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目的比较联机血液透析滤过(OL-HDF)、高通量血液透析(HF-HD)以及低通量血液透析(LF-HD)3种血液净化方式对尿毒症患者不同分子量毒素清除的效果。方法总共 25例长期常规血透患者进入本研究。所有患者分别接受上述3种方式血液净化治疗,每周3次,每次4 h,血流量230 ml/min,透析液流量500 ml/min。OL-HDF置换液为前稀释,流量150 ml／min, 平均置换液量36 L,透析液流量为700 ml／min,流经透析器透析液流量为550 ml／min。所有患者净脱水量根据病情需要约为体重的3％-5％。每1种方案治疗时间为4-6周,间隔2～3周,间隔期行常规HD治疗。测定治疗前后患者Scr、BUN及β2-MG、iPTH等水平,同时计算出其清除百分率。结果 LF-HD、HF-HD、OL-HDF治疗组Scr和BUN清除率分别为:72．4％±4．0％,70．6％±3％,71．7％±3．6％和75．1％±5％,73．0％±4%,76．2％±4％,3种治疗间的差异无统计学意义。血β2-MG及iPTH在LF-HD治疗前后无显著差异,而在HF-HD及OL-HDF组中,β2-MG治疗前后的清除率分别为32．5％±7％和44．2％±10％;iPTH清除率分别为42．7％±9．2％和54．4％± 8．8％,两组治疗前后溶质浓度及两组间清除率差异均有统计学意义(P均<0．05)。结论 3种血液净化治疗方式对小分子溶质清除效果基本相似。LF-HD对相对分子质量大于9500的中大分子β2-MG、iPTH清除效果不明显,而HF-HD及OL-HDF能有效地清除上述两种中大分子溶质,其中OL-HDF的清除率更高
Objective To compare the effects of three kinds of blood purification methods, OL-HDF, HF-HD and LF-HD, on detoxification of different molecular weight patients with uremia. Methods A total of 25 long-term conventional hemodialysis patients entered the study. All patients received the above three methods of blood purification treatment, 3 times a week, each time 4 h, blood flow 230 ml / min, dialysate flow 500 ml / min. OL-HDF replacement fluid was diluted before, flow 150 ml / min, the average replacement fluid volume 36 L, dialysate flow 700 ml / min, dialysate dialysate flow rate of 550 ml / min. All patients with net dehydration according to the needs of the disease is about 3% -5% of body weight. Each treatment schedule for a program 4-6 weeks, interval 2 to 3 weeks, interval HD routine treatment. The levels of Scr, BUN, β2-MG and iPTH in patients before and after treatment were measured, and the percentage of clearance was calculated. Results The clearance rates of Scr and BUN in the treatment group of LF-HD, HF-HD and OL-HDF were 72.4% ± 4.0%, 70.6% ± 3%, 71.7% ± 3.6% and 75.1% ± 5%, 73.0% ± 4%, 76.2% ± 4% respectively. There was no significant difference among the three treatments. Serum β2-MG and iPTH had no significant difference before and after treatment with LF-HD, but the clearance rates of β2-MG before and after treatment in HF-HD and OL-HDF groups were 32.5% ± 7% and 44.2% ± 10%; iPTH clearance rates were 42.7% ± 9.2% and 54.4% ± 8.8%, respectively. There was significant difference in solute concentration and clearance rate between the two groups before and after treatment (P <0.05). Conclusion The three methods of blood purification treatment of small molecules solute clearance effect is similar. LF-HD had no significant effect on the clearance of iPTH, but HD-HD and OL-HDF could effectively remove these two macromolecule solutes. The clearance rate of OL-HDF higher