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目的观察高通量血液透析治疗终末期肾衰竭的方法和临床效果,为临床救治提供参考。方法选取2014年6月至2015年6月收治的78例终末期肾衰竭患者,根据患者就诊时间先后,随机将患者分为观察组39例,对照组39例。两组均予以常规饮食及药物治疗,包括低磷、低盐、优质蛋白饮食,给予降压药物、铁剂、钙剂和重组人促红细胞生成素。在常规药物治疗基础上,对照组给予常规血液透析:采用醋酸纤维膜透析器,透析液流量维持在500 ml/min,血流量维持在210~260 ml/min,每周3次;观察组给予高通量血液透析:采用HI PS高通透性透析器,透析液流量、血流量及透析次数与对照组相同。分别于治疗前、治疗12个月后检测患者血清β2-微球蛋白(β2-MG)、血清白蛋白(ALB)、血红蛋白(Hb)、血清磷(PO43-)和甲状旁腺激素(PTH),并观察分析两组患者不良反应发生率。结果观察组终末期肾衰竭患者治疗后β2-MG、PTH、Hb、PO43-和ALB水平均优于治疗前和对照组,差异均有统计学意义(P均<0.05)。观察组不良反应发生率显著低于对照组(10.26%vs 30.77%,χ2=5.032,P<0.05)。结论与常规血液透析比较,高通量血液透析治疗终末期肾衰竭患者具有更高清除有害物质能力和较低的不良发生率,具有较高的临床应用价值。
Objective To observe the methods and clinical effects of high-throughput hemodialysis in the treatment of end-stage renal failure and provide reference for clinical treatment. Methods Seventy-eight patients with end-stage renal failure who were admitted to our hospital from June 2014 to June 2015 were randomly divided into observation group (39 cases) and control group (39 cases) according to the patient’s visiting time. Both groups were given regular diet and drug therapy, including low-phosphorus, low-salt, high-quality protein diet, given antihypertensive drugs, iron, calcium and recombinant human erythropoietin. On the basis of conventional drug treatment, the control group was given routine hemodialysis: with acetate membrane dialyzer, the dialysate flow rate was maintained at 500 ml / min, blood flow was maintained at 210-260 ml / min, and the observation group given High-throughput hemodialysis: The HIPS high-permeability dialyzer, dialysate flow, blood flow and dialysis the same number with the control group. Serum levels of β2-microglobulin (ALB), hemoglobin (Hb), serum phosphorus (PO43-) and parathyroid hormone (PTH) were measured before treatment and 12 months after treatment, , And observed and analyzed the incidence of adverse reactions in both groups. Results The levels of β2-MG, PTH, Hb, PO43- and ALB in patients with end-stage renal failure after treatment in the observation group were better than those before treatment and in the control group (all P <0.05). The incidence of adverse reactions in the observation group was significantly lower than that in the control group (10.26% vs 30.77%, χ2 = 5.032, P <0.05). Conclusion Compared with conventional hemodialysis, high-throughput hemodialysis treatment of patients with end-stage renal failure with higher ability to remove harmful substances and lower incidence of adverse, with high clinical value.