【摘要】 目的:从动脉结构及血流动力学的变化探讨不同血液净化方式对维持性血液透析(MHD)患者透析中低血压(IDH)的影响。方法:选择在佛山市禅城区中心医院血液透析中心符合纳入标准的IDH患者30例,随机分为血液透析(HD)组,血液透析滤过联合血液透析(HDF+HD)组,血液灌流联合血液透析(HP+HD)组,各组均为10例,观察时间为24周。(1)比较三组患者透析中低血压的发生率。(2)治疗前后采用全自动生化分析仪检测血清磷(P)的水平,采用电化学发光法检测甲状旁腺激素(PTH);散射比浊法检测超敏C-反应蛋白(hs-CRP)的变化。(3)治疗24周后采用彩色多普勒超声仪测量治疗后患者颈总动脉内膜-中层厚度(IMT)、收缩期血流峰值流速(Vmax)、舒张期血流峰值流速(Vmin)、阻力指数(RI)及粥样斑块发生率的变化。结果:(1)HDF+HD、HP+HD组透析中低血压发生率明显降低,差异有统计学意义(P<0.05)。(2)与治疗前相比,HDF+HD及HP+HD组均能有效清除P、PTH、Hs-CRP,差异有统计学意义(P<0.05),且与治疗后HD组相比,差异有统计学意义(P<0.05)。(3)治疗后,HD组Vmax、Vmin显著性降低,RI明显增高,差异有统计学意义(P<0.05),而HDF+HD组和HP+HD组颈动脉超声情况比较,差异无统计学意义(P>0.05)。结论:HDF+HD或HP+HD能改善IDH患者血管血流动力学的异常,有效降低IDH的发生率,值得推广。更多还原

【Abstract】 Objective To explore the efficacy of different blood purification methods on intradialytic hypotension(IDH) in maintenance hemodialysis(MHD) patients from the change of arterial structure and hemodynamic mechanics. Method Thirty IDH patients in hemdodialysis center of centra hospital of Chancheng District,Foshan City conforming to the inclusion criteria were selected randomly divided into hemodialysis(HD) group(n = 10),hemodiafiltration combined with hemodialysis(HDF +HD) group(n = 10),hemoperfusion combined with hemodialysis(HP + HD) group(n = 10),and they were observed for 24 weeks.(1)The changes of blood pressure in therapy and the frequency of intradialytic hypotension were compared.(2)Before and after 24 weeks of treatment,serum Phosphorus(P),parathyroid hormone(PTH),C-reactive protein(hs-CRP) were measure.(3)Their bilateral carotid intima media thickness(IMT),systolic peak velocity(Vmax),diastolic peak flow velocity(Vmin),resistive index(RI) and the incidence of atherosclerosis were detected after the treatment. Results(1)Compared with HD group,the frequency of intradialytic hypotension was significantly reduced in HDF + HD and HP + HD group(P < 0. 05).(2)serum P、PTH、Hs-CRP levels decreased significantly In HP + HD and HDF + HD group After the treatment for 24 weeks,and reduced remarkably Compared with HD group After the treatment(P < 0. 05).(3)After 24 weeks treatment,Vmax,Vmin decreased and RI increased significantly in HD group(P < 0. 05). Conclusion Hemodiafiltration or hemoperfusion associated with hemodilysis can improve the hemodynamic stability in IDH patients,can be used as a long term therapy.更多还原