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目的观察应用低钙透析联合口服碳酸钙对血液透析患者(HD)高磷血症的治疗及对血钙、血磷、甲状旁腺激素(iPTH)水平的影响和副反应。方法选择2010年10月至2011年12月于我院血透中心治疗的HD患者34例,随机分成AB两组,A组常规透析组17例,B组低钙透析组(透析液Ca离子浓度为1.25mmol/L联合口服碳酸钙1.5g/d)17例。所有患者均透析4个月,观察血钙、血磷、血iPTH水平的变化。所有入选患者治疗前、治疗后每个月测血钙、血磷、血iPTH水平的变化。结果常规透析组透析4个月后,患者血钙水平无明显变化,血磷无明显下降趋势(P>0.05),iPTH亦无明显升高(P>0.05)。低钙透析组透析4个月后,患者血钙水平无明显下降趋势(P>0.05),血磷呈下降趋势(P<0.05),iPTH呈上升趋势(P<0.05)。低钙透析组不良反应发生率为4/34(11.76%),主要为肌痉挛和低血压。结论对合并高磷血症的血透患者(iPTH<300ng/L)阶段性采用低钙透析联合口服碳酸钙的方法可以降低血磷,能维持比较正常的血钙血磷浓度,值得临床推广使用。
Objective To observe the effects of low calcium dialysis combined with oral calcium carbonate on hyperphosphatemia in hemodialysis patients (HD) and on the levels of serum calcium, phosphorus, and parathyroid hormone (iPTH) and side effects. Methods From October 2010 to December 2011 in our hospital hemodialysis treatment of HD patients 34 cases were randomly divided into AB two groups, A group of 17 cases of conventional dialysis group, B group of low-calcium dialysis group (dialysate Ca ion concentration 1.25mmol / L combined oral calcium carbonate 1.5g / d) in 17 cases. All patients were dialyzed for 4 months to observe the changes of blood calcium, phosphorus and blood iPTH levels. All selected patients before treatment, monthly measurement of blood calcium, phosphorus, blood iPTH levels change. Results After dialysis for 4 months in dialysis group, there was no significant change in serum calcium level, no significant decrease in serum phosphorus level (P> 0.05) and no significant increase in iPTH (P> 0.05). After 4 months of dialysis in low-calcium dialysis group, there was no significant decrease in serum calcium level (P> 0.05). The levels of serum phosphorus decreased (P <0.05) and iPTH increased (P <0.05). The incidence of adverse reactions in low-calcium dialysis group was 4/34 (11.76%), mainly muscle spasms and hypotension. Conclusions The hypocalcemic dialysis combined with oral calcium carbonate can reduce blood phosphorus and maintain the normal concentration of blood calcein in patients with hyperphosphatemia (iPTH <300ng / L), which is worthy of clinical promotion .