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目的探讨三种不同的钙离子浓度透析液对维持性血液透析患者血钙、血磷、甲状旁腺素(iPTH)的影响及不良反应,为临床上选择不同的钙离子浓度透析液,合理纠正钙磷代谢紊乱和继发性甲状旁腺功能亢进寻找更加合理的治疗方案。方法本院32例慢性肾衰竭长期维持性血液透析患者,先后应用钙离子浓度1.25mmol/L(DCa1.25)、1.50mmol/L(DCa1.50)、1.75mmol/L(DCa1.75)的透析液各连续进行15次血液透析,分别于第15次透析时,观察透析前后血钙、血磷、血清全段甲状旁腺素(iPTH)的变化及不良反应。结果使用DCa1.25血液透析时,血钙明显下降(P<0.05),血iPTH轻度升高,但与透析前相比,差异无显著性(P>0.05),且易出现血压降低,肌肉痉挛。采用DCa1.50血液透析时,血钙轻度升高,血iPTH明显下降,与DCa1.25血液透析相比,有显著性差异(P<0.05);采用DCa1.75血液透析时,血钙明显升高,血iPTH明显下降,与DCa1.25及DCa1.50血液透析后的结果相比差异均有显著性(P<0.05),且易出现血压升高。结论对血压正常、透前血钙正常或轻度低血钙者,DCa1.50透析液是合适的;对于高钙血症患者应当短期使用DCa1.25透析液;而对于低血压、低钙血症患者,可短期使用Dca1.75血液透析液。总之,透析液钙离子浓度应个体化。
Objective To investigate the effects and adverse reactions of three kinds of calcium ion dialysate on serum calcium, phosphorus and parathyroid hormone (iPTH) in maintenance hemodialysis patients. To choose different calcium ion concentration dialysate for clinical correction, Calcium and phosphorus metabolic disorders and secondary hyperparathyroidism to find a more reasonable treatment. Methods Thirty-two patients with long-term maintenance hemodialysis with chronic renal failure were treated with calcium ion concentration 1.25mmol / L (DCa 1.25), 1.50mmol / L (DCa 1.50), 1.75mmol / L The hemodialysis solution was continuously dialyzed for 15 times in each dialysis. Changes of blood calcium, phosphorus, total serum parathyroid hormone (iPTH) before and after dialysis and adverse reactions were observed at the 15th dialysis. Results When using DCa1.25 hemodialysis, blood calcium decreased significantly (P <0.05) and blood iPTH slightly increased, but there was no significant difference (P> 0.05) Spasm. When using DCa1.50 hemodialysis, serum calcium increased slightly and iPTH decreased significantly compared with DCa1.25 hemodialysis (P <0.05). When using DCa1.75 hemodialysis, serum calcium was significantly higher Elevated, blood iPTH decreased significantly, compared with DCa1.25 and DCa1.50 hemodialysis results were significantly different (P <0.05), and prone to blood pressure. CONCLUSION DCa1.50 dialysate is appropriate for patients with normotensive or pre-transcortical calcium supplementation or mild hypocalcaemia; DCa 1.25 dialysate should be used short-term for patients with hypercalcemia; and hypocalcemia Symptoms, short-term use of Dca1.75 hemodialysis. In short, dialysate calcium concentration should be individualized.