CAJ | 학술논문

目的了解高通量透析对维持性血液透析患者实验室检查指标及生活质量的影响.方法选取32例维持性血液透析患者,将每2周1次血液透析滤过、1次血液灌流,其余时间进行低通量透析的模改为每周3次高通量透析,进行为期6个月的观察.前3个月使用旭化成13u透析器,后3个月使用旭化成15u透析器,分别在使用前和使用后3个月、6个月监测患者血压、血红蛋白、血白蛋白、前白蛋白、钙、磷、维生素D、全片段甲状旁腺激素、β2-微球蛋白、总胆固醇、甘油三酯、高密度脂蛋白、低密度脂蛋白、脂蛋白a水平的变化,同时应用简明健康测量量表、匹兹堡睡眠量表、食欲量表调查评价患者的生活质量.结果 (1)患者收缩压、舒张压均显著下降(P＜0.05),换用15u透析器治疗3个月后,收缩压、舒张压继续下降(P＜0.05).(2)治疗3个月后患者血红蛋白、白蛋白、前白蛋白、β2-微球蛋白及超敏C反应蛋白未见明显变化,换用15u透析器治疗3个月后,白蛋白及前白蛋白显著上升,β2-微球蛋白显著下降(P＜0.05).(3)治疗3个月后患者钙、磷、全段甲状旁腺素及维生素D均无明显变化;换用15u透析器治疗3个月后,维生素D显著下降(P＜0.05),部分患者骨痛改善.(4)治疗3个月后患者血清低密度脂蛋白显著下降(P＜0.05),其余指标无明显变化;换用15u透析器治疗3个月后,患者血清低密度脂蛋白继续下降(P＜0.05),血清高密度脂蛋白水平升高,载脂蛋白A(I)水平下降(P＜0.05).(5)治疗6个月后,患者总体生活质量变化不显著,食欲和睡眠状况有改善趋势,但差别未见统计学意义.结论规律高通量透析对临床及实验室检查指标的改善作用明显优于每周或每2周1次血液透析滤过,其余时间进行低通量透析的组合模式,特别是在血压控制、营养状态的改善及脂代谢指标等方面.
목적 료해고통량투석대유지성혈액투석환자실험실검사지표급생활질량적영향.방법 선취32례유지성혈액투석환자,장매2주1차혈액투석려과、1차혈액관류,기여시간진행저통량투석적모개위매주3차고통량투석,진행위기6개월적관찰.전3개월사용욱화성13u투석기,후3개월사용욱화성15u투석기,분별재사용전화사용후3개월、6개월감측환자혈압、혈홍단백、혈백단백、전백단백、개、린、유생소D、전편단갑상방선격소、β2-미구단백、총담고순、감유삼지、고밀도지단백、저밀도지단백、지단백a수평적변화,동시응용간명건강측량량표、필자보수면량표、식욕량표조사평개환자적생활질량.결과 (1)환자수축압、서장압균현저하강(P＜0.05),환용15u투석기치료3개월후,수축압、서장압계속하강(P＜0.05).(2)치료3개월후환자혈홍단백、백단백、전백단백、β2-미구단백급초민C반응단백미견명현변화,환용15u투석기치료3개월후,백단백급전백단백현저상승,β2-미구단백현저하강(P＜0.05).(3)치료3개월후환자개、린、전단갑상방선소급유생소D균무명현변화;환용15u투석기치료3개월후,유생소D현저하강(P＜0.05),부분환자골통개선.(4)치료3개월후환자혈청저밀도지단백현저하강(P＜0.05),기여지표무명현변화;환용15u투석기치료3개월후,환자혈청저밀도지단백계속하강(P＜0.05),혈청고밀도지단백수평승고,재지단백A(I)수평하강(P＜0.05).(5)치료6개월후,환자총체생활질량변화불현저,식욕화수면상황유개선추세,단차별미견통계학의의.결론 규률고통량투석대림상급실험실검사지표적개선작용명현우우매주혹매2주1차혈액투석려과,기여시간진행저통량투석적조합모식,특별시재혈압공제、영양상태적개선급지대사지표등방면.
Objectives To evaluate the influence of high-flux hemodialysis to the result of laboratory examination and quality of life.Methods Thirty-two patients of maintenance hemodialysis who received hemodiafiltration and hemoperfusion every other week with low-flux hemodialysis in other time were converted to regular high -flux hemodialysis three times a week.The observation were continued for six months,in the first three months of which Asahi 13u dialyzer were used and Asahi 15u dialyzer were used in the remaining three months.Blood pressure,hemoglobin,albumin,prealbumin,calcium,phosphorus,vitamine D,intact parathyroid hormone,β2-microglobulin,cholesterol,triglyceride,high-density lipoprotein,low-density lipoprotein,apolipoprotein-A(1)and B2 were evaluated in every changing point.Meanwhile,short form 36 health survey questionnaire,Pittsburgh sleep quality index and appetide questionnaire were used to evaluate the life quality of the patients.Results(1)Systolic pressure and diastolic pressure were significantly declined(P ＜ 0.05)in the first three months.After three months use of 15u dialyzer,blood pressure still decline(P ＜0.05).(2)Hemoglobin,albumin,prealbumin,β2-microglobulin and hypersensitive C-reactive protein did not change in the first three months.After three months use of 15u dialyzer,albumin and prealbumin increased,while β2-microglobulin decreased significantly(P ＜0.05).(3)Calcium,phosphorus,vitamine D and intact parathyroid hormone did not change in the first three months.After three months use of 15u dialyzer,vitamine D declined significantly(P ＜ 0.05).Bone pain of some patients lessened.(4)Low-density lipoprotein declined significantly in the first three months(P ＜ 0.05).After three months use of 15u dialyzer,low-density lipoprotein continued to decline(P ＜ 0.05),while high-density lipoprotein and apolipoprotein A1 declined significantly(P ＜ 0.05).(5)Significant change of life quality did not occur during the observation.Appetite and quality of sleep intended to get better,but statistically significant change can not be detected.Conclusions After three months use of Asahi 13u high-flux dialyzer,systolic presaure,diastolic pressure and low-density lipoprotein declined significantly.After three months use of Asahi 15u high-flux dialyzer,systolic pressure,diastolic pressure and low-density lipoprotein continued to decline.Albumin,prealbumin and high density lipoprotein increased,while β2-microglobulin,apolipoprotein A1 and vitamine D declined significantly.