CAJ | 학술논문

目的：观察高通量血液透析联合加巴喷丁治疗终末期肾病（ES RD ）并发皮肤瘙痒症的有效性和安全性。方法选择ES RD并发皮肤瘙痒症的维持性血液透析患者，分为高通量血液透析联合加巴喷丁组（A组）、高通量血液透析联合盐酸赛庚啶组（B组）、常规通量血液透析联合加巴喷丁组（C组）和常规通量血液透析联合盐酸赛庚啶组（D组）。所有患者均规律血液透析2～3次／周，每次透析后晚间服用加巴喷丁200 mg或每天服盐酸赛庚啶2 mg ；检测6个月前后血尿素氮（BUN）、血清肌酐（Scr）、全段甲状旁腺素（iPTH）、血钙（Ca2＋）、血磷（P）实验室指标以及根据视觉模拟评分（VAS）对其皮肤瘙痒评分，进行疗效评价，同时观察不良反应。结果皮肤瘙痒症状得到不同程度改善，睡眠明显改善，未观察到严重不良反应。检测6个月前后BUN、Scr、Ca2＋检测指标差值各组间差异无统计学意义（P＞0．05）；而A、B组P、iPTH较C、D组明显降低，差异有统计学意义（P＜0．05）；A组与其他组间的VAS差值比较，差异有统计学意义（P＜0．05）。结论高通量血液透析联合短期小剂量加巴喷丁治疗ESRD并发皮肤瘙痒症较其他治疗组效果好，进一步证实了高通量血液透析在清除中大分子物质方面的优势，其长期应用疗效有待进一步观察。
목적：관찰고통량혈액투석연합가파분정치료종말기신병（ES RD ）병발피부소양증적유효성화안전성。방법선택ES RD병발피부소양증적유지성혈액투석환자，분위고통량혈액투석연합가파분정조（A조）、고통량혈액투석연합염산새경정조（B조）、상규통량혈액투석연합가파분정조（C조）화상규통량혈액투석연합염산새경정조（D조）。소유환자균규률혈액투석2～3차／주，매차투석후만간복용가파분정200 mg혹매천복염산새경정2 mg ；검측6개월전후혈뇨소담（BUN）、혈청기항（Scr）、전단갑상방선소（iPTH）、혈개（Ca2＋）、혈린（P）실험실지표이급근거시각모의평분（VAS）대기피부소양평분，진행료효평개，동시관찰불량반응。결과피부소양증상득도불동정도개선，수면명현개선，미관찰도엄중불량반응。검측6개월전후BUN、Scr、Ca2＋검측지표차치각조간차이무통계학의의（P＞0．05）；이A、B조P、iPTH교C、D조명현강저，차이유통계학의의（P＜0．05）；A조여기타조간적VAS차치비교，차이유통계학의의（P＜0．05）。결론고통량혈액투석연합단기소제량가파분정치료ESRD병발피부소양증교기타치료조효과호，진일보증실료고통량혈액투석재청제중대분자물질방면적우세，기장기응용료효유대진일보관찰。
Objective To observe the therapy efficacy and safety of high flux hemodialysis and gabapentin on the patients with end stage renal disease (ESRD) and itchy skin disease .Methods Patients with ESRD and itchy skin disease who accepted maintenance hemodialysis were selected in this study and divided into high flux hemodialy‐sis combined gabapentin group (group A ) ,high flux hemodialysis combined cyproheptadine hydrochloride group (group B) ,conventional flux hemodialysis combined gabapentin group (group C) and conventional flux hemodialysis combined cyproheptadine hydrochloride group(group D) .All the patients with regular hemodialysis 2 or 3 times a week ,each time after dialysis taking gabapentin 200 mg at night (only one time) or cyproheptadine hydrochloride 2 mg at every day .Before and after six months ,blood urea nitrogen (BUN) ,serum creatinine (Scr) ,entire section para‐thyroid hormone (iPTH) ,calcium (Ca2+ ) ,blood phosphorus (P) were detected and the skin pruritus score were e‐valuated according to the visual analogue scale (VAS ) ,curative effect and adverse reaction were observed too . Results The skin pruritus symptom of all the patients improved obviously ,and sleep ,no serious adverse reaction was observed .The differences on the disparities of BUN、Scr、Ca2+ before and after six moths weren′t significant (P>0 .05) ,but the differences on the disparities of P ,iPTH in group A and B were significant lower than those of group C and D(P<0 .05) .The disparities of VAS score in group A was significant different with other groups (P<0 .05) . Conclusion The patients accepted high flux hemodialysis combined short‐term small doses of gabapentin had better curative effect than others ,which confirmed the advantage of high flux hemodialysis in clearing macromolecules ,long‐term effect of it remains to be explored .