【摘要】 目的:观察高通量透析(HFHD)对尿毒症血透患者肺功能的影响。方法:64例患者随机分为高通量透析组(A组)与低通量透析组(LFHD,B组),分别比较两组患者分组治疗第一次透析前后1秒用力呼气量(FEV1.0)、最大呼吸中段流量(MMEF)、最大呼气流量-容积曲线(F-V)中的V50三项肺通气功能指标变化;分组治疗时和治疗6个月后透析前血红蛋白(Hb)、超敏C反应蛋白(hs-CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、血浆白蛋白(Alb)、前白蛋白(PAB)、中臂肌围(MAMC)、FEV1.0、MMEF、V50变化。结果:(1)单次透析后两组肺功能均明显改善(P<0.05),两组间差异无统计学意义(P>0.05);(2)治疗6个月后A组Hb、Alb、PAB、MAMC明显上升(P<0.05),hs-CRP、IL-6、TNF-α水平与治疗前相比明显下降(P<0.05);透前肺功能也有改善(P<0.05);B组患者各观察指标与治疗前相比差异无统计学意义(P>0.05),与A组相比差异有统计学意义(P<0.05)。结论:血液透析可改善尿毒症患者肺功能,而长期应用HFHD较LFHD能更好的改善透析患者肺功能,可能与HFHD能清除一些不易被LFHD清除的大中分子物质(主要是细胞因子)、明显改善贫血、微炎症及营养状态有关。更多还原

【Abstract】 Objective:To observe the effect of high-flux hemodialysis(HFHD) on pulmonary function in maintenance hemodialysis patients.Methods:Sixty-four cases of chronic hemodialysis patients were randomly divided into treatment group (group A) and control group(group B).Each group had 32 patients and they were followed up for 6 months.The high-flux polysulphone dialyzers were used in group A,while the low-flux common dialyzers(LFHD) were used in group B. Two groups of patients were compared before and after dialysis treatment 0 months respectively, in 1 second forced expiratory volume (FEV1. 0), maximum midexpiratory flow(MMEF), maximal expiratory flow-volume curve (F-V) V50 in three changes of pulmonary ventilation function index. Serum concentration of protein(hs-CRP)、interleukin-6(IL-6)、tumor necrosis factor-α(TNF-α) and mid-arm muscle circumference(MAMC)、FEV1、MMEF、V50 ventilation indicator changes were determined 6months after treatment.Results:(1)After HFHD and LFHD, values of FEV1、MMEF and V50 are significantly higher than those before blood dialysis,but those index had no apparent changes between group A and B;(2)6months after therapy,the level of Hb,Alb,PAB,MAMC ,FEV1,MMEF,V50 were markedly elevated and the level of hs-CRP、IL-6、TNF-α were markedly reduced in group A.but those index had no apparent changes in group B.Conclusion:Hemodialysis is efficacious for improving pulmonary function in MHD patients.HFHD is highly efficacious for improving Hb,Alb,PAB,MAMC ,FEV1,MMEF,V50 and reducing hs-CRP、IL-6、TNF-α.It is superior to low-flux hemodialysis in efficacy and safety.The probable mechanisms are that high-flux hemodialysis could efficiently remove large and medium-sized molecules(mainly cytokine) and greatly improved patient’s anemia and nutrition.更多还原