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目的探讨观察血液透析(HD)和血液灌流(HP)联合治疗维持性血液透析(MHD)尿毒症患者的临床疗效。方法67例MHD尿毒症患者随机被分为观察组(34例)和对照组(33例)。观察组采用HD和HP联合治疗,对照组采用单纯HD治疗。比较治疗后两组生存率、死亡原因、β2-微球蛋白(β2-MG)、甲状腺激素(PTH),并观测患者皮肤瘙痒改善情况。结果①观察组1年和3年生存率高于对照组,病死率低于对照组,但差异均无统计学意义(P>0.05);观察组5年生存率为82.4%,高于对照组(75.8%)(P<0.05);病死率17.6%,低于对照组(24.2%)(P<0.05)。②观察组PTH、β2-MG指标降低,与治疗前和对照组比较差异均有统计学意义(P<0.05)。对照组治疗前后PTH、β2-MG检测结果差异无统计学意义(P>0.05)。③观察组皮肤瘙痒临床症状明显改善,临床症状总有效率为94.1%,高于对照组(24.2%)(P<0.05)。结论HD+HP联合治疗能有效提高MHD患者的生存率,降低病死率,弥补单纯HD的不足,减轻瘙痒症状,值得临床推广应用。
Objective To investigate the clinical effects of combined hemodialysis (HD) and hemoperfusion (HP) on patients with maintenance hemodialysis (MHD) uremia. Methods 67 patients with MHD uremia were randomly divided into observation group (34 cases) and control group (33 cases). The observation group with HD and HP combined treatment, the control group with simple HD treatment. The survival rate, cause of death, β2-microglobulin (β2-MG) and thyroid hormone (PTH) were compared between the two groups after treatment, and the improvement of skin pruritus was observed. Results ① The 1-year and 3-year survival rates of the observation group were higher than those of the control group, but the mortality was lower than that of the control group (P> 0.05). The 5-year survival rate of the observation group was 82.4% (75.8%) (P <0.05). The case fatality rate was 17.6%, lower than that of the control group (24.2%) (P <0.05). ② The indexes of PTH and β2-MG in the observation group were lower than those in the control group (P <0.05). The results of PTH and β2-MG in control group before and after treatment showed no significant difference (P> 0.05). ③ The clinical symptoms of pruritus in the observation group were significantly improved. The total effective rate of clinical symptoms was 94.1%, higher than that of the control group (24.2%) (P <0.05). Conclusion HD + HP combination therapy can effectively improve the survival rate of patients with MHD, reduce mortality, make up for the lack of simple HD, reduce pruritus symptoms, worthy of clinical application.