血液透析前补充左卡尼汀对改善终末期尿毒症患者透析耐受性的影响

目的 探讨不同时段静脉补充左卡尼汀对终末期维持性血液透析患者透析过程中发生低血压、肌肉痉挛及透析患者耐受性的影响和血浆游离肉碱浓度变化.方法 选择终末期维持性血液透析患者30例,按照数字表法随机分为3组:A组为对照组(透析结束后给予左卡尼汀1.0g加入0.9％氯化钠20ml静脉注射)10例,B组(透析前给予左卡尼汀1.0g加入0.9％氯化钠20ml静脉注射,透析结束后左卡尼汀1.0g加入0.9％氯化钠20ml静脉注射)10例,C组(透析开始2h后给予左卡尼汀1.0g加入0.9％氯化钠20ml静脉注射,透析结束后给予左卡尼汀1.0g加入0.9％氯化钠20ml静脉注射)10例.观察各组用药前、用药4周、8周及12周后各项指标的变化、血浆肉碱浓度和血液透析充分性.结果 B、C两组患者较对照组临床症状及分级显著好转,差异有统计学意义(P＜0.05);游离血浆肉碱浓度较对照组升高,差异有统计学意义(P＜0.05);患者透析的耐受力和尿素氮清除效率(Kt/V)明显好转,差异有统计学意义(P＜0.05).结论 在透析前或透析中给予左卡尼汀即刻补充剂量能降低患者发生透析不良反应的风险,增加患者的透析耐受力,提高患者透析的充分性.

Effect of L-carnitine supplementation pre-hemodialysis on adequacy of hemodialysis in patients with maintenance hemodialysis

Objective To explore the effect of L-carnitine intravenous injection before or after hemodialysis on hypotension,muscle spasm and the tolerance of hemodialysis in patients with end-stage maintenance hemodialysis and the concentration of plasma free carnitine changes.Methods Thirty patients with maintenance hemodialysis were divided into three groups according to random number table.Control group (group A,n =10) was treated intravenously with L-carnitine 1.0 g after hemodialysis.Group B (n =10) was treated with 1.0 g L-carnitine before and after hemodialysis,respectively,and group C (n =10)was treated intravenously with 1.0 g L-carnitine 2 hours during hemodialysis and after hemodialysis.The changes of the laboratory indicators,clinical symptoms and Kt/V were collected before and 4,8 and 12 weeeks after treatment.The concentration of plasma free carnitine was detected by enzyme linked immunosorbent assay.Results Compared with the control group,the change of the concentration of plasma free carnitinein increased and clinical symptoms were improved in group B and group C,the difference was statistically significant (P＜0.05).Kt/V in group B and group C was also higher than that in group A,and the difference was statistically significant (P ＜ 0.05).Conclusion L-carnitine supplementation prehemodialysis or during hemodialysis can decrease the risk of adverse reaction,improve the tolerance and the adequacy of hemodialysis in patients with maintenance hemodialysis.