摘要
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 by using polymethylmethacrylate(PMMA)membrane dialyzer and diacetate membrane dialyzer.Methods Forty uremic patients were randomly divided into PMMA membrane group(n=20)receiving hemodialysis by using PMMA membrane dialyzer and diacetate membrane group(n=20)receiving hemodialysis by using diacetate membrane dialyzer for 4 to 5 heach time,three times a week,in addition to the comprehensive symptomatic treatment as controlling blood pressure,correcting anemia,acidosis and abnormity calcium-phosphorus metabolism.The forced vital capacity(FVC),forced expiratory volume in one second(FEV1),peak expiratory flow(PEF),forced expiratory flow at 50% of FVC exhaled(FEF50),forced expiratory flow at 75% of FVC exhaled(FEF75)and diffusing capacity of the lung for carbon monoxide(DLco)were detected in two groups before and after 6-month hemodialysis.The Kt/V and time-average concentration of urea(TACurea)were compared between two groups.Results The levels of 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)%)and DLco((92.58±19.39)%,(82.15±20.05)%)after 6-month hemodialysis were significantly higher than those before hemodialysis both in PMMA membrane group and diacetate membrane group((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).DLco level was significantly higher in PMMA membrane group than that in diacetate membrane group after 6-month hemodialysis(P<0.05),and there were no significant differences in the levels of FVC,FEV1,PEF,FEF50 and FEF75 between two groups(P>0.05).There were no significant differences in Kt/V and TACurea between PMMA membrane group(1.47±0.29,(16.57±2.37)mmol/L)and diacetate membrane group(1.38±0.23,(15.62±2.21)mmol/L)(P>0.05).Conclusion Both PMMA membrane and diacetate membrane dialyzers can improve pulmonary function during hemodialysis in uremic patients,and the former is superior to the latter in improving pulmonary diffusing capacity.
出处
《中华实用诊断与治疗杂志》
2017年第11期1122-1125,共4页
Journal of Chinese Practical Diagnosis and Therapy
关键词
尿毒症
血液透析
聚甲基丙烯酸甲酯膜
二醋酸膜
肺功能
Uremia
hemodialysis
polymethylmethacrylate membrane
diacetate membrane
pulmonary function
