A group was lower than that of B group and C group,and the difference was statistically significant(χ^(2)=5.192,4.403;P=0.023,0.044<0.05).Clinical follow-up observation for 25 months,A group had 2 cases of cerebral hemorrhage;B group had 5 cases of cerebral hemorrhage,2 cases of myocardial infarction and 2 cases of cerebral infarction;C group had 4 cases of cerebral hemorrhage,1 case of cerebral infarction and 3 cases of myocardial infarction.The incidence of cardiovascular and cerebrovascular events in A group was lower than that in B group and C group.The difference was statistically significant(χ^(2)=5.455,4.320;P=0.020,0.038<0.05).The difference in the comparison of incidence of cardiovascular and cerebrovascular event between B group and C group was not statistically significant(χ^(2)=0.082,P=0.774>0.0

关 键 词：高通量血液透析 低通量血液透析 血液透析滤过 混合透析 内毒素 生存率 

分 类 号：R47[医药卫生—护理学]