【摘要】 目的探讨不同血液净化模式对维持性血液透析难治性高血压患者肾素-血管紧张素-醛固酮系统(RASS)的影响。方法选取2013年1月至2015年12月维持性血液透析患者90例为研究对象,将患者随机分成三组各30例,分别采用血液透析(HD)、血液透析+血液灌注(HD-HP)与血液透析+血液滤过(HDF)三种不同的治疗方法。观察治疗前及治疗12周后的24 h动态血压,并计算平均动脉压;测定治疗前及治疗12周后血清肾素活性(PRA)、血管紧张素Ⅱ(ATⅡ)、醛固酮(Ald)的水平,对三组患者进行组间比较。结果治疗前三组间平均收缩压与舒张压均无显著性差异(P>0.05),治疗后三组间血压存在显著性差异(P<0.05);HD组治疗后血压虽较治疗前有所下降,但差异无统计学意义(P>0.05),HDF组与HD-HP组治疗后血压均较治疗前显著下降(P<0.05),且两组间比较未见显著性差异(P>0.05)。治疗前三组间PRA、ATⅡ、Ald水平均无显著性差异(P>0.05),治疗后三项指标组间出现显著性差异(P<0.05);HD组治疗后PRA、ATⅡ、Ald水平较治疗前差异无显著性(P>0.05),HDF组与HD-HP组治疗后PRA、ATⅡ、Ald均较治疗前显著下降(P<0.05),且两组间各指标比较未见显著性差异(P>0.05)。结论 HD-HP与HDF对于维持性血液透析难治性高血压治疗效果均优于HD,因此均可作为治疗此类患者的方法在临床进行推广。更多还原

【Abstract】 Objective To discuss the impact of different blood purification modes in RASS of RH patients during the MHD process.Methods 90 patients who received MHD from January 2013 to December 2015 were selected. The subjects were randomly divided into three groups,30 cases in each group. Three groups respectively adopted HD,HD- HP and HDF. Before treatment and after 12 w of treatment,24 h ambulatory blood pressure were monitored. Mean arterial pressure as well as the level of PRA,ATⅡand Ald for three groups were observed. Results Before treatment,the average systolic blood pressure and diastolic blood pressure for three groups were not signficantly different( P > 0. 05).After treatment,the blood pressure for three groups was signficantly different( P < 0. 05). The blood pressure for HD group was lower than before( P > 0. 05); the blood pressure of HDF group and HD- HP group were lower than before( P < 0. 05); the blood pressure of HDF group and HD- HP group was not signficantly different( P > 0. 05); before treatment,the level of PRA,ATⅡand Ald for three groups was not signficantly different( P > 0. 05). After treatment,the level of PRA,ATⅡand Ald for three groups was significantly different( P < 0. 05). The level of PRA,ATⅡand Ald for HD group before and after treatment was not signficantly different( P > 0. 05). The level of PRA,ATⅡand Ald for HDF group and HD- HP group was signficantly lower than before( P < 0. 05). The level of PRA,ATⅡand Ald for HDF group and HD- HP group was not signficantly different( P > 0. 05). Conclusion During the MHD process,HD- HP and HDF have a better effect than HD in the RH patients. The HD- HP therapy is rather cheap and easy to operate. The HD- HP therapy can be recommended in clinical practices.更多还原