高通量血液透析与常规血液透析、血液透析滤过的透析效果比较

目的比较高通量血液透析、常规低通量血液透析及血液透析滤过三种不同方法对尿毒症毒素清除及营养物质的影响。方法38例维持性血透患者,随机分为高通量血液透析组(n=14)和常规血液透析组(n=14),分别每周透析2次,每次4.5 h;血液透析滤过组(n=10),血液透析每2周3次,每次4.5 h,结合每2周血液透析滤过1次,每次4 h。分别于单次常规血液透析、高通量血液透析、血液透析滤过治疗前、治疗结束时取血检测患者血清Urea,C r,K+,Ca2+,P-,CO2-CP,β2-MG和ALB。结果高通量透析组及血液透析滤过组对β2-MG的清除率高于常规血液透析组(P<0.05)。高通量透析对β2-MG的清除率低于血液透析滤过组(P<0.05)。三组Urea、C r清除率、KT/V值以及透析前后血清白蛋白无明显差异。三组Na+,C l-,K+,Ca2+,P-、CO2-CP改善无显著性差异。结论高通量血液透析及血液透析滤过对中分子物质的清除明显优于常规血液透析。血液透析滤过对中分子物质的清除优于高通量血液透析。高通量血液透析与常规血液透析、血液透析滤过对小分子物质具有同样的清除效果,并能改善酸碱平衡及电解质紊乱,且不引起蛋白质的丢失。

Comparison of Effects among High-flux Hemodialysis, Conventional Hemodialysis and Hemodiafiltration

Objective To compare the effect on clearing uremic toxins and changing of nutrient substance among high-flux hemodialysis,conventional hemodialysis and hemodiafiltration.Methods The patients(n=38) with maintaining hemodialysis were divided into conventional hemodialysis(CHD) group(n=14),high-flux hemodialysis(HFHD) group(n=14) and hemodiafiltration(HDF) group(n=10) at random.CHD group and HFHD group was given treatment twice every week(4.5 hours per time),respectively.HDF group was given hemodialysis thrice every two weeks(4.5 hours per time) and HDF once every two weeks(4.0 hours per time) Their plasma levels of urea,creatinine(Cr),Na~+,Cl~-,K~+,Ca~2+,β_2-microglobulin(β_2-MG),albumin(ALB),and so on,were detected before the treatment and at the end of the treatment.The data of three groups were compared one another.Results(1) The clearance rates of β_2-MG were higher in HFHD group and in HDF group than in CHD group(P<0.05).(2) The clearance rate of β_2-MG was significantly higher in HDF group than in HFHD group(P<0.05).(3) There were no significant differences in urea,Cr and albumin among the three groups.(4) There were no significant differences in the improvement of Na~+,Cl~-,K~+,Ca~2+,P,and CO_2 combining power among the three groups.Conclusion(1) The clearance rates of medium molecular solutes in HFHD group and HDF group are superior to that in CHD group.(2) The clearance effect of HDF group is superior to that of HFHD group.(3) The clearance rates of small molecular solutes and the rectification of acid-base balance and electrolyte disturbancesare are similar to one another in the three groups.The elimination of ALB in HFHD group or HDF group is the same as that in CHD.