论文下载：高通量血液透析对血透患者甲状旁腺素的影响及护理体会

高通量血液透析对血透患者甲状旁腺素的影响及护理体会(1)

http://www.100md.com 2010年8月1日张留平,杨金芳,刘宏,薛莹莹

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     [摘要] 目的:探讨高通量血液透析(HFHD)对血透患者血清甲状旁腺素(PTH)的影响,讨论护理特点。方法:选择40例慢性肾衰维持性血液透析患者,随机分为HFHD组、普通血液透析(HD)组各20例,分别于单次透析前、后测定患者血清尿素氮(BUN)、肌酐(Cr)、钙(Ca)、磷(P)和PTH水平。结果:HD和HFHD治疗对血BUN、Cr、Ca的清除率差异无统计学意义(P>0.05)。HFHD对血P和PTH的清除率明显高于HD(P<0.05)。结论:HFHD能有效降低血PTH浓度。透析护理过程中,必须加强观察并重视患者的不适主诉;对于超滤量少的患者,可在适当补充液体的同时增加超滤量,以提高跨膜压,防止反超。

    [关键词]高通量透析; 甲状旁腺素; 护理

    [中图分类号] R692.5

    [文献标识码] A

    [文章编号] 1671-7562(2010)04-0349-03

    doi:10.3969/j.issn.1671-7562.2010.04.008

    Effect of highflux hemodialysis on parathyroid hormone and the nursing experience

    ZHANG Liuping,YANG Jinfang,LIUhong,XUE Yingying

    (Department of Nephrology, Zhongda Hospital, Southeast University,Nanjing 210009,China)

    

    [Abstract] Objective:To investigate the effect of highflux hemodialysis (HFHD) on parathyroid hormone (PTH), and explore the care characteristics.Methods:forty patients with maintain hemodialysis were randomly divided into two groups:HFHD group and low flux maintenance hemodialysis (HD) group. Blood urea nitrogen (BUN), creatinine (Cr), calcium (Ca), phosphorus (P) and PTH were measured before and after these treatments. Results:There was no significant difference between HD and HFHD in the clearance rate of BUN, Cr and Ca(P>0. 05), but the clearance rate of P and PTH of HFHD were superior to that of HD (P>0. 05). Conclusion:HFHD can decrease PTH level. Great importance should be attached to the complaints from patients during dialysis. For those with less ultrafiltration, fluid as well as ultrafiltration should be supplemented to increase the transmembrane pressure.

    [Key words]highflux hemodialysis; parathyroid hormone; care

    继发性甲状旁腺功能亢进是慢性肾功能衰竭患者常见的并发症,它可引起肾性骨病、周围神经病变、皮肤瘙痒、软组织钙化,与患者病死率密切相关[1]。甲状旁腺素(PTH)有很强的血管扩张作用,它通过拮抗去甲肾上腺素、去氧肾上腺素及血管紧张素Ⅱ,从而抑制血管平滑肌的收缩[2]。常规的低通量血液透析不能有效清除PTH,近来研究表明,高通量血液透析(HFHD)具有低通量血液透析治疗无可比拟的清除中大分子物质的作用[3],且不需要特殊设备,费用与低通量血液透析相当。本研究观察了HFHD对患者血钙(Ca)、血磷(P)和PTH的影响,现报道如下。

    1 对象与方法

    1.1 研究对象

    选择在我院行维持性血液透析的患者40例,近期透析稳定,无感染、发热,无严重心脏、肝脏疾病及其他严重慢性疾病。40例中男24例,女16例,年龄(476±225)岁,透析时间(454±322)个月。原发病分别为:慢性肾小球肾炎16例,高血压良性小动脉肾硬化症10例,糖尿病肾病8例,多囊肾4例,梗阻性肾病2例。患者按随机数字表分为HFHD组和普通血液透析(HD)组,每组20例。

    1.2 透析方案

    HFHD组和HD组分别采用德国Fresennius公司生产的F60聚砜膜血液透析滤过器(表面积13 m2,超滤系数40 ml·(h·mmHg)-1(1 mmHg=0.133 kPa)和F6聚砜膜血液透析器(表面积12 m2,超滤系数55 ml·(h·mmHg)-1 ......

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