血液透析联合血液灌流治疗慢性肾衰竭高磷血症的临床观察

目的观察血液透析加血液灌流（HD＋HP）对慢性肾衰竭伴高磷血症患者磷代谢的治疗效果。方法慢性肾衰竭伴高磷血症患者60例，分为HD组和HD＋HP组。分别给予相应治疗，观察疗效。治疗前后抽取静脉血测定血清尿素氮（BUN）、血清肌酐（Scr）、血钙（Ca^2＋）、血磷（P^3＋）及血甲状旁腺素（iPTH）等指标，比较各指标治疗前后变化。结果两组患者治疗后全身皮肤瘙痒、骨痛、食欲症状均有改善，而HD＋HP组临床症状较HD组改善明显。两组病人治疗前与治疗后BUN、Scr均明显下降（P〈0．01），但下降幅度无显著性差异（P〉0．05）。两组二氧化碳结合力均明显升高，有显著性差异（P〈0．01）。HD＋HP组血磷、iPTH明显下降（P〈0．01）。血钙无明显升高。HD组血磷iPTH无明显下降（P〉0．05）。血钙升高，有显著性差异（P〈0．05）。结论对于需行维持性血液透析的慢性肾衰竭伴高磷血症患者，HD＋HP能有效清除尿毒症毒素，可以改善患者的高磷血症。

Clinical observation of hemoperfusion combined with hemodialysis in the treatment of chronic renal failure hyperphosphatemia

Objective To observe the effect of Hemodialysis Combined Hemoperfusion （HD＋HP） in patients with high phosphorus and phosphorus metabolism in chronic renal failure with therapeutic effect. Methods A total of 60 patients with chronic renal failure patients with hyperphosphatemia were divided into HD group and HD＋HP group, were given corresponding treatment, curative effect observation. Before and after the treatment of venous blood was sampled to measure the serum urea nitrogen （BUN）,serum creatinine （Scr）, serum calcium （Ca^2＋） ,phosphorus （p^3＋） and serum parathyroid hormone （iPTH） were compared before and after treatment. Results Improved the body skin itching,pain, appetite symptoms after treatment between two groups,and the clinical symptoms improved ＂significantly in HD＋HP group than in HD group. Treatment of two groups of patients before and after treatment, BUN, Scr decreased significantly （P 〈 0.01 ） ,there was significant difference,but no significant difference （P 〉 0.05）. Two groups of carbon dioxide combining power were significantly increased （P 〈 0.01 ）,there was significant difference. HD＋HP group blood phosphorus,iPTH significantly decreased （P 〈 0.01 ）,there was significant difference. No significant increase in calcium. In group HD,iPTH no significant decrease in serum phosphorus （P 〉 0.05） with no significant difference. Eleva- tion of serum calcium （P 〈 0.05）,there was significant difference. Conclusion The need to maintain hemodialysis of chronic renal failure with patients with hyperphosphatemia,HD＋HP can effectively remove uremic toxins, hyperphos- phatemia can improve patient.