高通量透析改善尿毒症血透患者心功能的临床研究

发布时间：2018-06-26 01:07

本文选题：高通量透析 + 低通量透析　；参考：《安徽医科大学》2014年硕士论文

【摘要】：背景和目的：随着中国社会经济的发展和医药卫生体制改革的实施，基本上已实现人人享有基本医疗卫生服务。随着医疗进步，终末期肾脏病（ESRD）生存期越来越长，目前依靠维持性血液透析（MHD）生存的病人超过百万。心血管病变是慢性肾功能衰竭的严重并发症，是慢性肾功能衰竭患者的主要死因，严重影响慢性肾衰竭患者的预后。临床症状主要表现为左心室肥大、瓣膜病变、心功能不全、缺血管性心脏病及血管病变为主。该实验旨在观察HFHD对MHD患者心血管功能的影响。方法：选择2012年10月-2013年10月期间，在中国人民解放军第174医院血液净化中心透析且病情稳定的64名患者，，随机分为HFHD组（治疗组A组）和LFHD组（对照组B组）。HFHD组使用金宝17R血液滤过器，面积1.7m2，超滤系数57ml/mmHg.h，LFHD组使用金宝8LR血液滤过器，面积1.7m2，超滤系数11.3ml/mmHg.h。两组透析患者，透析龄均达3年以上，病情相对稳定，透析间期体重增长不超过干体重5%，近3个月内未发生急性心脑血管、严重感染、恶性肿瘤、慢性肺部疾病。透析机为德国Fresenius4008S型血透机，双级反渗加热消毒水处理系统，反渗水符合国际标准。A、B液干粉由广州康盛生物科技公司生产，专人配置透析液，现配现用。透析通路为自体动静脉内瘘或长期导管，抗凝剂为低分子量肝素钙，碳酸氢盐行血液透析，透析液流量为血流量2倍，约500ml/min，每次4小时，每周透析3次。在治疗期间所有患者常规使用促红细胞生成素、降压药、活性维生素D、磷结合剂等。在实验开始时，所有患者第1次透析上机前抽血检测生化指标：肌酐（Scr）、血红蛋白（Hb）、血浆白蛋白（Alb）、β2微球蛋白（β2MG）、超敏C反应蛋白（CRP）、磷（P3+）、甲状旁腺激素（iPTH）、B型利钠肽（BNP），行心脏彩超检查左心室舒张末期容积（LVDd）、左心室后壁厚度（LVPWT）、室间隔厚度（IVST）、左室射血分数（EF）、快速充盈期和心房收缩期二尖瓣血流速度比值（E/A）、和左心室心肌重量指数（LVMI）。组内及组间比较，LFHD及HFHD患者心血管功能的变化情况。结果：iPTH、P3+在HFHD组的清除率明显高于LFHD组（P0.05），BNP水平在HFHD组明显低于LFHD组（P〈0.05）。治疗12个月后，HFHD组心功能较LFHD组有明显改善（P0.05）。结论： HFHD能清除中大分子毒素、改善微炎症和贫血，进而能更好的提高尿毒症透析患者的心血管功能状态。BNP水平可以用作慢性肾衰竭患者合并心血管疾病发生心衰危险的一个重要指标。
[Abstract]:Background and objective: with the development of China's social economy and the implementation of the reform of the medical and health system, the basic medical and health services for all have been basically realized. With medical progress, end-stage kidney disease (ESRD) survival is growing, currently dependent on maintenance hemodialysis (MHD) of more than 1 million patients. Cardiovascular disease is a serious complication of chronic renal failure. It is the main cause of death in patients with chronic renal failure and seriously affects the prognosis of patients with chronic renal failure. The main clinical symptoms were left ventricular hypertrophy, valvular disease, cardiac insufficiency, vascular heart disease and vascular disease. The aim of this study was to observe the effects of HFHD on cardiovascular function in MHD patients. Methods: from October 2012 to October 2013, 64 patients with stable condition were selected from hemodialysis center of the 174 Hospital of the Chinese people's Liberation Army. They were randomly divided into HFHD group (treatment group A) and LFHD group (control group B). The HFHD group was treated with Jinbao 17R hemofilter with an area of 1.7 m2. The ultrafiltration coefficient of 57 ml / mmHg.hLFHD group was treated with Jinbao 8LR hemofilter with an area of 1.7 m2 and a ultrafiltration coefficient of 11.3 ml / mmHg.h. The hemodialysis patients in the two groups were over 3 years old, the condition was relatively stable, the weight gain in the interdialysis period was not more than 5 dry weight, there was no acute cardio-cerebrovascular disease, severe infection, malignant tumor and chronic pulmonary disease in the last 3 months. The dialyzer is the German Fresenius 4008S hemodialysis machine, the double stage reverse osmosis heating sterilizing water treatment system, the reverse seepage water conforms to the international standard. AZB liquid dry powder is produced by Guangzhou Kangsheng Biotechnology Company. The dialysis pathway was autologous arteriovenous fistula or long-term catheter, the anticoagulant was low molecular weight heparin calcium, bicarbonate was used for hemodialysis, the flow rate of dialysate was 2 times, about 500ml / min, 4 hours each time, 3 times a week dialysis. Erythropoietin, hypotensive drugs, active vitamin D, phosphorus binders were routinely used in all patients during treatment. At the beginning of the experiment, Biochemical parameters were detected before the first dialysis: creatinine (SCR), hemoglobin (HB), plasma albumin (Alb), 尾 2 microglobulin (尾 2MG), hypersensitive C-reactive protein (CRP), phosphorus (P3), parathyroid hormone (iPTH) and B-type natriuretic peptide (BNP). Left ventricular end-diastolic volume (LVDd), left ventricular posterior wall thickness (LVPWT), interventricular septal thickness (IVST), left ventricular ejection fraction (EF), rapid filling and atrial systolic mitral flow velocity ratio (E / A), and left ventricular mass index (LVMI). The changes of cardiovascular function in patients with LFHD and HFHD were compared within and between groups. Results the clearance rate in HFHD group was significantly higher than that in LFHD group (P0.05) and the level of BNP in HFHD group was significantly lower than that in LFHD group (P < 0.05). After 12 months of treatment, cardiac function in HFHD group was significantly improved than that in LFHD group (P0.05). Conclusion: HFHD can eliminate medium and macromolecular toxin and improve microinflammation and anemia. Therefore, it can be used as an important indicator of the risk of heart failure in patients with chronic renal failure (CRF) by improving the level of cardiovascular function and BNP in uremic dialysis patients.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R692.5

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