持续低效缓慢血液透析治疗终末期糖尿病肾病临床观察
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摘要
目的观察持续低效缓慢血液透析治疗终末期糖尿病肾病的临床效果。方法选择2016年12月—2018年3月收治的终末期糖尿病肾病患者65例,根据透析方法分为观察组33例和对照组32例。对照组给予普通血液透析,观察组给予持续低效缓慢血液透析。比较2组透析前后的平均动脉压和心率变化,观察低血压发生率,并对比肾功能及血清溶质的变化情况。结果观察组低血压发生率低于对照组(P <0. 05)。透析后,观察组心率低于对照组,平均动脉压高于对照组(P <0. 05)。透析后,2组血尿素、血肌酐、β2-微球蛋白和K+均低于透析前,且观察组血尿素和β2-微球蛋白低于对照组(P <0. 05)。结论持续低效缓慢血液透析治疗终末期糖尿病肾病安全有效,可避免低血压发生。
Objective To observe clinical effect of continuous low efficiency slowing hemodialysis in treatment of patients with final-stage diabetic nephropathy. Methods A total of 65 patients with final-stage diabetic nephropathy admitted during December 2016 and March 2018 were divided into observation group( n = 33) and control group( n = 32)according to dialysis methods. Control group received routine hemodialysis,while observation group was treated with continuous low efficiency slowing dialysis. In two groups,changes of mean arterial pressure and heart rate before and after dialysis were compared,and incidence rates of hypotension were observed,and changes of renal function and serum solute were compared. Results Incidence rate of hypotension in observation group was significantly lower than that in control group( P < 0. 05). After dialysis,in observation group,heart rate was significantly lower,while value of average arterial pressure was significantly higher than those in control group( P < 0. 05). After dialysis,levels of blood urea nitrogen,serum creatinine,β2-microglobulin and K+were significantly lower than those before dialysis in two groups,and levels of blood urea nitrogen and β2-microglobulin in observation group were significantly lower than those in control group( P <0. 05). Conclusion Continuous low efficiency slowing hemodialysis is safe and effective in treatment of patients with final-stage diabetic nephropathy,and it may avoid pathogenesy of hypotension.
Objective To observe clinical effect of continuous low efficiency slowing hemodialysis in treatment of patients with final-stage diabetic nephropathy. Methods A total of 65 patients with final-stage diabetic nephropathy admitted during December 2016 and March 2018 were divided into observation group( n = 33) and control group( n = 32)according to dialysis methods. Control group received routine hemodialysis,while observation group was treated with continuous low efficiency slowing dialysis. In two groups,changes of mean arterial pressure and heart rate before and after dialysis were compared,and incidence rates of hypotension were observed,and changes of renal function and serum solute were compared. Results Incidence rate of hypotension in observation group was significantly lower than that in control group( P < 0. 05). After dialysis,in observation group,heart rate was significantly lower,while value of average arterial pressure was significantly higher than those in control group( P < 0. 05). After dialysis,levels of blood urea nitrogen,serum creatinine,β2-microglobulin and K+were significantly lower than those before dialysis in two groups,and levels of blood urea nitrogen and β2-microglobulin in observation group were significantly lower than those in control group( P <0. 05). Conclusion Continuous low efficiency slowing hemodialysis is safe and effective in treatment of patients with final-stage diabetic nephropathy,and it may avoid pathogenesy of hypotension.
引文
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[11]叶文玲,方理刚,马杰,等.长期动静脉内瘘对非糖尿病肾病血液透析患者心脏结构和功能的影响[J].中国医学科学院学报,2013,35(1):95-101.
[12]江波,王晓斐,江华,等.不同血液透析方式治疗终末期糖尿病肾病对患者心脏结构及功能的影响[J].解放军医药杂志,2016,28(6S):19-21.
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[14]Fieghen H E,Friedrich J O,Burns K E,et al. The hemodynamic tolerability and feasibility of sustained low efficiency dialysis in the management of critically ill patients with acute kidney injury[J]. BMC Nephrol,2010,11:32.
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[16]毕礼明,高峻,朱冬云,等.持续缓慢低效透析应用的研究进展[J].广东医学,2012,33(19):3015-3017.
[17]柴剑丽,吴春燕,王文娟,等.糖尿病肾病患者血液透析中低血糖管理的持续质量改进[J].中华护理杂志,2015,50(2):170-174.
[18]张艳丽,马静静,张红杰,等.不同胰岛素治疗方案在血液透析中低血糖护理观察[J].护士进修杂志,2013,28(15):1370-1371.
[19]吴震,马燕.持续低效缓慢血液透析对比普通血液透析治疗终末期糖尿病肾病疗效[J].中西医结合心血管病杂志,2017,5(19):41,44.
[20]辛克明,王建青.持续低效缓慢血液透析与普通血液透析在终末期糖尿病肾病患者中的对照研究[J].影像研究与医学应用,2017,1(5):196-198.
[21]于晓妍.低效缓慢血液透析(持续)、普通血液透析治疗糖尿病肾病患者(终末期)对照分析[J].世界最新医学信息文摘,2017,17(19):17,19.
[2]郑晓敏,杨芳远,刘翠平,等.触珠蛋白对早期糖尿病肾病患者肾功能损害的预测作用[J].首都医科大学学报,2019,40(1):53-58.
[3]宋丽妮,刘敬怡,张怡尘,等.糖尿病肾病早期诊断标志物的研究新进展[J].首都医科大学学报,2017,38(2):145-150.
[4]田瑞,周芸.三种常用公式对糖尿病肾病合并高血压患者肾小球滤过率估算的准确性比较[J].中国医药,2019,14(2):253-255.
[5]李锐钊,梁馨苓,陈源汉,等.持续低效缓慢血液透析与普通血液透析在终末期糖尿病肾病患者中的对照研究[J].实用医学杂志,2011,27(22):4005-4007.
[6]高华,刘艳,王荣.持续低效缓慢血液透析在老年终末期糖尿病肾病患者中的临床应用[J].中国老年学杂志,2013,33(17):4285-4286.
[7]刘萍,许家岭,胡小红,等.终末期糖尿病肾衰竭患者的血液透析方式的析因对比研究[J].安徽医药,2015,19(10):1925-1928.
[8]徐丹,孟宇,胡波,等.基于HPLC-MS/MSQ-TOF分析糖尿病肾病维持性血透患者含糖透析的代谢特征[J].中国病理生理杂志,2013,29(3):455-461.
[9]杨静,蒋文勇,于黔,等.高通量血液透析对糖尿病肾病维持性血液透析患者氧化应激和微炎症状态的影响[J].广东医学,2016,37(18):2784-2786.
[10]刘晓斌,王凉,刘斌,等.高通量血液透析对老年糖尿病肾病患者胰岛素抵抗及微炎症状态的影响[J].中华老年医学杂志,2014,33(2):159-162.
[11]叶文玲,方理刚,马杰,等.长期动静脉内瘘对非糖尿病肾病血液透析患者心脏结构和功能的影响[J].中国医学科学院学报,2013,35(1):95-101.
[12]江波,王晓斐,江华,等.不同血液透析方式治疗终末期糖尿病肾病对患者心脏结构及功能的影响[J].解放军医药杂志,2016,28(6S):19-21.
[13]庞新华.持续低效缓慢血液透析与普通血液透析在终末期糖尿病肾病患者中的对照研究[J].中国伤残医学,2013,21(7):40-41.
[14]Fieghen H E,Friedrich J O,Burns K E,et al. The hemodynamic tolerability and feasibility of sustained low efficiency dialysis in the management of critically ill patients with acute kidney injury[J]. BMC Nephrol,2010,11:32.
[15]孟建中,刘文渊,王素霞,等.持续缓慢低效血液透析对透析中顽固性低血压患者血液动力学的影响[J].实用医药杂志,2011,28(6):481-484.
[16]毕礼明,高峻,朱冬云,等.持续缓慢低效透析应用的研究进展[J].广东医学,2012,33(19):3015-3017.
[17]柴剑丽,吴春燕,王文娟,等.糖尿病肾病患者血液透析中低血糖管理的持续质量改进[J].中华护理杂志,2015,50(2):170-174.
[18]张艳丽,马静静,张红杰,等.不同胰岛素治疗方案在血液透析中低血糖护理观察[J].护士进修杂志,2013,28(15):1370-1371.
[19]吴震,马燕.持续低效缓慢血液透析对比普通血液透析治疗终末期糖尿病肾病疗效[J].中西医结合心血管病杂志,2017,5(19):41,44.
[20]辛克明,王建青.持续低效缓慢血液透析与普通血液透析在终末期糖尿病肾病患者中的对照研究[J].影像研究与医学应用,2017,1(5):196-198.
[21]于晓妍.低效缓慢血液透析(持续)、普通血液透析治疗糖尿病肾病患者(终末期)对照分析[J].世界最新医学信息文摘,2017,17(19):17,19.