连续肾替代与血液透析治疗2型糖尿病并重症肾衰竭疗效及安全性分析
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摘要
目的探讨连续肾替代与血液透析治疗2型糖尿病并重症肾衰竭的疗效及安全性。方法收集我院2015年1月-2017年3月期间收治的64例行血液透析的2型糖尿病并重症肾衰竭患者作为研究对象,根据随机数字表法将64例患者分为对照组和研究组,各32例,研究组患者给予持续肾替代(CRRT)治疗,对照组患者给予普通血液透析(HD)治疗。观察并记录两组患者治疗3个月后血糖、肾功能、不良反应及治疗1年后临床总有效率和存活率。结果 (1)研究组临床总有效率(62.50%)和存活率(75.00%)均明显高于对照组,差异有统计学意义(P<0.05);(2)两组患者治疗后FGB、2h PG、Hb A1c水平较治疗前均明显改善(P<0.05),且研究组患者治疗后血糖抑制程度优于对照组,存在明显差异(P<0.05);(3)两组患者治疗后Scr、BUN水平均较治疗前明显降低(P<0.05),且研究组患者降低更明显(P<0.05);(4)观察组不良反应发生率(43.75%)明显低于对照组(71.88%),具有统计学差异(P<0.05)。结论连续肾替代治疗2型糖尿病并重症肾衰竭患者可显著提高治疗效果和生存率,改善临床指标和肾功能。
Objective To investigate the clinical efficacy and safety of continuous renal replacement and hemodialysis in the treatment of type 2 diabetes mellitus complicated with severe renal failure. Methods Sixty-four patients with type 2 diabetes mellitus and severe renal failure who were treated with hemodialysis between January 2015 and March 2017 were collected,who were equally divided into the control group and study group using the random number table method. Patients in the study group were treated with CRRT,while those in the control group were treated with general hemodialysis( HD). Blood glucose,renal function and adverse reactions were observed in the two groups after three months of treatment,and total effective rate and survival rate were recorded after one year of treatment. Results( 1) The total effective rate( 62.50%) and survival rate( 75.00%) in the study group were significantly higher than those in the control group, and the difference was statistically significant( P<0.05).( 2) The levels of FGB,2 h PG,and Hb A1 c in both groups were significantly improved after treatment( P<0.05),blood glucose inhibition of the study group was better than that of the control group after treatment,and there was significant difference( P<0.05).( 3) The levels of Scr and BUN in the two groups were significantly lower after treatment( P<0.05),especially in the study group( P<0.05).( 4) The incidence of adverse reactions in the observation group( 43.75%) was significantly lower than that in the control group( 71.88%),with statistically significant difference( P< 0.05). Conclusion Continuous renal replacement therapy for type 2 diabetes and severe renal failure patients can significantly enhance the therapeutic effect and survival rate while improving clinical indicators and renal function.
Objective To investigate the clinical efficacy and safety of continuous renal replacement and hemodialysis in the treatment of type 2 diabetes mellitus complicated with severe renal failure. Methods Sixty-four patients with type 2 diabetes mellitus and severe renal failure who were treated with hemodialysis between January 2015 and March 2017 were collected,who were equally divided into the control group and study group using the random number table method. Patients in the study group were treated with CRRT,while those in the control group were treated with general hemodialysis( HD). Blood glucose,renal function and adverse reactions were observed in the two groups after three months of treatment,and total effective rate and survival rate were recorded after one year of treatment. Results( 1) The total effective rate( 62.50%) and survival rate( 75.00%) in the study group were significantly higher than those in the control group, and the difference was statistically significant( P<0.05).( 2) The levels of FGB,2 h PG,and Hb A1 c in both groups were significantly improved after treatment( P<0.05),blood glucose inhibition of the study group was better than that of the control group after treatment,and there was significant difference( P<0.05).( 3) The levels of Scr and BUN in the two groups were significantly lower after treatment( P<0.05),especially in the study group( P<0.05).( 4) The incidence of adverse reactions in the observation group( 43.75%) was significantly lower than that in the control group( 71.88%),with statistically significant difference( P< 0.05). Conclusion Continuous renal replacement therapy for type 2 diabetes and severe renal failure patients can significantly enhance the therapeutic effect and survival rate while improving clinical indicators and renal function.
引文
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[11]张占岭,赵芳芳,蔡晓丹.连续肾脏替代疗法感染的危险因素及护理管理对策研究[J].中国全科医学,2017,20(s1):190.
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[14]蔡成.新生儿急性肾衰竭的连续性肾脏替代治疗[J].中华实用儿科临床杂志,2017,32(2):84.
[15]王满琴,宋磊,杨尚凌,等.高通量血液透析联合左卡尼汀治疗慢性肾衰竭合并神经病变疗效及安全性分析[J].临床军医杂志,2017,45(10):1087.
[16]孔亚玲,周刚,陈蕊.老年慢性肾衰竭患者持续性血液透析治疗的临床疗效分析[J].川北医学院学报,2016,31(5):681.
[17]RONCO C,TETTA C,MARIANO F,et al.Interpreting the mechanisms of continuous renal replacement therapy in sepsis:the peak concentration hypothesis[J].Artif Organs,2015,27(9):792.
[18]曹蕾,汪蓉,邓春艳,等.重症急性肾衰竭患者连续性肾脏替代治疗的效果观察及护理[J].检验医学与临床,2015,18(6):855.
[2]左建娇.血液透析患者应用低分子肝素导致肺出血原因分析[J].解放军医药杂志,2015,27(6):76.
[3]王慧卿,王桂英,尉杰忠.2型糖尿病肾病危险因素的临床分析[J].山西医药杂志,2017,46(1):50.
[4]陶静,季大玺.糖尿病肾病患者的血液透析治疗[J].临床内科杂志,2015,12(9):521.
[5]李领香,胡建军,过嘉明,等.护理程序对尿毒症血液透析患者净化效果及生活质量的影响分析[J].解放军预防医学杂志,2016,6(s1):250.
[6]杨春琴,翁明祥,黄敏.糖尿病肾病维持性血液透析患者20例死亡原因及相关因素分析[J].中国中西医结合肾病杂志,2015,16(1):67.
[8]SPLENDIANI G,ZAZZARO D,DI P P,et al.Continuous renal replacement therapy and charcoal plasma perfusion in treatment of amanita mushroom poisoning[J].Artif Organs,2015,24(4):305.
[9]姜文芝,张九峰.维持性血液透析致低转运性肾性骨病的诊疗进展[J].临床误诊误治,2016,29(7):113.
[10]姚向飞,韦巧宁.不同透析方式对慢性肾功能衰竭患者血清叶酸和维生素B_(12)水平的影响[J].临床误诊误治,2017,30(5):75.
[11]张占岭,赵芳芳,蔡晓丹.连续肾脏替代疗法感染的危险因素及护理管理对策研究[J].中国全科医学,2017,20(s1):190.
[12]陈大鹏,李文歌.连续性肾脏替代治疗临床应用的时机[J].临床内科杂志,2017,34(4):221.
[13]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.
[14]蔡成.新生儿急性肾衰竭的连续性肾脏替代治疗[J].中华实用儿科临床杂志,2017,32(2):84.
[15]王满琴,宋磊,杨尚凌,等.高通量血液透析联合左卡尼汀治疗慢性肾衰竭合并神经病变疗效及安全性分析[J].临床军医杂志,2017,45(10):1087.
[16]孔亚玲,周刚,陈蕊.老年慢性肾衰竭患者持续性血液透析治疗的临床疗效分析[J].川北医学院学报,2016,31(5):681.
[17]RONCO C,TETTA C,MARIANO F,et al.Interpreting the mechanisms of continuous renal replacement therapy in sepsis:the peak concentration hypothesis[J].Artif Organs,2015,27(9):792.
[18]曹蕾,汪蓉,邓春艳,等.重症急性肾衰竭患者连续性肾脏替代治疗的效果观察及护理[J].检验医学与临床,2015,18(6):855.