CAJ | 학술논문

目的探讨连续性静脉-静脉血液滤过(CVVH)治疗血液透析患者伴发顽固性高血压的短期临床疗效及其可能的机制.方法选择2005年以来在我院进行血液透析伴发顽固性高血压患者34例作为治疗组,经过2～3次、每次8～10 h的CVVH治疗,观察其降压效果和治疗前后干体重、血浆甲状旁腺激素(PTH)、肾素(RA)及血管紧张素Ⅰ、Ⅱ(AT Ⅰ、ATⅡ)和醛固酮(Ald)水平的变化.另外选择同期血压控制良好的血液透析患者30例作为对照组.结果 (1)治疗组所有患者经过2～3次的CVVH治疗,血压均较治疗前有明显下降,显效率64.7%,有效率100.0%;(2)治疗组治疗前与对照组比较,血浆RA[分别为(1.10±0.25)、(0.78±0.26)μg(L·h)]、AT Ⅰ[分别为(0.89±0.21)、(0.52±0.14)μg/L]、ATⅡ[分别为(177.68±89.46)、(89.25±12.84)]ng/L、Ald[分别为(72.06±11.47)、(48.92±8.65)ng/L]和PTH[(306.81±69.37)、(248.76±134.62)ng/L]水平均明显升高(P均＜0.01);(3)治疗组CVVH治疗后与治疗前比较,血浆RA[分别为(0.76±0.17)、(1.10±0.25)μg/(L·h)]、AT Ⅰ[分别为(0.50±0.12)、(0.89±0.21)μg/L]、ATⅡ[分别为(87.13±14.22)、(177.68±89.46)ng/L]、Ald[分别为(46.01±9.86)、(72.06±11.47)ng/L]和PTH(186.53±32.93)、(306.81±69.37)ng/L]水平均明显下降(P均＜0.01);而对照组常规血液透析治疗前后上述指标无明显变化(P均＞0.05).结论 CVVH不失为治疗血液透析伴发顽固性高血压的一种有效方法,其降压效果可能与CVVH能有效清除患者体内多余水分以及降低血浆RA、AT Ⅰ、ATⅡ、Ald、PTH水平有关.
목적 탐토련속성정맥-정맥혈액려과(CVVH)치료혈액투석환자반발완고성고혈압적단기림상료효급기가능적궤제.방법 선택2005년이래재아원진행혈액투석반발완고성고혈압환자34례작위치료조,경과2～3차、매차8～10 h적CVVH치료,관찰기강압효과화치료전후간체중、혈장갑상방선격소(PTH)、신소(RA)급혈관긴장소Ⅰ、Ⅱ(AT Ⅰ、ATⅡ)화철고동(Ald)수평적변화.령외선택동기혈압공제량호적혈액투석환자30례작위대조조.결과 (1)치료조소유환자경과2～3차적CVVH치료,혈압균교치료전유명현하강,현효솔64.7%,유효솔100.0%;(2)치료조치료전여대조조비교,혈장RA[분별위(1.10±0.25)、(0.78±0.26)μg(L·h)]、AT Ⅰ[분별위(0.89±0.21)、(0.52±0.14)μg/L]、ATⅡ[분별위(177.68±89.46)、(89.25±12.84)]ng/L、Ald[분별위(72.06±11.47)、(48.92±8.65)ng/L]화PTH[(306.81±69.37)、(248.76±134.62)ng/L]수평균명현승고(P균＜0.01);(3)치료조CVVH치료후여치료전비교,혈장RA[분별위(0.76±0.17)、(1.10±0.25)μg/(L·h)]、AT Ⅰ[분별위(0.50±0.12)、(0.89±0.21)μg/L]、ATⅡ[분별위(87.13±14.22)、(177.68±89.46)ng/L]、Ald[분별위(46.01±9.86)、(72.06±11.47)ng/L]화PTH(186.53±32.93)、(306.81±69.37)ng/L]수평균명현하강(P균＜0.01);이대조조상규혈액투석치료전후상술지표무명현변화(P균＞0.05).결론 CVVH불실위치료혈액투석반발완고성고혈압적일충유효방법,기강압효과가능여CVVH능유효청제환자체내다여수분이급강저혈장RA、AT Ⅰ、ATⅡ、Ald、PTH수평유관.
Objective To study the short-term clinical efficacy and its possible mechanism of refractory hypertension(RH) treated by continuous veno-venous hemofiltration (CVVH) in maintenance hemodialysis (MHD) patients. Methods Thirty-four MHD patients with RH treated with CVVH enrolled in the treatment group,all these patients were treatment of 2 -3 times,each time 8 - 10 hours. Thirty MHD patients with wellcontroled blood pressure were recruited as control. Changes of blood pressure, dry weight, plasma levels of parathyroid hormone (PTH), renin ( RA), angiotensin Ⅰ , Ⅱ ( AT Ⅰ , AT Ⅱ ), aldosterone ( Ald ) were observed before and after hemodialysis. Results In the treatment group,compared with pre-treatment, the blood pressure decreased significantly with an effective rate of 64.7% and efficient rate of 100. 0%. Before treatment, plasma RA was ([1.10 ±0.25] μg/(L · h)and [0:78 ±0.26] μg/(L · h),AT Ⅰ was [0.89 ±0.21] μg/L and [ 0. 52 ± 0. 14 ] μg/L, AT Ⅱ was [ 177.68 ± 89.46 ] ng/L and [ 89. 25 ± 12. 84 ] ng/L, Ald was [72. 06 ± 11.47 ]ng/L and [ 48.92 ± 8. 65 ] ng/L, PTH was [ 306. 81 ± 69. 37 ] ng/L and [ 248.76 ± 134. 62 ] ng/L in the treatment and control group respectively. All the measurements in the treatment group were significantly higher than those in the control group (P ＜ 0. 05 ). In the treatment group, compared to pre-treatment, plasma RA significantly decreased ( [ 1.10 ± 0. 25 ]μg/ ( L · h) vs [ 0. 76 ± 0. 17 ] μg/( L · h ), as well as AT Ⅰ ( [ 0. 89 ±0.21]μg/L vs [0.50 ±0.12] μg/L),ATⅡ([177.68±89.46]ng/L vs [ 87.13±14.22] ng/L),Ald ([72.06±11.47]ng/Lvs [ 46. 01± 9. 86 ] ng/L ) and PTH ( [ 306. 81 ±69.37]ng/L vs [ 186.53 ±32.93 ] ng/L) ( P ＜ 0. 05 ). However, there was no significant changes in the above mentioned measurements between before and after hemodialysis in the control group (P ＞ 0. 05). Conclusion CVVH may be an effective methods in the treatment of MHD patients with RH, and its antihypertensive mechanisms may be that CVVH can effectively remove the excess water in the body, and reduce plasma RA, AT Ⅰ , AT Ⅱ ,Ald and PTH levels.