高龄尿毒症患者血液透析滤过治疗的临床观察

目的观察高龄尿毒症患者联机血液透析滤过（OL-HDF）治疗的临床疗效和不良反应。方法将年龄大于75岁的40例尿毒症患者随机分为两组,血液透析滤过（HDF）组20例,每周行OL-HDF 1次,常规血液透析（HD）2次;血液透析（HD）组20例,每周行HD治疗3次。观察两组治疗前及治疗12周后甲状旁腺素（PTH）、β2-微球蛋白（β2-MG）、血磷及血压的水平;以及治疗期间心血管并发症发生率。结果 HDF疗效优于HD,治疗后PTH、β2-MG、血磷及收缩压下降差异有统计学意义（P〈0.05）,而对照组下降不明显（P〉0.05）。低血压、高血压、心绞痛、心律失常及心力衰竭的发生率OL-HDF组明显低于HD组（P〈0.05）。结论 OL-HDF能有效清除高龄患者的尿毒症毒素,患者耐受性好,并发症发生率低,值得临床推广。

Clinical Observation of Hemodiafiltration for Elderly Patients with Uremia

Objective To observe the clinical efficacy and adverse reaction of on-line hemodiafiltration（OL-HDF）for elder patients with uremia.Methods 40 patients with uremia over 75 year-old were divided into two groups randomly.20 patients were incorporated into HDF group and each of them were received one time of OL-HDF and two times of regular hemodialysis（HD）per week.The other half of the patients belonged to HD group and each of them were treated three times of HD per week.The patients＇ serum parathyrin hormone（PTH）,2-microglobulin（β2-MG）,phosphorus,blood pressure prior treatment and 12 weeks post-treatment,as well as the cardiovascular complications during the study period were observed.Results The clinical efficacy of HDF was better than that of HD group（P0.05）.The serum PTH,β2-MG,phosphorus,and systolic pressure were observably reduced in HDF group than those in HD group after treatment（P0.05）.Meanwhile,the complications of hypotension,hypertension,angina,arrhythmia,and heart failure significantly decreased in HDF group compared with those in HD group（P0.05）.Conclusion OL-HDF can clean away the uremia toxins of elder patients.Patients have height tolerance and less cardiovascular complications during treatment period.OL-HDF is worth of clinic application.