李学旺 李明喜 刘彤 李莉 段琳 李艳 郭莉 杨桂琴 100730 中国医学科学院、中国协和医科大学、北京协和医院肾内科 中华肾脏病杂志 1998 0 14 1


    关键词：透析机自产回输液；血液滤过；血液透析滤过 期刊 zhszbzz 0 论著 fur -->


    

目的 评价透析机自产回输液(on-line)行血液滤过(HF)及血液透析滤过(HDF)对尿毒症患者不同分子量物质的清除及治疗的安全性、心血管稳定性。方法 40例患者随机分为前稀释HF、前稀释HDF、后稀释HDF及HD四组。观察KT/V及血清肌酐(Cr)、β₂ 微球蛋白(β₂ -m)、甲状旁腺激素(PTH)、α₁ 微球蛋白(α₁ -m)下降率，评价治疗中低血压及发热反应发生率。结果 与HD相比，HF或HDF治疗中发热反应发生率没有增加；HF及前稀释HDF的超滤量(UFV)明显高于HD，但低血压的发生率并未增加；HF或HDF治疗后血清Cr、β₂ -m、PTH水平显著降低；后稀释HDF的KT/V及Cr下降率均明显高于 HD、前稀释HF及HDF，而前稀释HDF的KT/V明显高于HD及HF。结论 on-line HF及HDF治疗安全可靠，能有效地清除PTH及β₂ -m。后稀释HDF对小分子物质的清除及治疗中的KT/V均较理想，而HF及前稀释HDF更适用于HD中易出现低血压的血透患者，其长期疗效还有待进一步观察。

Hemofiltration or hemodiafiltration with on-line production of substitution fluid:clinical observation of safety and effectiveness

Li Xuewang, Li Mingxi, Liu Tong, et al. Division of Nephrology, Peking Union Medical College Hospital, Beijing 100730

Objective To evaluate the safety and cardiovascular stability of on-line HF or HDF. Methods 40 patients were randomly divided into four groups:group predilutional(PRD) HF,group predilutional HDF, group postdilutional(POD)HDF and group HD.The reduction rate of PTH, β ₂ -m, α ₁ -m and KT/V in the initial treatment of every month was observed, and the incidence of hypotension during each treatment was evaluated. Results The KT/V for group POD HDF was better than that for other three groups, and for group PRD HDF was better than that for group HF and HD. Significant removal of PTH and β ₂ -m was observed in group HF, PRD HDF and POD HDF. Although the UFV was significantly higher during HF or PRD HDF than during HD, the incidence of hypotension in HF or PRD HDF was similar to that in HD. Conclusion On-line HF or HDF is proved to be a safe and reliable method. POD HDF mode seems to have the best KT/V and HF or PRD HDF offers a better choice for preventing intradialytic hypotension.

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