不同钙浓度透析液对腹膜透析患者钙磷代谢及心血管系统的影响

发布时间：2018-04-18 14:33

本文选题：腹膜透析 + 低钙透析液　；参考：《浙江中医药大学》2017年硕士论文

【摘要】：目的观察不同钙浓度透析液对腹膜透析患者钙磷代谢及心血管系统的影响,比较长期使用低钙透析液(PD4)和标准钙透析液(PD2)对腹膜透析患者钙磷代谢及心血管系统的影响,为临床选择合适钙浓度透析液提供参考依据。方法选择2010年1月至2015年12月在杭州市中医院腹透门诊规律随访的持续非卧床腹膜透析(CAPD)患者,筛选出透析时间大于1年的初始腹透患者,按照透析液含钙浓度分为两组,PD4组和PD2组,比较两组患者透析初始和1年后钙磷代谢、颈动脉中层厚度及心超的变化差异;同时,进行组内比较,各组患者透析1年前后各项指标的变化;然后筛选出透析时间大于3年的腹透患者,比较两组患者透析初始和3年后钙磷代谢及心血管系统的影响。结果1.组间比较,低钙透析液(PD4)与标准钙透析液(PD2)对腹膜透析患者透析1年及3年后钙磷代谢和心血管指标影响差异无统计学意义(P0.05);2.组内比较,低钙透析液患者透析1年后较透析初始,血磷水平下降(P0.05);3.组内比较,标准钙透析液患者透析1年后较透析初始,血钙水平明显升高(P0.05),iPTH水平下降(P0.05),颈动脉中层厚度(IMT)增厚(P0.05),左室后壁厚度(LVPWD)增厚(P0.05)。结论1.腹膜透析患者长期使用低钙透析液在钙磷代谢及心血管功能保护方面较标准钙透析液好;2.标准钙透析液对纠正继发性甲旁亢较低钙透析液更好,但对心血管损害风险较大;3.建议临床根据患者血钙磷基础水平、心血管基础风险、继发性甲旁亢及用药情况等,个体化选择合适钙浓度透析液。
[Abstract]:Objective to observe the effects of different calcium concentration dialysate on calcium and phosphorus metabolism and cardiovascular system in peritoneal dialysis patients, and compare the effects of long-term low calcium dialysate PD4) and standard calcium dialysate PD2 on calcium and phosphorus metabolism and cardiovascular system in peritoneal dialysis patients.To provide reference for clinical selection of suitable calcium dialysate.Methods continuous ambulatory peritoneal dialysis (CAPDD) patients who were followed up regularly in Hangzhou traditional Chinese Medicine Hospital from January 2010 to December 2015 were selected and the initial peritoneal dialysis patients whose dialysis time was more than one year were selected.According to the calcium concentration of dialysate, the patients were divided into two groups: PD4 group and PD2 group. The changes of calcium and phosphorus metabolism, carotid artery medial thickness and cardiac hypertrophy were compared between the two groups at the beginning and one year after dialysis.The changes of the indexes before and after 1 year dialysis and the effects of calcium and phosphorus metabolism and cardiovascular system were compared between the two groups after dialysis for more than 3 years.Result 1.There was no significant difference between low calcium dialysate (PD4) and standard calcium dialysate (PD2) on calcium and phosphorus metabolism and cardiovascular indexes after 1 and 3 years of peritoneal dialysis.Compared with the initial dialysate one year after dialysis, the blood phosphorus level of the patients with low calcium dialysate decreased by 3. 05%.Compared with the initial level of dialysis, the level of serum calcium increased significantly in patients with standard calcium dialysate 1 year after dialysis. The level of iPTH decreased significantly (P 0.05), the thickness of carotid artery medial thickness (IMT) and left ventricular posterior wall thickness (LVPWD) increased (P 0.05) and the thickness of left ventricular posterior wall (LVPWD) increased significantly in patients with standard calcium dialysate than at the beginning of dialysis.Conclusion 1.Long-term use of low calcium dialysate in peritoneal dialysis patients is better than standard calcium dialysate in calcium phosphorus metabolism and cardiovascular function protection.Standard calcium dialysate is better than low calcium dialysate in correcting secondary hyperparathyroidism, but it has a higher risk of cardiovascular damage.It was suggested that appropriate calcium dialysate should be selected clinically according to the basic level of serum calcium and phosphorus, cardiovascular risk, secondary hyperparathyroidism and medication.
【学位授予单位】：浙江中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R692.5

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