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目的探讨序贯性血液净化治疗对维持性血液透析(MHD)患者清晨高血压(MH)的治疗效果。方法选取天津市第一中心医院血液净化中心2016年1-6月MHD伴MH患者60例为研究对象,随机分为序贯性血液净化组和对照组,各30例。序贯性血液净化组以两周为1个治疗周期,即第1周行常规血液透析(HD)治疗2次,在线血液透析滤过(HDF)治疗1次;第2周行常规血液透析(HD)治疗2次,血液透析(HD)+血液灌流(HP)1次。对照组进行常规血液透析治疗。两组每次治疗时间均为4 h,持续12周。两组患者于干预前、干预4周、干预8周和干预12周记录家庭自测清晨血压水平,采用透析症状调查量表(DSI)进行调查,比较症状困扰得分。于干预前、干预12周检测血浆肾素(RA)、血浆血管紧张素(ATⅡ)、醛固酮(Ald)、甲状旁腺素(i-PTH)、β2微球蛋白(β2-MG)、血磷、血钙水平,并计算钙磷乘积值。采用SPSS 20.0软件进行分析,计量资料的比较用t检验,计数资料的比较用χ~2检验。结果干预前,两组患者清晨血压水平比较,差异无统计学意义(P>0.05)。干预4、8、12周,序贯性血液净化组清晨收缩压、舒张压、平均动脉压及症状困扰得分均低于对照组,差异均有统计学意义(P<0.05)。干预12周,序贯性血液净化组RA、ATⅡ、AId、i-PTH、β2-MG、血磷和钙磷乘积均低于干预前,差异均有统计学意义(P<0.05)。结论序贯性血液净化治疗能够有效地控制透析患者清晨高血压和改善患者透析症状。
Objective To investigate the effect of sequential blood purification on early morning hypertension (MH) in patients with maintenance hemodialysis (MHD). Methods Totally 60 patients with MHD with MH in January 2016 in Tianjin Central Blood Purification Center were enrolled, and randomly divided into sequential blood purification group and control group, with 30 cases in each group. The patients in the sequential blood purification group were treated with two cycles of one treatment cycle, ie, the first two weeks of conventional hemodialysis (HD) treatment and the one of on-line hemodialysis (HDF) treatment. The second week of conventional hemodialysis HD) twice a day, hemodialysis (HD) + hemoperfusion (HP) once. Control group for routine hemodialysis treatment. Each treatment time for both groups was 4 h for 12 weeks. Two groups of patients before intervention, intervention for 4 weeks, intervention for 8 weeks and intervention for 12 weeks record home-based early morning blood pressure levels, dialysis Symptom Inventory (DSI) were investigated to compare the symptoms of distress scores. Before intervention, the levels of plasma renin (RA), plasma angiotensin (ATⅡ), aldosterone (Ald), parathyroid hormone (PTH), β2-microglobulin , Blood calcium levels, and calculate the value of calcium and phosphorus products. SPSS 20.0 software was used to analyze the comparison of measurement data using t test, count data comparison with χ ~ 2 test. Results Before intervention, there was no significant difference in morning blood pressure between the two groups (P> 0.05). At 4, 8, and 12 weeks after intervention, systolic blood pressure, diastolic blood pressure, mean arterial pressure and symptom distress scores of sequential blood purification group were lower than those of the control group at the 4th, 8th and 12th week respectively. The differences were statistically significant (P <0.05). After intervention for 12 weeks, the products of RA, ATⅡ, AId, i-PTH, β2-MG, serum phosphorus and calcium-phosphorus in sequential blood purification group were all lower than those before intervention, the differences were statistically significant (P <0.05). Conclusions Sequential blood purification treatment can effectively control early morning hypertension in dialysis patients and improve dialysis symptoms in patients.