【作者】 崔岩；

【导师】 孙平辉；

【作者基本信息】 吉林大学 ， 公共卫生， 2010， 硕士

【摘要】 研究背景血液净化技术作为慢性肾脏病(CKD)和终末期肾病(ESRD)的治疗手段现已经历了40余年的发展,成功挽救了众多尿毒症患者的生命,但是,血液透析技术仍有其局限性,加上患者自身的一些因素,患者的长期生存率及生活质量仍然达不到预期目标,为此,对维持性血液透析患者进行生存分析,可以了解不同血液透析技术对血液透析患者生理生化指标和生命质量的影响,从而选择高效的血液透析方法进行治疗,挽救患者生命,改善患者生命质量。目的在大庆油田总医院肾内科血液透析室调查并收集了90例尿毒症维持性血液透析患者的合格问卷以及临床资料,旨在了解大庆油田总医院肾内科血液透析室维持血液透析患者的机体生理生化指标水平、生存质量,就此评价不同血液透析方法的治疗效果。方法血液透析治疗1~4年的维持性血液透析患者90例随机分配至血液透析组、血液透析滤过组、高通量血液透析组,每组30名。所有患者每周均治疗3次,每次4小时。观察时间6个月。记录不同血液净化方式患者在进入研究前及研究结束后的化验指标,利用SF-36量表调查不同透析方式对患者生理机能(PF)、生理职能(RP)、躯体疼痛(BP)、一般健康状况(GH)、精力(VI)、社会功能(SF)、情感职能(RE)、精神健康(MH)、健康变化(HT)方面的影响,评价不同血液净化方式后患者生存质量的变化和症状的改善情况。结果不同血液净化方式治疗后患者生理生化指标,血红蛋白、血钙、血磷(P)、血浆白蛋白、C-反应蛋白、β2-微球蛋白(β2-MG)、血清总胆固醇、甘油三酯、低密度脂蛋白、甲状旁腺素(PTH)在三组间的差异有统计学意义。治疗前后上述指标HFHD组内差异有统计学意义,其他两组差异无统计学意义。治疗前三组患者症状差异无统计学意义,治疗后三组患者症状差异有统计学意义。三组间出现的并发症中高血压和肌肉痉挛的差异有统计学意义。治疗后三组患者SF-36量表PF、RP、BP、GH、RE、MH六项评分的组间差异有统计学意义。结论1、三种血液透析方法对小分子物质具有同样的清除效果,并能改善酸碱平衡及电解质紊乱。2、高通量血液透析组对中分子物质的清除优于血液透析滤过组。3、高通量血液透析组对大分子物质的清除明显优于血液透析滤过组和常规血液透析组。4、高通量血液透析组在提高治疗效果、降低并发症发病率和改善患者生存质量方面的作用要好于血液透析滤过组和血液透析组。更多还原

【Abstract】 BackgroundMaintenance hemodialysis Patients who need renal replacement therapy are increasing. The hemodialysis technique has experienced 40 years and has saved many uremia patients,but,as a therapeutic tool,the Hemodialysis technique has its limits,plusing some factors of Patients,The survival rate and quality of life can‘t attain expectant target.ObjectTo analyze the physical signs、biochemical criterion and quality of life of 90 patients with maintenance hemodialysis(MHD) in Daqing Oilfield Hospital.According to the results of this study, we can take effective measures to improve the prognosis of maintain hemodialysis patients.MethodsWe separate the patients into three group according to the different dialysis methods. There are 30 MHD patients in each group who are selected randomly. All three groups received hemodialysis treatment three times a week and four hours each time. The levels of the physical signs、biochemical criterion and Quality of life were detected through the S-36 scale, prior to treatment and, eight weeks after treatment..Finaly, the measurement results of three groups were compared.ResultsThere were significant differences of HGB、Ca2+、Cr、p、ALB、CRP、β2-MG、CHO、TG、LDL and PTH between three groups after MHD of 6 months.There were significant differences of these signs afther high-flux hemodialysis. There were significant differences of the symptoms between three groups after trentment.There were significant differences of PF、RP、BP、GH、RE and MH between three groups after trentment. Conclusions1. The clearance rates of small molecular soluts and the rectification acid-base balance are similar to each other in the three groups.2. The clearance rates of median molecular solutes in HFHD group is superier to those in HDF group.3. The clearance rates of macromolecule solutes in HFHD group is superier to those in the other two groups.4. HFHD group are better than HDF group and the HD group in improving the therapeutic effect、reduce the incidence of morbidity and improve patient quality of life.更多还原