本文選題：血液透析　切入點(diǎn)：血液灌流　出處：《河北大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:本研究通過觀察血液透析聯(lián)合血液灌流對(duì)維持性血液透析患者繼發(fā)性甲旁亢(SHPT)的治療,分析兩組治療后對(duì)相關(guān)生化指標(biāo)包括血鈣(Ca)、血磷(P)、鈣磷乘積、尿素氮(BUN)、血肌酐(Cr)、全段甲狀旁腺激素(iPTH)、β2-微球蛋白(β2-MG)、胱抑素C(CysC)的影響,計(jì)算尿素清除指數(shù)(Kt/V);并監(jiān)測(cè)血液透析聯(lián)合血液灌流治療后iPTH的變化情況,探討再次行血液透析聯(lián)合血液灌流治療的周期,為選擇血液透析聯(lián)合血液灌流治療SHPT提供理論依據(jù)。方法:選取我院血液凈化中心維持性血液透析合并SHPT的患者40例,并將其隨機(jī)分為2組:血液透析聯(lián)合血液灌流(HD+HP)組20例和常規(guī)血液透析(HD)組20例。比較兩組患者治療前后血鈣(Ca)、血磷(P)、鈣磷乘積、全段甲狀旁腺激素(iPTH)、尿素氮(BUN)、血肌酐(Cr)、β2-微球蛋白(β2-MG)、胱抑素C(CysC)的變化情況,計(jì)算尿素清除指數(shù)(Kt/V);并觀察HD+HP組患者治療后第7天、第14天、第28天全段甲狀旁腺素(iPTH)、血紅蛋白(Hb)、血小板(PLT)、白蛋白(Alb)的變化情況。統(tǒng)計(jì)學(xué)分析采用SPSS16.0軟件完成;計(jì)量資料以(?)±s表示,組間比較采用t檢驗(yàn);計(jì)數(shù)資料以(n,n%)表示,組間比較采用χ~2檢驗(yàn);單樣本區(qū)間比較采用方差分析,并以P0.05為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果:治療后兩組的血P、鈣磷乘積、BUN、Cr水平均較治療前明顯下降(P0.05),血Ca水平均較治療前明顯上升(P0.05);兩組治療后的血Ca、P、鈣磷乘積、BUN、Cr水平比較,差異均無統(tǒng)計(jì)學(xué)意義(P0.05)。HD+HP組治療后iPTH、β2-MG、CysC水平均較治療前下降,差異具有統(tǒng)計(jì)學(xué)意義(P0.05);治療后HD+HP組iPTH、β2-MG、CysC水平(268.05±100.16、40.31±14.75、6.56±2.14)均低于HD組(435.28±147.17、66.80±25.39、9.85±2.58),差異有統(tǒng)計(jì)學(xué)意義(P0.05)。第14天、第28天iPTH水平均高于第1天治療后iPTH水平,差異均有統(tǒng)計(jì)學(xué)意義(P0.05);進(jìn)一步兩兩比較發(fā)現(xiàn),第14天iPTH水平與第7天iPTH水平相比,差異無統(tǒng)計(jì)學(xué)意義(P0.05);第28天iPTH水平高于第14天iPTH水平,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:1.HD+HP清除iPTH、β2-MG、CysC優(yōu)于HD。2.建議維持性血透SHPT患者可于2周再次行HD+HP治療。
[Abstract]:Objective: to observe the therapeutic effect of hemodialysis combined with hemoperfusion on secondary hyperthyroidism parathyroid hyperthyroidism (SHPTT) in patients with maintenance hemodialysis. The effects of bun, creatinine, parathyroid hormone, 尾 2-MGG, cystatin cystatin CysCon were calculated, and the change of iPTH after hemodialysis combined with hemoperfusion was monitored, and the effect of urea nitrogen bun, creatinine creatinine (Cr), total parathyroid hormone (PTH), 尾 2-microglobulin (尾 2-MGG), cystatin cystatin (Cy) CysC were calculated. To explore the cycle of hemodialysis combined with hemoperfusion therapy, and to provide the theoretical basis for selecting hemodialysis combined with hemoperfusion therapy for SHPT. Methods: 40 patients with maintenance hemodialysis combined with SHPT in our blood purification center were selected. The two groups were randomly divided into two groups: hemodialysis combined with hemoperfusion with HD (n = 20) and routine hemodialysis (HD) (n = 20). The changes of total parathyroid hormone iPTHN, urea nitrogen bun, creatinine creatinine, 尾 2-MGG, cystatin cystatin CysC were calculated, and the urea clearance index (KT / V) was calculated, and the 7 and 14 days after treatment in HD HP group were observed. On the 28th day, the changes of parathyroid hormone (PTH), hemoglobin (HB), platelets (PLT), Alb (Alb) were analyzed by SPSS16.0 software. ) 鹵s, t-test was used for inter-group comparison, and 蠂 ~ 2 test was used for inter-group comparison, and ANOVA was used for single-sample interval comparison. Results: after treatment, the blood P, Ca and P products of the two groups were significantly lower than those before treatment (P 0.05), the blood Ca levels were significantly higher than those before treatment (P 0.05), and the levels of calcium and phosphorus in the blood of the two groups after treatment were significantly higher than those before treatment, and the levels of BUNCr in the blood of the two groups after treatment were significantly higher than those before treatment, and the levels of BUNCr in the blood of the two groups after treatment were higher than those before treatment. There was no significant difference in the levels of iPTHand 尾 2-MGfCysC in HD HP group after treatment, and the difference was statistically significant (P 0.05), and the level of iPTH, 尾 2-MGG CysC in HD HP group was 268.05 鹵100.160.160.31 鹵14.756.56 鹵2.14), which was significantly lower than that in HD group (435.28 鹵147.176.80 鹵25.396.80 鹵25.39.85 鹵2.58g / d). The level of iPTH on the 28th day was higher than that on the first day after treatment, and the difference was statistically significant (P 0.05). Further comparison showed that the level of iPTH on the 14th day was higher than that on the 7th day, and the level of iPTH on the 14th day was higher than that on the 7th day. There was no significant difference (P 0.05); the level of iPTH on the 28th day was higher than that on the 14th day, and the difference was statistically significant (P 0.05). Conclusion: 1. HD HP is superior to HD.2. it is suggested that the patients with maintenance hemodialysis SHPT should be treated with HD HP again at 2 weeks.
【學(xué)位授予單位】：河北大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R692.5;R582.1

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