發(fā)布時(shí)間：2018-01-02 04:10

  本文關(guān)鍵詞：不同血液凈化方式對(duì)維持性血液透析患者鈣磷代謝的影響　出處：《皖南醫(yī)學(xué)院》2017年碩士論文　論文類(lèi)型：學(xué)位論文

  更多相關(guān)文章： 低通量血液透析 高通量血液透析 血液透析濾過(guò) 甲狀旁腺激素

【摘要】：目的:探討低通量血液透析(Low flux hemodialysis,LFHD)、高通量血液透析(High flux hemodialysis,HFHD)以及血液透析濾過(guò)(Hemodiafiltration,HDF)三種不同血液凈化方式對(duì)維持性血液透析(Maintence hemodialysis,MHD)患者的鈣、磷、甲狀旁腺激素(Parathyroid hormone,PTH)等生化檢測(cè)指標(biāo)的影響,為MHD患者鈣磷代謝紊亂及繼發(fā)性甲狀旁腺功能亢進(jìn)癥(Secondary hyperparathyroidism,SHPT)的治療探索一種最佳透析方式,為改善其臨床癥狀、提高生活質(zhì)量以及遠(yuǎn)期生存率提供臨床應(yīng)用價(jià)值。方法:嚴(yán)格按照入選標(biāo)準(zhǔn)和排除標(biāo)準(zhǔn)選取2015年01月至2016年12月在皖南醫(yī)學(xué)院附屬弋磯山醫(yī)院血液凈化中心規(guī)律接受MHD治療的尿毒癥患者60例,根據(jù)透析方式的不同分為L(zhǎng)FHD組、HFHD組、HDF+LFHD組3組,每組20例,觀察1年,比較各組患者1年前后血鈣、血磷、PTH等檢測(cè)指標(biāo)的變化,探討不同血液凈化方式對(duì)MHD患者血鈣、血磷、PTH的影響。結(jié)果:1.三組組內(nèi)自身比較:三組治療前后,血鈣水平變化程度,差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。LFHD組治療前后,血磷、PTH水平變化程度,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);HFHD組和HDF+LFHD組治療前后,血磷、PTH水平均下降,差異有統(tǒng)計(jì)學(xué)差異(P0.05)。2.三組組間比較:三組組間血鈣下降率相比,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。組間血磷下降率相比:LFHD組分別與HFHD組和HDF+LFHD組相比,差異有統(tǒng)計(jì)學(xué)意義(P0.05);HFHD組(血磷下降率為15.88±22.65)與HDF+LFHD組(血磷下降率為10.68±26.68),差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。組間PTH下降率相比:LFHD組分別與HFHD組及HDF+LFHD組相比,差異有統(tǒng)計(jì)學(xué)意義(P0.05);HFHD組(PTH下降率為28.28±27.85)與HDF+LFHD組(PTH下降率為35.41±30.14)相比,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:HFHD和HDF較LFHD均能有效降低血磷、PTH,糾正MHD患者的鈣磷代謝紊亂,從而有效治療SHPT。
[Abstract]:Objective: To investigate the low flux hemodialysis (Low flux, hemodialysis, LFHD), high flux hemodialysis (High flux, hemodialysis, HFHD) and hemodiafiltration (Hemodiafiltration, HDF) three different blood purification methods on hemodialysis (Maintence hemodialysis, MHD) with calcium, phosphorus, parathyroid hormone (Parathyroid hormone. PTH) the influence of biochemical index for patients with MHD, calcium and phosphorus metabolism and secondary hyperparathyroidism (Secondary hyperparathyroidism, SHPT) treatment to explore a best way for dialysis, improve the clinical symptoms, improve the quality of life and clinical value of long-term survival rate. Methods: according to inclusion criteria and exclusion the standard from 2015 01 months to December 2016 in Wangnan Medical College affiliated rocky 60 uremia patients treated with MHD blood purification center. The hospital, According to different dialysis methods for the LFHD group, HFHD group, HDF+LFHD group, 3 groups, 20 cases in each group, the observation group compared with 1 years, 1 years before and after the blood calcium, blood phosphorus, PTH detection index, to explore different ways of blood purification on MHD serum calcium, serum phosphorus, the effect of PTH. Results: 1. the three groups in their comparison: three groups before and after treatment, the degree of change in blood calcium levels, there were no significant differences (P0.05) before and after treatment in group.LFHD, blood phosphorus, changes of PTH level, the difference was not statistically significant (P0.05); HFHD group and HDF+LFHD group before and after treatment of blood phosphorus and PTH levels were decreased, the difference is statistical difference (P0.05) between the three groups: comparison of.2. between the three groups of blood calcium decreased compared to the rate, there was no statistically significant difference between groups (P0.05). Serum phosphorus decreased compared to LFHD group respectively compared with HFHD group and HDF+LFHD group, the difference was statistically significant (P0.05); HFHD group (the blood phosphorus decline rate 15.88 + 22.65) and HDF +LFHD group (the blood phosphorus decline rate is 10.68 + 26.68), there was no statistically significant difference between groups (P0.05). The decline rate of PTH compared to LFHD group compared with HFHD group and HDF+LFHD group, the difference was statistically significant (P0.05); HFHD group (the decline rate of PTH was 28.28 + 27.85 (PTH) and HDF+LFHD group decreased rate of 35.41 + 30.14) compared to the difference was not statistically significant (P0.05). Conclusion: HFHD and HDF LFHD can effectively reduce serum phosphorus, PTH, calcium and phosphorus metabolism correction in MHD patients, which is effective in the treatment of SHPT.

【學(xué)位授予單位】：皖南醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R692.5

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本文編號(hào)：1367600