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目的探讨多模式组合透析对维持性血液透析(MHD)患者脑钠肽(BNP)水平及左心功能相关指标的影响。方法采用前瞻性研究方法,选择2015年12月至2016年12月在贵阳市第二人民医院肾内科血液净化中心接受MHD>3个月的慢性肾衰竭尿毒症患者120例。将120例患者按随机数字表法分为3组:血液透析(HD)+血液滤过(HF)+血液灌流(HP)组(每月进行8次HD、每月4次HF、每月1次HP),共40例;HD+HF组(每月8次HD、每月1次HF),共40例;HD组(每月8次HD),共40例。所有患者于治疗前后从静脉端采血,分离血清,整批送检,检测3组患者的BNP水平,每半年复检1次。由专人用同一超声心动图仪检测所有患者左心室舒张期末内径(LVDd)、左心室收缩期末内径(LVDs)、左心室舒张期末容积(LVVd)、左心室收缩期末容积(LVVs)、左心室后壁厚度(LVPWT)、室间隔厚度(LVST)、舒张早期及晚期最大血流比(E/A)、射血分数(EF),每半年复检1次。结果 120例尿毒症患者经过各种模式组合透析治疗后,体内BNP均有所降低(均P<0.05);BNP降低水平在HD+HF+HP组>HD+HF组>HD组。治疗后,HD+HF+HP组LVDd、LVDs、LVVd、LVVs、LVPWT、LVST均降低,EF升高(均P<0.05),E/A差异无统计学意义(P>0.05);HD+HF组LVDd、LVDs、LVVd、LVVs、LVPWT、LVST均降低,EF升高(均P<0.05),E/A差异无统计学意义(P>0.05);HD组LVDd、LVDs、LVVd、LVVs均降低(均P<0.05),LVPWT、LVST、E/A、EF差异均无统计学意义(均P>0.05)。HD+HF+HP组治疗后BNP降低、LVPWT减轻及EF升高较HD+HF组更显著(P<0.05)。结论多模式组合透析(HD+HF+HP)能有效改善MHD患者左心功能,从而能减少心血管事件发生率、降低患者病死率。
Objective To investigate the effect of multimodal combination dialysis on brain natriuretic peptide (BNP) level and left ventricular function in patients with maintenance hemodialysis (MHD). Methods A prospective study was conducted in 120 patients with uremia of chronic renal failure who received MHD> 3 months from December 2015 to December 2016 in the Renal Department of Nephrology Blood Purification Center, Second People’s Hospital of Guiyang. 120 patients were divided into 3 groups according to random number table: HD + HF + HP group (8 HD per month, 4 HF monthly, 1 per month 40 cases in HD + HF group (HD of 8 times a month, once a month of HF), 40 cases in HD group (8 times a month HD). All patients before and after treatment from the venous side of the blood, serum separation, the entire batch submission, detection of BNP levels in three groups of patients, retest every six months. Left ventricular end-diastolic diameter (LVDd), left ventricular end systolic diameter (LVDs), left ventricular end-diastolic volume (LVVd), left ventricular end systolic volume (LVVs), left ventricular The LVPWT, LVST, E / A and EF were measured every 6 months. Results 120 cases of uremia patients after various modes of combination dialysis treatment, BNP were reduced (all P <0.05); BNP decreased HD + HF + HP HD group> HD group. After treatment, the levels of LVDd, LVDs, LVVd, LVVs, LVPWT, LVST and EF in HD + HF + HP group were all significantly lower than those in HD + HF group (all P0.05) LVDd, LVDs, LVVd, LVVs, LVPWT, LVST, EF were all increased (all P <0.05), and there was no significant difference in E / A between LVDd, LVDs, LVVd, LVVs, LVVd, LVVs (All P <0.05). There were no significant differences in LVPWT, LVST, E / A and EF (all P> 0.05). Compared with HD + HF group, BNP decreased, LVPWT reduced and EF increased in HD + HF + HP group (P <0.05). Conclusions Multimodal combination dialysis (HD + HF + HP) can effectively improve left ventricular function in patients with MHD, thereby reducing the incidence of cardiovascular events and reducing the mortality of patients.