發(fā)布時間：2018-06-26 01:07

  本文選題：高通量透析 + 低通量透析��； 參考：《安徽醫(yī)科大學》2014年碩士論文

【摘要】：背景和目的：隨著中國社會經(jīng)濟的發(fā)展和醫(yī)藥衛(wèi)生體制改革的實施，基本上已實現(xiàn)人人享有基本醫(yī)療衛(wèi)生服務。隨著醫(yī)療進步，終末期腎臟�。‥SRD）生存期越來越長，目前依靠維持性血液透析（MHD）生存的病人超過百萬。心血管病變是慢性腎功能衰竭的嚴重并發(fā)癥，是慢性腎功能衰竭患者的主要死因，嚴重影響慢性腎衰竭患者的預后。臨床癥狀主要表現(xiàn)為左心室肥大、瓣膜病變、心功能不全、缺血管性心臟病及血管病變?yōu)橹�。該實驗旨在觀察HFHD對MHD患者心血管功能的影響。 方法：選擇2012年10月-2013年10月期間，在中國人民解放軍第174醫(yī)院血液凈化中心透析且病情穩(wěn)定的64名患者，，隨機分為HFHD組（治療組A組）和LFHD組（對照組B組）。HFHD組使用金寶17R血液濾過器，面積1.7m2，超濾系數(shù)57ml/mmHg.h，LFHD組使用金寶8LR血液濾過器，面積1.7m2，超濾系數(shù)11.3ml/mmHg.h。兩組透析患者，透析齡均達3年以上，病情相對穩(wěn)定，透析間期體重增長不超過干體重5%，近3個月內(nèi)未發(fā)生急性心腦血管、嚴重感染、惡性腫瘤、慢性肺部疾病。透析機為德國Fresenius4008S型血透機，雙級反滲加熱消毒水處理系統(tǒng)，反滲水符合國際標準。A、B液干粉由廣州康盛生物科技公司生產(chǎn)，專人配置透析液，現(xiàn)配現(xiàn)用。透析通路為自體動靜脈內(nèi)瘺或長期導管，抗凝劑為低分子量肝素鈣，碳酸氫鹽行血液透析，透析液流量為血流量2倍，約500ml/min，每次4小時，每周透析3次。在治療期間所有患者常規(guī)使用促紅細胞生成素、降壓藥、活性維生素D、磷結(jié)合劑等。 在實驗開始時，所有患者第1次透析上機前抽血檢測生化指標：肌酐（Scr）、血紅蛋白（Hb）、血漿白蛋白（Alb）、β2微球蛋白（β2MG）、超敏C反應蛋白（CRP）、磷（P3+）、甲狀旁腺激素（iPTH）、B型利鈉肽（BNP），行心臟彩超檢查左心室舒張末期容積（LVDd）、左心室后壁厚度（LVPWT）、室間隔厚度（IVST）、左室射血分數(shù)（EF）、快速充盈期和心房收縮期二尖瓣血流速度比值（E/A）、和左心室心肌重量指數(shù)（LVMI）。組內(nèi)及組間比較，LFHD及HFHD患者心血管功能的變化情況。 結(jié)果：iPTH、P3+在HFHD組的清除率明顯高于LFHD組（P0.05），BNP水平在HFHD組明顯低于LFHD組（P〈0.05）。治療12個月后，HFHD組心功能較LFHD組有明顯改善（P0.05）。 結(jié)論： HFHD能清除中大分子毒素、改善微炎癥和貧血，進而能更好的提高尿毒癥透析患者的心血管功能狀態(tài)。BNP水平可以用作慢性腎衰竭患者合并心血管疾病發(fā)生心衰危險的一個重要指標。
[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.
【學位授予單位】：安徽醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R692.5

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