不同血液净化方式对老年维持性血液透析患者皮肤瘙痒的影响

目的探讨不同血液净化方式对老年维持性血液透析患者皮肤瘙痒的影响。方法选取2008年1月—2013年1月接受治疗的伴有皮肤瘙痒的维持性血液透析老年患者80例作为研究对象,其中血液透析组27例,血液透析联合血液灌流组27例,高通量血液透析组26例。计量资料采用t检验,计数资料采用χ2检验,P0.05为差异有统计学意义。结果血液透析联合血液灌流组和高通量血液透析组的β2-MG值[(22.79±12.74)、(20.47±12.31)mg/L]和血磷值[(1.80±0.39)、(1.78±0.35)mmol/L]要明显低于血液透析组[(31.16±13.15)、(2.11±0.40)mmol/L],比较差异均有统计学意义(均P0.05)。三组12周后皮肤瘙痒情况比较差异有统计学意义(P0.05)。结论血液透析联合血液灌流和高通量血液透析两种血液净化方式均可以较好的清除患者血液β2-微球蛋白值并有效降低血磷水平,两种效果相近,均是治疗维持性血液透析老年患者皮肤瘙痒的有效血液净化方式。     

高通量透析联合血液灌流对血清钙、磷及甲状旁腺激素代谢的影响

目的分析高通量透析联合血液灌流对中老年维持性血液透析患者血清钙、磷及甲状旁腺激素代谢的影响。方法选取蚌埠市第一人民医院2015年2月~2018年7月收治的中老年维持性血液透析患者119例,按入院顺序分为观察组(60例)与对照组(59例),对照组患者采用高通量透析治疗,观察组联合血液灌流治疗,比较两组患者治疗前后血清钙(Ca)、磷(P)和甲状旁腺激素(iPTH)变化情况,以及肾功能改善情况。结果治疗后,观察组血清iPTH、P表达水平显著低于对照组,差异有统计学意义(t=14.281,5.746,P<0.05);而两组患者血清Ca表达水平比较差异无统计学意义(P>0.05)。治疗前后血清BUN和Cr水平组间比较差异无统计学意义(P>0.05)。治疗过程中两组患者均无严重不良反应发生,治疗后观察组2例患者发生低血糖,不良反应发生率比较差异无统计学意义(P>0.05)。结论高通量透析联合血液灌流对中老年维持性血液透析患者血清P和iPTH降低作用显著,但高通量透析是否联合血液灌流对血Ca变化无显著影响。     

利用血液透析开展血液灌流治疗皮肤瘙痒的疗效观察

目的:观察利用血液透析开展血液灌流治疗皮肤瘙痒的疗效。方法:选择2013年1月~2018年12月本院肾内科接收的66例老年慢性肾衰竭皮肤瘙痒患者,以血液透析时机作为分组标准,分为观察组和对照组,观察组每两周进行1次血液灌流+6次血液透析。对照组每周进行3次血液透析。比较两组患者的比较治疗前和治疗后的血肌酐、血尿素氮、血磷和治疗疗效。结果:①与治疗前对比,两组患者治疗后血肌酐水平、血尿素氮水平、血磷水平明显下降,APACHE-Ⅱ评分明显减少,数据差异存在统计学意义,P<0.05。和对照组对比,观察组治疗后血肌酐水平、血尿素氮水平、血磷水平明显更低,APACHE-Ⅱ评分明显更少,数据差异存在统计学意义,P<0.05。②观察组治疗疗效明显高于对照组,数据差异存在统计学意义,P<0.05。结论:HP+HD能够有效地改善维持性血透患者的皮肤瘙痒症状,解除患者的痛苦,提高尿毒症患者的生活质量。     

血液灌流联合血液透析治疗尿毒症皮肤瘙痒的观察及护理

目的：观察血液灌流联合血液透析治疗尿毒症患者皮肤瘙痒的治疗效果,为该类患者的治疗提供依据,改善其生活质量。方法：对44例患者随机分为血液灌流＋血液透析（HP/HD）组（治疗组）和血液透析（HD）组（对照组）各22例,治疗6周后皮肤瘙痒临床症状的改善情况。结果：6周后皮肤瘙痒改善率治疗组为86.36%（19/22例）,对照组为18.18%（4/22例）,二者比较差异有统计学意义（χ1=16.3,P〈0.05）。结论：血液灌流联合血液透析治疗尿毒症皮肤瘙痒症状效果明显,弥补了单纯血液透析的缺点。     

血液灌流联合血液透析对维持性血液透析患者钙磷代谢指标的影响

目的探讨血液灌流联合血液透析对维持性血液透析患者钙磷代谢指标的影响。方法选择2014年1月-2016年1月本院进行血液透析的98例患者作为研究对象,按照数字随机法分为对照组和观察组,每组49例。其中对照组患者进行血液透析治疗,观察组患者进行血液灌流与血液透析的联合治疗,比较两组患者治疗效果及钙磷代谢指标。结果观察组患者血清中钙、磷以及钙磷乘积和甲状旁腺素(i PTH)等指标均显著优于对照组;观察组患者皮肤瘙痒的视觉模拟评分7分48例,占97.96%,显著多于对照组(42例、85.71%);以上差异均有统计学意义(均P0.05)。结论血液灌流联合血液透析对维持性血液透析患者的钙磷代谢指标影响较小,可降低钙磷代谢紊乱的发生率,减少患者的皮肤瘙痒感,安全性高,实用性强,值得临床推荐。     

血液透析联合血液灌流治疗尿毒症性皮肤瘙痒临床观察

目的 观察血液透析联合血液灌流治疗尿毒症性皮肤瘙痒的效果.方法 选择16例尿毒症并伴有皮肤瘙痒的维持性血液透析患者,运用血液透析联合血液灌流的方法进行治疗.结果 联合治疗后患者的瘙痒症状明显减轻（P〈0.05）.结论 血液透析联合血液灌流能有效地改善皮肤瘙痒症状.     

血液灌流联合血液透析治疗尿毒症的临床分析

目的：观察联合应用血液灌流与血液透析治疗尿毒症的临床效果。方法以2010年1月-2013年1月我院收治的80例尿毒症患者为临床观察对象,随机均分为实验组与对照组,各40例。对照组给予常规的血液透析治疗,实验组给予血液灌流联合血液透析治疗法。对照两组患者治疗后在皮肤瘙痒、高血压、贫血等方面的改善情况。同时比较两组患者肌酐（Cr）、血红蛋白（Hb）、血尿素氮（BUN）、β2-微球蛋白（β2-MG）等生化指标的水平。结果治疗后两组患者的皮肤瘙痒、高血压、贫血症状均有明显改善,但是实验组各项的改善程度更优于对照组,比较差异具有统计学意义（P＜0.05）;两组的 Cr、BUN 水平均有所下降,实验组的下降幅度显著大于对照组（P＜0.05）;实验组的Hb升高幅度显著大于对照组（P＜0.05）;β2-MG 清除率也比对照组显著提多（P＜0.05）。结论采取血液灌流联合血液透析法治疗尿毒症,具有更显著的临床效果。     

血液灌流联合血液透析治疗尿毒症皮肤瘙痒的护理

目的:分析尿毒症皮肤瘙痒患者采用血液透析(HD)与血液灌流(HP联合的治疗方式,并且其进行护理,观察其护理效果。方法:选取2017年3月-2018年3月期间我院治疗的76例尿毒症皮肤瘙痒患者作为调查研究对象进行分组对比,按照随机数字表法分成对照组38例、研究组38例,血液透析与血液灌流联合治疗,对照组实施血液透析治疗,研究组采用血液透析与血液灌流联合治疗,给两组患者进行优质护理,对比两组患者的治疗有效率以及不良反应发生率。结果:研究组患者的治疗有效率与对照组比较高,两组数据对比经过统计学计算结果为(P0.05),存在对比意义;研究组患者的不良反应发生率低于对照组,两组对比差异有统计学意义存在(P0.05)。结论:在尿毒症皮肤瘙痒患者的治疗中采用血液透析联合血液灌流方式,并给予优质护理,能够有效改善皮肤瘙痒的症状,降低不良反应发生率,值得推广和应用。     

血液灌流联合血液透析治疗尿毒症皮肤瘙痒的观察和护理

目的:探讨血液灌流联合血液透析治疗尿毒症皮肤瘙痒的临床效果及护理措施.方法:选取2013年10月至2016年10月我院收治的尿毒症皮肤瘙痒患者40例,随机分为两组,各20例.对照组行一般血液透析治疗,观察组行血液灌流联合血液透析治疗,对比两组治疗效果.结果:观察组皮肤瘙痒总缓解率高于对照组,差异显著(P＜0.05).结论:血液灌流联合血液透析配合全面护理措施应用于治疗尿毒症皮肤瘙痒效果显著,可有效提高患者皮肤瘙痒总缓解率,值得推广.     

血液透析联合血液灌流对维持性血液透析患者甲状旁腺激素清除的应用研究

目的 观察血液透析联合血液灌流治疗对维持性血液透析患者甲状旁腺激素清除的疗效研究.方法 选取本院2019年1月—2020年6月行维持性血液透析且合并有甲状旁腺激素异常升高的28例患者,随机分为两组,对照组采用单纯血液透析治疗模式,观察组采用血液透析联合血液灌流治疗模式,观察治疗前后甲状旁腺激素水平下降情况.结果 观察组...     

Malnutrition, inflammation, atherosclerosis in hemodialysis patients

Protein-energy malnutrition with muscle wasting occurs in a large proportion of patients with chronic renal failure and is, in addition to atherosclerosis, a strong risk factor for cardiovascular mortality in dialysis patients. There is evidence that a chronic inflammation with activation of C-reactive protein and proinfalammatory cytokines is associated with increased oxidative stress and endothelial dysfunction. Strong relations between malnutrition, inflammation and atherosclerosis in dialysis patients suggest the presence of a MIA (malnutrition, inflammation and atherosclerosis) syndrome, which is associated with high mortality rate. Thus, it could be speculated that suppression of the vicious cycle of malnutrition, inflammation and atherosclerosis would improve survival in dialysis patients.     

Appetite and inflammation, nutrition, anemia, and clinical outcome in hemodialysis patients

BACKGROUND: Malnutrition-inflammation complex syndrome, an outcome predictor in maintenance hemodialysis (MHD) patients, may be related to anorexia. OBJECTIVES: We examined whether subjectively reported appetite is associated with adverse conditions and increased morbidity and mortality in MHD patients. DESIGN: A cohort of 331 MHD outpatients was asked to rate their recent appetite status on a scale from 1 to 4 (very good, good, fair, and poor appetite, respectively). Anemia indexes and nutritional and inflammatory markers-including serum concentrations of C-reactive protein, tumor necrosis factor alpha, and interleukin 6-were measured. The malnutrition-inflammation score was used to evaluate the malnutrition-inflammation complex syndrome, and the SF36 questionnaire was used to assess quality of life (QoL). Mortality and hospitalization were followed prospectively for up to 12 mo. RESULTS: Patients were aged 54.5 +/- 14.4 y. Diminished appetite (fair to poor) was reported by 124 patients (38%). Hemoglobin, protein intake, and QoL scores were progressively lower, whereas markers of inflammation, malnutrition-inflammation scores, and the required erythropoietin dose were higher across the worsening categories of appetite. The adjusted odds ratios of diminished versus normal appetite for increased serum tumor necrosis factor alpha and C-reactive protein concentrations were significant. Significant associations between a poor appetite and an increased rate of hospitalization and mortality were observed. The hazard ratio of death for diminished appetite was 4.74 (95% CI: 1.85, 12.16; P = 0.001). CONCLUSION: Diminished appetite (anorexia) is associated with higher concentrations of proinflammatory cytokines and higher levels of erythropoietin hyporesponsiveness and poor clinical outcome, including a 4-fold increase in mortality, greater hospitalization rates, and a poor QoL in MHD patients. Appetite status may yield significant insight into the clinical status of dialysis patients.     

Body composition, treatment time, and outcome in hemodialysis patients.

OBJECTIVE: To review the nutritional status, hemodialysis (HD) treatment times, and outcome in stable HD patients. DESIGN: A cross-sectional study with follow-up 12 months later. SETTING: Five HD units in the Southwest of England, United Kingdom. PATIENTS: A random selection of 180 stable HD patients who had been receiving dialysis treatment for at least 6 months. MEASURES: Anthropometric measurements of triceps and biceps skinfold thickness, and mid arm circumference, to calculate indices of nutritional status and body composition. RESULTS: (1) Male HD patients had severe reductions in muscle mass compared with the normal population (P < 0.01), with 50% below the 10th percentile of normal; (2) nondiabetic female patients had significant reductions in body fat stores compared with the normal (P < 0.001); (3) reduced HD treatment times (less than 12 hours per week) were associated with significantly reduced values of muscle mass (P < 0.02) in males and significantly reduced body fat stores (P < 0.001) and muscle mass (P < 0.05) in females; (4) reduced treatment times were also associated with the lowest serum albumin (P < 0.001) and creatinine (P < 0.001) levels; and (5) a serum albumin level below 36 g/L was associated with a 2.4-fold higher mortality rate. CONCLUSION: Despite the apparent well-being of the patients, a substantial proportion are malnourished, with reduced body fat in females and reduced muscle mass in males. Those patients who receive shorter treatment times are at the greatest risk of malnutrition and of having a low serum albumin level, which is related to a higher mortality rate.     

Pyrogenic reactions in hemodialysis patients, Hanoi, Vietnam.

Of 33,111 patients admitted to a large hospital in Vietnam from November 2000 through July 2001, a total of 303 were undergoing hemodialysis and had pyrogenic reactions (ie, fever and/or rigors). Ten case patients (3.3%) had documented bacteremia; pathogens were largely waterborne microorganisms. Pyrogenic reactions in case patients might have occurred because of suboptimal water quality or inadequate dialyzer reprocessing procedures.     

The effect of hemodialysis, using acetate and bicarbonate, on erythrocyte deformability

The red blood cell filtration parameters were examined in 82 patients with chronic renal failure and 50 healthy controls. The most expressed decrease in deformability was observed in uremic patients who had not been haemodialysed; the values nearest to the healthy ones were observed in transplanted patients. The deformability was considerably improved after haemodialysis, especially when acetate-containing dialyzing solution was applied.     

医院门诊血液透析患者血液透析事件的监测分析

目的了解医院门诊血液透析患者血液透析事件的发生及不良结局,为预防控制措施的制定和实施提供依据。方法采用前瞻性调查方法,选取2013年1-12月每月前两个工作日内维持血液透析治疗的门诊患者3 196例,借鉴美国NHSN血液透析事件监测方案,结合我国实际设计血液透析事件监测表格,由血液透析感染控制护士和管床护士负责观察、监测、追踪患者感染情况,并填写相关监测表格,感染控制专职人员每月对监测资料进行统计分析。结果血液透析事件共237例次,发生率为7.4%,内瘘、人工血管、隧道式中心静脉置管、非隧道式中心静脉置管和其他通路血液透析事件发生率分别为6.6%、0、9.8%、18.3%和0;血液透析事件类型主要为全身使用抗菌药物,共179例占5.6%,用药途径以口服为主;血管穿刺部位感染率以非隧道式中心静脉最高,高达6.7%;血培养结果阳性仅1例,为金黄色葡萄球菌,来源为隧道式中心静脉导管。结论门诊血液透析患者全身使用抗菌药物和血管穿刺部位感染较为常见;通过监测可获得真实有效的数据,有利于采取针对性的预防控制措施,最终减少血液透析事件的发生。