中通量透析與低通量透析對(duì)透析充分性的評(píng)估觀察

仝旭珍沈萬生+周紅+吳敏+包雅各+占永標(biāo)+葛永亮+胡惠莉

[摘要] 目的 通過觀察中通量血液透析與低通量血液透析對(duì)慢性腎衰竭維持性透析患者尿素清除率（URR）及Kt/v值的變化，有效評(píng)估患者透析充分性。 方法 選取2012年3月～2016年3月維持性血液透析患者164例，觀察組（n=114）：中通量透析組（B-16P聚砜膜），對(duì)照組（n=50）：低通量透析組（F7HPS聚砜膜），每周血液透析3次，每次4 h，療程1年，隨訪6個(gè)月。監(jiān)測患者每季度單次透析前后的腎功能變化，監(jiān)測URR、Kt/v值，觀察中通量透析與低通量透析方式對(duì)患者尿素氮、尿酸、肌酐清除效果。 結(jié)果 兩組透析前尿素氮、尿酸、尿素氮、肌酐數(shù)值比較差異無統(tǒng)計(jì)學(xué)意義（P>0.05），透析后兩組尿素氮、尿酸、肌酐值及尿素清除率URR、尿素氮Kt/v比較，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。 結(jié)論 在血液透析頻次相同、成本相同的前提下，中通量血液透析對(duì)尿素、肌酐等小分子毒素清除效果優(yōu)于低通量透析，透析充分性更佳，患者受益更多。

[關(guān)鍵詞] 血液透析；小分子毒素；透析充分性；尿素清除率

[中圖分類號(hào)] R692.5 [文獻(xiàn)標(biāo)識(shí)碼] B [文章編號(hào)] 1673-9701（2017）34-0098-03

Evaluation of dialysis sufficiency by medium flux dialysis and low flux dialysis

TONG Xuzhen SHEN Wansheng ZHOU Hong WU Min BAO Yage ZHAN Yongbiao GE Yongliang HU Huili

Department of Nephrology， Zhejiang Xiaoshan Hospital， Hangzhou 311200， China

[Abstract] Objective To effectively evaluate the sufficiency of dialysis in patients by observing the effect of medium-flux hemodialysis and low-flux hemodialysis on the changes of URR and Kt/v in chronic renal failure patients with maintenance dialysis. Methods A total of 164 patients with maintenance hemodialysis from March 2012 to March 2016 were enrolled in this study. The observation group（n=114）： medium flux dialysis group（B-16P polysulfone membrane）. The control group（n=50）： low-flux dialysis group（F7HPS polysulfone membrane）. Hemodialysis was performed three times a week for 4 hours each time. The course of treatment was 1 year， and the patients were followed up for 6 months. The changes of renal function in patients before and after single dialysis in each quarter， URR and Kt/v were monitored. The effects of medium and low-flux dialysis on urea nitrogen， uric acid and creatinine clearance were observed. Results There was no significant difference in the values of urea nitrogen， uric acid， urea nitrogen and creatinine before dialysis between medium dialysis group and low-flux dialysis group （P>0.05）. After dialysis， there were significant differences in the levels of urea nitrogen， uric acid， creatinine， urea clearance rate URR and urea nitrogen Kt/v between the two groups（P<0.05）. Conclusion Under the premise of the same hemodialysis frequency and the same cost， the removal effect of small molecule toxins including medium flux hemodialysis on urea， creatinine is better than that of the low-flux dialysis. And the medium flux hemodialysis has better dialysis sufficiency， from which patients benefit more.

[Key words] Hemodialysis； Small molecule toxin； Dialysis sufficiency； Urea clearance rateendprint