血液灌流联合血液透析对尿毒症并发症疗效观察

目的观察血液灌流联合血液透析对尿毒症并发症的治疗效果。方法选取维持性透析尿毒症患者40例，将灌流器串联于透析器前，血流量150～240ml／min，透析液流量500ml／min，肝素用量首剂16-20mg，追加6～8mg／h或低分子肝素3500-5000U，追加肝素6mg／h。灌流治疗时间为2～2．5h，之后继续血液透析1．5—2h，连续治疗2次（间隔1日）。观察治疗前后患者皮肤瘙痒、骨痛、不安腿综合征、食欲、睡眠及自主感觉等临床症状变化，检测肾功能、电解质、甲状旁腺素（PTH）、p2微球蛋白（β2-MG）及血常规。结果血液灌流联合血液透析治疗后多数患者皮肤瘙痒、骨痛、不安腿综合征症状减轻、食欲增加，睡眠改善，自主感觉良好；尿素、肌酐、血磷、血钾、血PTH、血β2-MG显著降低，无严重的不良反应。结论血液灌流联合血液透析可显著降低尿毒症患者血中PTH、β2-MG等中分子物质，对患者的皮肤瘙痒、骨痛、不安腿综合征等症状疗效显著，并且能够增进食欲、改善睡眠及自主感觉。

The Effect of Hemoperfusion Combined with Hemodialysis in Patients with Uremia

Objective To observe the effect of hemoperfusion combined with hemodialysis in patients with uremia. Methods Forty uremia patients were treated with hemoperfusion combined with hemodialysis for 2 -2.5 h then with single hemodialysis for 1.5 - 2 h, which was performed again after one day. The blood flow rate was 150 - 240 ml/min, and dialysate flow 500 ml/min. Anticoagulant was heparin or low molecular weight heparin. The blood urea nitrogen, creatinine, electrolyte, parathyroid hormone （ PTH ）, β2--mioeroglobulin （ β2-MG） ,blood routine and clinical manifestation were observed before and after the treatment. Results The clini- cal manifestations were improved in majority of the patients. The blood urea nitrogen, creatinine, phosphorus, po- tassium, PTH and β2-MG were decreased significantly after treatment（ P 〈 0.05 ）. No serious side-effect was observed. Conclusion The treatment of hemoperfusion combined with hemodialysis can clear the middle molecu- lar substance and improve some of clinical manifestations in uremic patients effectively.