透析不同时期加入血液灌流治疗尿毒症的疗效评价

目的:比较血液透析联合血液灌流治疗中，在治疗前期和后期分别加入血液灌流的临床疗效。方法:将采用血液透析联合血液灌流治疗的106例尿毒症病人随机分为A、B2组，各53例。A组为在透析治疗前2 h加入血液灌流，B组在透析治疗后2 h加入血液灌流。治疗后3个月，比较2组病人甲状旁腺素（PTH）、血尿素氮（BUN）、肝酐（Cr）及β₂-微球蛋白β₂-（MG）变化，并观察治疗前后的睡眠、血压、食欲、皮肤瘙痒及肢体疼痛、麻木感、不宁腿综合征神经症状变化情况。结果:2组病人BUN、PTH、Cr和β₂-MG的含量经治疗后均明显降低（P<0.05~P<0.01），且B组治疗后降低幅度大于A组（P<0.01）。治疗后2组睡眠障碍、高血压、皮肤瘙痒和趾端疼痛均有改善（P<0.05~P<0.01），食欲差在2组间均没有得到改善（P>0.05），而感觉障碍和麻木感仅在B组得到改善（P<0.01）。结论:治疗后期进行血液灌流联合治疗方式能显著提高尿毒症病人血液中有害物质的清除效率，改善感觉障碍和麻木感的症状。

Clinical efficacy of hemoperfusion at different stages in the treatment of uremia

Objective:To compare the clinical efficacy of hemoperfusion at early or late stage during the hemodialysis combined with hemoperfusion treatment. Methods:A total of 106 uremia patients who were treated by combination of hemodialysis and hemoperfusion were included and randomly divided into group A and group B(53 cases each group). Blood perfusion was added 2 hours before dialysis in group A, while blood perfusion was added at last 2 hours of dialysis in group B. Three months after treatment, the levels of parathormone( PTH) ,blood urea nitrogen( BUN) ,creatinine( Cr) ,β2-microglobulin (β2-MG) between two groups were compared. The changes of the sleep situation,blood pressure,appetite,skin itching,body pain,numbness and restless leg syndrome before and after treatment were also observed. Results:The levels of BUN,PTH, Cr andβ2-MG in two groups significantly decreased after treatment( P<0.05 to P<0. 01),while the decreasing degree of these indexes in group B was more than that in group A(P <0. 01). After treatment, the sleep disorder, high blood pressure and toe pain in two groups significantly improved(P<0. 05 to P<0. 01),while the poor appetite in two groups did not improve significantly(P>0. 05). The sensory disorder and numbness improved only in group B(P<0. 01). Conclusions:The combination of hemoperfusion at late stage of dialysis can significantly increase the clear rate of serum harmful substance, and improve the sensory disorder and numbness symptom.