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目的探讨高通量血液透析(HHD)和血液透析滤过+普通透析(HDF+HD)在慢性肾功能衰竭尿毒症患者中的应用效果。方法选择2013年8月—2014年12月间在温州康宁医院进行透析治疗的62例慢性肾衰竭尿毒症患者做观察组,并选择同期在合作单位进行透析治疗的74例慢性肾衰竭尿毒症患者作为对照组。观察组患者每周给予3次高通量透析,对照组患者每周给予1次血液透析滤过和2次普通血液透析。透析前、后,对2组患者血清中小分子毒素(血尿素、血肌酐、血尿酸、血钾、血磷)、中分子毒素(甲状旁腺激素)、大分子毒素(血β2微球蛋白、半胱氨酸蛋白酶抑制剂C)水平进行检测。透析后,对2组尿素透析充分性指标(尿素清除指数、标准蛋白质分解代谢率、时间平均尿素浓度)进行检测。通过2组数据的对比分析,对HHD和HDF+HD透析方法的临床效果进行比较。结果 2组患者透析后,各毒素的水平均出现显著性降低(P<0.05);且观察组血磷、甲状旁腺激素、半胱氨酸蛋白酶抑制剂C水平显著性低于对照组(P<0.05)。2组尿素清除指数、标准蛋白质分解代谢率、时间平均尿素浓度比较,差异无统计学意义(P>0.05)。结论相对于HDF+HD,HHD对中、大分子毒素的清除效果更好。
Objective To investigate the effect of high-throughput hemodialysis (HHD) and hemodiafiltration plus general dialysis (HDF + HD) in uremic patients with chronic renal failure. Methods Sixty-two patients with uremia of chronic renal failure who underwent dialysis at Corning Hospital in Wenzhou from August 2013 to December 2014 were selected as the observation group and 74 patients with uremia of chronic renal failure As a control group. Patients in the observation group were given high-throughput dialysis three times per week, while patients in the control group were given one hemodialysis filtration and two times ordinary hemodialysis once a week. Before and after dialysis, the levels of small-molecule toxins (blood urea, serum creatinine, serum uric acid, potassium, phosphorus), middle molecular toxins (parathyroid hormone), macromolecular toxins (blood β2 microglobulin, Cystatin C) levels were tested. After dialysis, two groups of urea dialysis adequacy indicators (urea clearance index, standard protein catabolism rate, time average urea concentration) were detected. By comparing two sets of data, the clinical effects of HHD and HDF + HD dialysis methods were compared. Results After dialysis, the levels of all toxins in both groups were significantly decreased (P <0.05). The levels of serum phosphorus, parathyroid hormone and cystatin C in the observation group were significantly lower than those in the control group (P <0.05). No significant difference was found between the two groups of urea clearance index, standard protein catabolism rate and time average urea concentration (P> 0.05). Conclusion Compared with HDF + HD, HHD has a better effect on removal of middle and large molecules of toxins.