血液透析联合血液灌流改善维持性血液透析患者睡眠质量研究

摘要

目的：探讨血液透析联合血液灌流( HD+HP)对改善维持性血液透析( MHD)患者睡眠质量的临床效果。方法选取我科30例睡眠质量较差的MHD患者,随机分为HD+HP组和HD组,每组15例。治疗6个月后,采用匹兹堡睡眠质量指数量表( PSQI)评定睡眠质量,并检测治疗前后β2-MG、iPTH、CRP、血钙/磷水平的变化。结果 HD+HP组治疗后的睡眠质量指数及PSQI总分较治疗前明显下降(P<0．05),HD组治疗前后各项睡眠质量指数无显著差异(P>0．05)。 HD+HP组治疗后血β2-MG、iPTH、CRP、血磷水平较治疗前均显著下降( P<0．05), HD组治疗前后各项指标无显著差异( P>0．05)。治疗后PSQI总分与血β2-MG(r=0．93,P<0．05)、iPTH(r=0．92,P<0．05)、CRP(r=0．96,P<0．05)、血磷水平(r=0．95,P<0．05)成显著正相关。结论HD+HP能有效改善MHD患者的睡眠质量,其机制可能与进一步降低MHD患者血液中中大分子毒素和炎症因子有关。%Objective To investigate the effect of hemoperfusion combined with hemodialysis in the treatment of sleep disturbances in maintenance hemodialysis patients. Methods Thirty maintenance hemodialysis patients with sleep disturbances in our department were enrolled and randomly divided into two groups, conventional hemodialysis ( HD) group and hemodialysis combined with hemoperfusion ( HD+HP) group, with 15 patients in each group. After 6 months of treatment, the Pittsburgh sleep quality index ( PSQI) score was used to as-sess sleep quality, and β2-MG, iPTH, CRP, calcium and phosphorus levels were detected before and after treatment. Results The PSQI score and all sleep quality indexes were markedly reduced after treatment in HD+HP group, while no significant difference existed in HD group. ( The serum levels ofβ2-MG, iPTH, CRP and phosphorus were significantly decreased after treatment in HD+HP group, whereas no difference was found in HD group. The correlation analysis showed that there was distinctly positive relationship between PSQI score andβ2-MG (r=0. 93, P<0. 001), iPTH (r=0. 92, P<0. 001), CRP (r=0. 95, P<0. 001), phosphorus (r=0. 95,P<0. 001) after treat-ment. Conclusion Hemodialysis plus hemoperfusion can significantly improve sleep quality in maintenance hemodialysis patients, which may possibly be attributed to the higher efficiency of clearing macromolecular toxins and inflammatory factors.