摘要
目的回顾性分析终末期肾脏病(ESRD)伴肝硬化失代偿患者血液透析(HD)和腹膜透析(PD)的临床效果。方法选取我院2003年4月~2018年3月收治的ESRD伴肝硬化失代偿患者53例,根据患者肾脏替代治疗方式不同分组,HD组29例,PD组24例,两组患者皆给予维持性透析治疗,比较两组患者治疗2年后的生存质量、并发症发生率及透析治疗前与治疗2年后各临床指标变化。结果两组患者透析治疗前血小板计数(PLT)、估算肾小球滤过率(e GFR)、血清清蛋白(ALB)水平比较,差异无统计学意义(P> 0.05);治疗2年后,两组e GFR水平皆明显降低,HD组下降幅度较PD组大,差异有统计学意义(P <0.05);HD组PLT降低,PD组无明显变化,差异有统计学意义(P <0.05);两组ALB水平皆上升,HD组上升幅度明显,差异有统计学意义(P <0.05);治疗2年后,PD组生存质量评分高于HD组,差异有统计学意义(P <0.05);治疗2年后,两组并发症比较,高血压、消化道出血、败血症发生率比较,差异无统计学意义(P> 0.05),皮下出血、腹膜炎、透析时抽搐发生率存在差异,PD组腹膜炎发生率高于HD组,皮下出血、透析时抽搐低于HD组,差异有统计学意义(P <0.05)。结论 ESRD伴肝硬化失代偿患者采取不同透析治疗措施,在治疗效果上不同,PD对PLT、残余肾功能影响较小,患者生活质量方面相对于HD者更高,且并发症发生率低,近期疗效显著,临床可推荐PD为ESRD伴肝硬化失代偿患者初始透析方案。
Objective To analyze the clinical efficacy of hemodialysis(HD) and peritoneal dialysis(PD) in patients with endstage renal disease(ESRD) and decompensated cirrhosis retrospectively. Methods A total of 53 patients with ESRD complicated with decompensated cirrhosis admitted to our hospital from April 2003 to March 2018 were selected and divided into the HD group(n=29) and the PD group(n=24) according to different methods of renal replacement therapy. Both groups were given maintenance dialysis treatment. The quality of life after 2 years of treatment, the incidence of complications and the changes of clinical indexes before and 2 years after dialysis treatment were compared between the two groups of patients. Results There were no statistically significant differences in platelet count(PLT), estimated glomerular filtration rate(eGFR) and serum albumin(ALB) level between the two groups before dialysis treatment(P > 0.05). After two years of treatment, eGFR levels in both groups decreased significantly, and the decrease in the HD group was larger than that in the PD group, with statistically significant difference(P < 0.05). PLT decreased in the HD group, but there was no obvious change in the PD group, with statistically significant difference(P < 0.05). The ALB levels in both groups increased, and the increase in the HD group was obvious, with statistically significant difference(P < 0.05). After 2 years of treatment, the quality of life score of PD group was higher than that of HD group, with statistically significant difference(P < 0.05).After two years of treatment, there were no statistically significant differences in the incidences of complications of hypertension, gastrointestinal hemorrhage and septicemia between the two groups(P > 0.05). However, there were differences in the incidences of subcutaneous hemorrhage, peritonitis and convulsion during dialysis. The incidences of peritonitis in the PD group was higher than that in the HD group, while the subcutaneous hemorrhage and convulsion during dialysis were lower than those in the HD group, with statistically significant differences(P < 0.05). Conclusion Patients with ESRD complicated with decompensated cirrhosis take different dialysis treatment measures, in which there are different therapeutic efficacies. There are less impacts of PD on PLT and residual renal function, and the quality of life of patients is higher than that of hemodialysis patients, with low incidence of complications and remarkable short-term therapeutic efficacy. PD can be recommended as the initial dialysis scheme for patients with ESRD complicated with decompensated cirrhosis.
作者
蓝梅金
陈勇平
丘美兰
LAN Meijin;CHEN Yongping;QIU Meilan(Department of Renal Medicine,the Second Hospital of Longyan,Fujian,Longyan 364000,China)
出处
《中国医药科学》
2020年第23期247-249,254,共4页
China Medicine And Pharmacy
关键词
终末期肾脏病
肝硬化失代偿
血液透析
腹膜透析
End-stage renal disease
Decompensated cirrhosis
Hemodialysis
Peritoneal dialysis
