血液灌流联合常规血液透析治疗维持性血液透析伴长期高血压

发布时间：2018-01-12 02:12

本文关键词：血液灌流联合常规血液透析治疗维持性血液透析伴长期高血压　出处：《实用医学杂志》2016年10期 　论文类型：期刊论文

【摘要】：目的:通过血液灌流(HP)联合常规血透(HD)的血液净化方式,对维持性血液透析(MHD)伴长期高血压患者的血压进行动态观察,并测定治疗前后血浆内皮素-1(ET-1)和血清瘦素(Lep)水平。方法:选择MHD伴长期高血压患者90例,根据不同的血液净化模式入组,HD组45例,血透串联血灌(HD+HP)组45例,慢性肾脏病3期患者30例为对照组。分别测定治疗前,治疗4、8、12周的ET-1、Lep水平及24 h动态血压。结果:3组患者血清ET-1、Lep检出量和24 h动态血压监测比较,治疗前HD和HD+HP两组指标差异无统计学意义(P0.05)。治疗前HD+HP组和治疗12周HD组分别与治疗12周HD+HP组、对照组比较,ET-1、Lep均在较高水平,收缩压和舒张压均明显偏高,差异有统计学意义(P0.01);治疗12周HD+HP组与对照组比较,ET-1及舒张压差异有统计学意义(P0.05),Lep及收缩压则差异无统计学意义(P0.05)。结论:HP联合HD的复合血液净化方式,在应用降压药物的基础上,能够把MHD伴长期高血压患者的血压控制在较为理想的水平。
[Abstract]:Objective: to observe the blood pressure of maintenance hemodialysis (MHD) patients with long-term hypertension by the blood purification method of hemoperfusion with HPand conventional hemodialysis (HD). Before and after treatment, plasma endothelin-1 (ET-1) and serum leptin (Lep1) levels were measured. Methods: 90 patients with MHD complicated with long-term hypertension were selected and divided into the group according to different blood purification modes. 45 cases of HD group, 45 cases of hemodialysis combined with hemoperfusion group and 30 cases of chronic kidney disease in 3 stage were used as control group. The ET-1 was measured for 12 weeks before treatment. Results the detection of serum ET-1 and 24 h ambulatory blood pressure (ABBP) were compared among the three groups. There was no significant difference between HD group and HD HP group before treatment (P 0.05). Before treatment, HD HP group and 12 week HD group were compared with 12 week HD HP group and control group respectively. ET-1 Lep was at a higher level, systolic and diastolic blood pressure were significantly higher, the difference was statistically significant (P 0.01). The difference of ET-1 and DBP between HD HP group and control group at 12 weeks was statistically significant (P 0.05). There was no significant difference between Lep and systolic blood pressure (SBP). Conclusion the combined blood purification method of Lep combined with HD is based on the application of antihypertensive drugs. The blood pressure of MHD patients with long term hypertension can be controlled at an ideal level.
【作者单位】：郑州人民医院器官移植科;
【基金】：河南省卫生厅科技公关项目(编号:9412015Y0437)
【分类号】：R459.5;R544.1
【正文快照】： 终末期肾病尿毒症可通过接受同种异体肾移植手术达到临床治愈,因经济条件和肾源等客观原因的存在,临床治愈率有限。而长期血液透析(hemodialysis,HD)带来的问题是,约65%的患者高血压不能控制满意,最终因长期高血压导致死亡的发生率可达50%[1]。其根源大多是因为肾衰患者体内的

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