尿毒症性皮肤瘙痒采用血液透析联合血液灌流治疗的临床效果分析

目的探讨尿毒症性皮肤瘙痒采用血液透析联合血液灌流治疗的临床效果及安全性。方法将2008年1月～2012年12月本院收治的376例尿毒症性皮肤瘙痒患者随机分为对照组与观察组,各188例。对照组给予单纯血液透析治疗,观察组在此基础上联合血液灌流治疗,比较两组临床治疗效果,观察治疗前后血尿素氮（BUN）、肌酐（Cr）、尿酸（UA）、血红蛋白（Hb）、超敏C反应蛋白（hs-CRP）、血钙（Ca）、血磷（P）、甲状旁腺素（PTH）变化及不良反应情况。结果①对照组临床治疗总有效率（54.79%）明显低于观察组（88.30%）（P〈0.01）;②两组治疗前后BUN、Cr、UA、Hb、hs-CRP、Ca、P及PTH均差异具有统计学意义（P〈0.05,P〈0.01）,且观察组治疗后上述各指标与对照组治疗后相比,差异均具有统计学意义（P〈0.05）;③两组患者治疗后皮肤瘙痒、睡眠、高血压、肾性骨病及周围神经病变等症状均得到显著改善,且无明显并发症发生。结论血液透析联合血液灌流治疗尿毒症性皮肤瘙痒,效果显著,不良反应明显改善,值得临床推广应用。

Analysis of clinical efficacy of hemodialysis combined with hemoperfusion in treatment of uremic pruritus

Objective To investigate the clinical efficacy and safety of hemodialysis combined with hemoperfusion in the treatment of uremic pruritus. Methods 376 patients with uremic pruritus hospitalized in our hospital from January ：2008 to December 2012 were randomly divided into the control group and the observation group according to the drawing method, with 188 patients in each group. The control group received simple hemodialysis and the observation group received additional hemoperfusion on the basis of the control group. The blood urea nitrogen （BUN）, creatinine （Cr）, uric acid（UA）, hemoglobin（Hb）, high-sensitivity C-reactive protein（hs-CRP）, blood calcium（Ca）, blood phospho- rus（P）, parathyroid hormone （PTH） and incidences of adverse reactions of the two groups before and after the treatment were compared. Results ①The total response rate of the control group was 54.79%, which was significantly lower than the 88.30% of the observation group （P〈0.01）; ②BUN, Cr, UA, Hb, hs-CRP, blood Ca, blood P and PTH in both two groups before and after the treatment were statistically different （P〈0.05,P〈0.01）, and the observation group and the control group were significantly different in the above indicators after the treatment （P〈0.05）; ③After treatment, the skin itching, sleep, hypertension, renal osteopathy, peripheral neuropathy and other symptoms of both groups improved significantly, without any adverse complications. Conclusion The combination of hemodialysis and hemoperfusion shows significant efficacy and obviously improves the adverse reactions in the treatment of uremic pruritus, thereby worthy of clinical promotion and application.