血液滤过代替传统诱导透析的临床研究

目的比较血液滤过和传统诱导透析疗法在诱导期肾脏替代治疗中的应用,探讨血液滤过用于诱导期肾替代治疗的可行性及优势。方法回顾山东大学附属济南市中心医院血液净化中心85例新进入肾替代治疗的慢性肾功能不全尿毒症期患者,其中血液滤过（HF）组（38例）和常规诱导透析（HD）组（47例）。分别观察两组入院时、治疗后3天、7天时的尿素氮（BUN）、肌酐（Cr）、总超滤量（TUF）、平均动脉压（MAP）、APACHEⅢ评分,治疗并发症、住院天数及住院总花费。结果行HF治疗的患者年龄较HD者大（P〈0.05）。入院时,患者血BUN、Cr、MAP及APACHEⅢ评分均无统计学意义,第3天及第7天,患者BUN、Cr无统计学意义,APACHEⅢ评分、MAP、TUF均有统计学意义。60岁以上患者中（占62.36%）,两组年龄、入院时BUN、Cr、MAP、APACHEⅡ评分均无统计学意义,第3天及第7天,患者BUN、Cr无统计学意义,APACHEⅢ评分、MAP、TUF均有统计学意义。并且,HF组可以显著减少患者住院天数,两组住院花费无统计学意义。两组均未见失衡综合征等并发症。结论血液滤过可以代替传统的诱导透析疗法用于诱导期的治疗。

The substitution of hemofiltration for conventional hemodialysis in the induction period of dialysis:a clinical study

Objective In this article we investigated the feasibility and advantages of hemofiltration （HF） by comparing the application of hemofiltration and conventional hemodialysis （HD） in induction period. Methods We retrospectively analyzed 85 patients beginning to accept renal replacement therapy for chronic renal failure. In these patients, 38 cases were treated with hemofiltration （HF Group） and 47 cases received conventional hemodialysis （HD Group）. BUN, Cr, total ultrafiltration （TUF）, mean arterial pressure （MAP） and APACHE Ⅲ score were observed on admission day, and on third and seventh day after treatment. Complications, medical expenses, and hospitalization days were also recorded. Results Patients age was older in HF group than in HD group （P 〈 0.05）. On admission, BUN, Cr, MAP and APACHE Ⅲ score were statistically indifferent between the two groups. On the third and seventh days after the treatment, APACHE Ⅲ score, MAP and TUF were statistically different between the two groups. Comparison of patients older than 60 years old in the two groups found that patient age, BUN, Cr, MAP and APACHE Ⅲ score had no differences on admission, but APACHE Ⅲ score, MAP and TUF were statistically different on the third and seventh days after the treatment. In addition, hospitalization days were less in HF group, but medical expenses were similar between the two groups. Dialysis disequilibrium syndrome was not found in both groups. Conclusion HF may replace HD in the induction period of renal replacement therapy.