论文部分内容阅读
目的探讨尿毒症患者应用聚甲基丙烯酸甲酯(polymethylmethacrylate,PMMA)膜透析器、二醋酸膜透析器行血液透析治疗对肺功能的影响。方法 40例尿毒症患者随机分为PMMA膜组和二醋酸膜组各20例,均根据患者情况给予控制血压,纠正贫血、酸中毒、钙磷代谢异常等综合治疗,并分别应用PMMA膜和二醋酸膜透析器行维持性血液透析,每周3次,每次4~5h。测定2组透析前及透析6个月后用力肺活量(forced vital capacity,FVC)、1s用力呼气容积(forced expiratory volume in one second,FEV1)、最大呼气流速(peak expiratory flow,PEF)、用力呼出50%肺活量的呼气流量(forced expiratory flow at 50%of FVC exhaled,FEF50)、用力呼出75%肺活量的呼气流量(forced expiratory flow at 75%of FVC exhaled,FEF75)、肺一氧化碳弥散量(diffusing capacity of the lung for carbon monoxide,DLco),比较2组尿素清除指数(Kt/V)、时间平均尿素浓度(time-average concentration of urea,TACurea)。结果 PMMA膜组和二醋酸膜组血液透析6个月后FVC[(88.65±13.41)%、(86.71±14.52)%]、FEV1[(85.37±11.36)%、(86.43±12.42)%]、PEF[(82.63±15.37)%、(85.52±16.55)%]、FEF50[(80.21±17.28)%、(79.67±18.43)%]、FEF75[(80.65±16.61)%、(76.38±15.85)%]、DLco[(92.58±19.39)%、(82.15±20.05)%]均显著高于透析前[(72.13±15.25)%、(73.20±14.13)%;(74.38±13.64)%、(71.44±15.25)%;(72.21±14.31)%、(73.14±15.21)%;(67.42±15.13)%、(68.56±16.01)%;(62.31±14.47)%、(60.35±13.07)%;(74.35±15.28)%、(68.40±16.34)%](P<0.05);血液透析6个月后,PMMA膜组DLco高于二醋酸膜组(P<0.05),FVC、FEV1、PEF、FEF50、FEF75与二醋酸膜组比较差异均无统计学意义(P>0.05)。Kt/V(1.47±0.29)、TACurea[(16.57±2.37)mmol/L]与二醋酸膜组[1.38±0.23,(15.62±2.21)mmol/L]比较差异均无统计学意义(P>0.05)。结论尿毒症患者血液透析治疗应用PMMA膜、二醋酸膜透析器均可改善肺功能,应用PMMA膜透析器较二醋酸膜透析器有助于肺弥散功能的改善。
Objective To investigate the effect of hemodialysis on pulmonary function in patients with uremia using polymethylmethacrylate (PMMA) dialyzer and diacetate dialyzer. Methods 40 patients with uremia were randomly divided into PMMA membrane group and diacetate membrane group, 20 patients were given according to the patient’s condition to control blood pressure, correct anemia, acidosis, calcium and phosphorus metabolism and other comprehensive treatment, and respectively PMMA membrane and two Acetate dialyzer line maintenance hemodialysis, 3 times a week, each 4 ~ 5h. The forced vital capacity (FVC), forced expiratory volume in one second (FEV1) and peak expiratory flow (PEF) were measured in two groups before dialysis and six months after dialysis. Forced expiratory flow at 50% of FVC exhaled (FEF50), forced expiratory flow at 75% of FVC exhaled (FEF75), diffuse volume of lung carbon monoxide diffusing capacity of the lung for carbon monoxide (DLco). The two groups of urea clearance index (Kt / V) and time-average concentration of urea (TACurea) were compared. Results FVC [(88.65 ± 13.41)%, (86.71 ± 14.52)%], FEV1 [(85.37 ± 11.36)%, (86.43 ± 12.42)%], PEF (82.63 ± 15.37)%, (85.52 ± 16.55)%], FEF50 [(80.21 ± 17.28)%, (79.67 ± 18.43)%], FEF75 [(80.65 ± 16.61)%, (76.38 ± 15.85)%] DLco was 92.58 ± 19.39% and 82.15 ± 20.05%, respectively, which were significantly higher than those before dialysis (72.13 ± 15.25%, 73.20 ± 14.13%, 74.38 ± 13.64%, 71.44 ± 15.25% ; (72.21 ± 14.31)%, (73.14 ± 15.21)%; (67.42 ± 15.13)%, (68.56 ± 16.01)%; (62.31 ± 14.47)%, (60.35 ± 13.07)%; (68.40 ± 16.34)%] (P <0.05). After 6 months of hemodialysis, DLco of PMMA membrane group was higher than that of diacetate membrane group, FVC, FEV1, PEF, FEF50 and FEF75 There was no significant difference between the two groups (P> 0.05). There was no significant difference in Kt / V (1.47 ± 0.29), TACurea [(16.57 ± 2.37) mmol / L] and diacetate group [1.38 ± 0.23, (15.62 ± 2.21) mmol / L] ). Conclusion Hemodialysis treatment of patients with uremia using PMMA membrane, diacetate dialyzer can improve lung function, the use of PMMA dialyzer diacetate dialyzer membrane contribute to the improvement of pulmonary function.