高通量透析模式对改善维持性血液透析患者β2微球蛋白清除率及高血压的影响

来源期刊：广州医药 | 35-39 发布时间：2021-11-24 收稿时间：2025/11/13 18:03:07 阅读量：29

作者：: 何同林,

何兰,

刘俊,

刘俊华,

阮宪东,

朱艳红,

关键词：: 维持性血液透析高通量透析模式 β2微球蛋白清除率高血压; maintenance hemodialysis high flux dialysis mode β2-microglobulin clearance rate hypertension

DOI：: 10.3969/j.issn.1000-8535.2021.05.007

收稿时间：: 2021-01-29
修订日期：
接收日期：
引用总数：: 0

目的探讨高通量透析模式对改善维持性血液透析(MHD)患者β2微球蛋白清除率及高血压的影响。方法选择2018年9月1日—2018年10月31日期间在广州市增城区新塘医院血液净化中心接受MHD患者40例为实验对象(除外因自身耐受因素长期使用低通量透析患者)。采用随机数表法分两组,每组20例。对照组接受低通量血液透析,观察组接受高通量血液透析。比较两组治疗效果,并记录0个月、3个月、6个月、12个月、18个月治疗前后β2微球蛋白(β2-MG)、全段甲状旁腺激素(iPTH)、心率、血压变化,并对两组心血管疾病情况进行统计。结果观察组总有效率为95.00%,高于对照组的20.00%(P<0.05);治疗后,观察组β2-MG、iPTH均降低,而3个月后对照组略有升高,观察组[(12.48±2.10)mg/L、(210.13±18.12)ng/L]低于对照组[(30.21±2.37)mg/L、(289.41±17.02)ng/L],观察组治疗3个月、6个月、12个月、18个月的β2-MG清除率高于对照组(P<0.05);与治疗前比较,两组的平均动脉压、收缩压均降低,且观察组低于对照组(P<0.05);对照组各时间点24小时舒张压及收缩压差异无统计学意义(P>0.05);与治疗前比较,观察组24小时舒张压、收缩压治疗后1个月、3个月、6个月、12个月、18个月均降低,且低于对照组(P<0.05);两组患者心血管疾病发生率比较:观察组有1例因急性心肌梗死住院行PCI术;对照组有2例因心力衰竭住院治疗,1例因急性冠脉综合症住院治疗。两组并发症发生率比较P>0.05。结论高通流量透析模式可有效提高MHD患者的治疗效果,有效清除血液毒素,降低患者的高血压,减少并发症,可在临床推广使用。

Objective To investigate the effect of high flux dialysis mode on the improvement of β2-microglobulin clearance and hypertension in maintenance hemodialysis (MHD) patients. Methods Patients who received MHD at the Blood Purification Center of Xintang Hospital, Zengcheng District, Guangzhou from September 1, 2018 to October 31, 2018 (except for long-term low-flux dialysis patients due to self-tolerance factors)were selected. Random number table method was used to divide the patients into two groups,20 patients in each group. The control group received low flux hemodialysis, and the observation group received high flux hemodialysis. The treatment effects of the two groups were compared, levels of β2-microglobulin (β2-MG), intact parathyroid hormone (iPTH), changes in heart rate and blood pressure, and statistics on cardiovascular disease in the two groups before and after treatment at 3, 6, 12, and 18 months were recorded. Results The total effective rate in the observation group was 95.00%, which was higher than the 20.00% in the control group (P<0.05). After treatment, the levels of β2-MG and iPTH of the two groups decreased, and the observation group [(13.02±2.10) mg/L, (210.13±18.12) ng/L] was lower than the control group [(19.78±2.37) mg/L, (289.41±17.02)ng/L]; the β2-MG clearance rate of the observation group was higher than that of the control group at 3 months, 6 months, 12 months, and 18 months (P<0.05).Compared with that before treatment, the average arterial pressure and systolic blood pressure of the two groups were reduced, and the observation group was lower than that of the control group (P<0.05); the differences between diastolic blood pressure and systolic blood pressure at each time point in the control group were not significant (P>0.05); the 24-hour diastolic blood pressure and systolic blood pressure of the observation group decreased after 1, 3, 6, 12 and 18 months, compared with those before treatment (P<0.05), and were lower than those in the control group (P＜0.05).Comparison of the incidence of cardiovascular disease between the two groups: 1 case in the observation group was hospitalized for acute myocardial infarction; 2 cases in the control group were hospitalized for heart failure and 1 case was hospitalized for acute coronary syndrome; complications incidence in the two groups were compared (P>0.05). Conclusion The high flux dialysis mode can effectively improve the treatment outcomes of MHD patients, effectively remove blood toxins, lower blood pressure, and reduce the incidence of complications. It can be used in clinical practise.

1、 BEBERASHVILI I, GOLOVKO E, GOLINSKY L,et al. A single center, open-label, randomized, parallel group study assessing the relationship between asymptomatic bacteriuria and inflammation in maintenance hemodialysis patients[J].Hemodial Int,2018,22(1):110-118.

2、张少鑫.血液透析联合血液灌流治疗对尿毒症患者β2-微球蛋白的清除效果研究[J].中国临床医生杂志,2017,45(10):30-33.

3、 BELLO B T, SANUSI I, BRAIMOH R W, et al. Challenges of providing maintenance hemodialysis in a resource poor country: experience from a single teaching hospital in Lagos, Southwest Nigeria[J].Hemodial Int,2018,17(3):427-433.

4、 YORIFUJI M, KURAGANO T, KAWADA S,et al. Factors associated with serum magnesium and vascular stiffness in maintenance hemodialysis patients[J].Hemodial Int, 2018,22(3):342-350.

5、段斌,职瑾,杜鹏,等.两种血液净化方式对维持性血液透析伴高血压患者血压的影响[J].西部医学, 2019,31(2):250-254,259.

6、 LUNNEY M, TONELLI B, LEWIS R,et al. A comparison of temporal artery thermometers with internal blood monitors to measure body temperature during hemodialysis[J].BMC Nephrol, 2018,19(1):137-141.

7、肖友文,潘红霞,张帆,等.高通量透析对尿毒症患者体内毒素清除效果及生活质量的影响[J].西部医学, 2018, 30(11):80-83.

8、龚豪,黄丽,张庆红,等.高通量血液透析和血液透析滤过对慢性肾功能衰竭患者临床疗效、肾功能及毒素清除率的影响[J].解放军医药杂志, 2019, 31(8):62-65.

9、 KELLER T, WANNER C, KRANE V,et al. prognostic value of high-sensitivity versus conventional cardiac troponin T assays among patients with type 2 diabetes mellitus undergoing maintenance hemodialysis[J].Am J Kidney Dis,2018,71(6):822-830.

10、胡诗德,简讯,陈慧,等.血液透析滤过与高通量血液透析对尿毒症患者血管钙化的影响[J].临床肾脏病杂志, 2017,17(9):553-556,577.

11、汤晓静,盛晓华,梅长林,等.高通量血液透析与常规血液透析联合血液透析滤过的临床疗效对比研究[J].中国血液净化, 2019, 18(7):486-490.

12、 MATETI U V, NAGAPPA A N, ATTUR R P, et al. Cost-effectiveness of pharmaceutical care on patients undergoing maintenance hemodialysis-a multicenter randomized controlled study[J].Postgrad Med, 2018,130(7):621-626.

13、张凯.慢性肾脏病临床实践指南:浙江省肾脏病骨干医师学术研讨会论文汇编[C]. 浙江省医学会肾脏学分会:浙江省科学技术协会,2005.

14、陆再英.内科学[M].北京:人民卫生出版社,2008.

15、吴其顺, 王文燕, 何建强,等. 高通量血液透析联合血液透析滤过序贯治疗慢性肾衰竭临床观察[J]. 山东医药, 2017, 57(37):87-89.

16、李芸,胡天晓,郑朝霞,等.高通量透析联合低钙透析液对维持性血液透析患者甲状旁腺激素及钙磷代谢的影响[J].解放军医药杂志, 2019, 31(9):51-55.

17、 BOURBONNAIS F F, TOUSIGNANT K F.Experiences of nephrology nurses in assessing and managing pain in patients receiving maintenance hemodialysis[J].Nephrol Nurs J,2020,47(1):37-44.

18、赵洁,蒙军平,周一丹,等.高通量血液透析对MHD患者血清β2-微球蛋白和甲状旁腺激素清除及对心血管保护疗效评价[J].海南医学, 2018, 29(23):3283-3285.

19、李文静,史聪,宋培,等.不同通量透析膜对维持性血液透析患者氧化应激状态及血清炎症因子的影响[J].中国临床研究,2018,31(4):486-489,493.

20、刘伟,刘丽芳,王玉柱.高通量血液透析对维持性血液透析患者微炎症状态及并发症的影响[J].中国医刊, 2017, 52(3):101-103.