目的 观察使用组合型人工肾即血液透析联合血液灌流对继发性甲状旁腺功能亢进患者甲状旁腺激素(PTH)的清除效果及护理体会.方法 将60例血液透析患者完全随机分为2组(各30例),组合型人工肾组每周行3次血液透析治疗中2次联合血液灌流;单纯血液透析组每周行3次血液透析.2组均连续治疗10周.2组均检测治疗前后PTH及血小板变化,同时观察2组患者治疗前后皮肤瘙痒、肢体疼痛、睡眠等临床症状的改善情况.总结有关的护理资料.结果 组合型人工肾组血中PTH由(987±531)ng/L降至(769±496)ng/L,治疗前后差异有统计学意义(P＜0.05),治疗前后血小板无明显变化.血液透析组PTH及血小板均无明显变化.组合型人工肾组皮肤瘙痒、肢体疼痛、睡眠、食欲及高血压的改善率(83.3%、26.7%、73.3%、80.0%、66.7%)均明显高于血液透析组(50.0%、6.7%、46.7%、53.3%、33.3%),差异均有统计学意义(P＜0.01或P＜0.05).结论 组合型人工肾可有效清除PTH,改善临床症状,提高患者生活质量,减少并发症发生,加强护理策略的实施是保证其治疗效果的关键.%Objective To observe the clearance effect of hemoperfusion associated with hemodialysis on parathyroid hormone(PTH) levels in patients of secondary hyperparathyroidism and the nursing comprehension. Methods Sixty patients on maintenance hemodialysis were randomly divided into two groups:hemoperfusion plus hemodialysis group ( HP +HD) ,hemodialysis group (HD). HD + HP group received 2 times HD + HP and 1 time HD treatment per week. HD group received 3 times HD treatment per week. Serum PTH and platelet levels were observed before and after treatment. The improvement of symptoms such as skin itching, sleeping, ache, appetite and hypertension were observed. Results Serum PTH in HP + HD group decreased significantly from (987 ± 531 ) ng/L to( 769 ± 496 ) ng/L after treatment ( P ＜ 0.05 ), but serum PTH in HD group showed no obvious change. The level of platelet showed no significant differences. The clinical symptoms improvement ratio of HD + HP group in skin itching, sleeping, ache, appetite and hypertension ( 83.3%, 26.7%, 73.3%, 80.0%, 66.7% )was higher than that in HD group(50.0%, 6.7%, 46.7%, 53.3%, 33.3% ) ,the difference is statistical significance (P ＜ 0.05). Conclusions Hemoperfusion associated with hemodialysis can safely and effectively clear PTH, improve clinic symptoms and decrease complications. At the same time sophisticated nursing very important during the treatment.
展开▼
