不同置换液量血液透析滤过治疗尿毒症皮肤瘙痒疗效观察

目的：观察不同置换液量血液透析滤过(HDF)对尿毒症皮肤瘙痒的治疗作用。方法：将30例并发皮肤瘙痒的维持性血液透析尿毒症患随机分为三个组，分别接受高置换液量后稀释HDF(置换液20L)、低置换液量后稀释HDF(置换液10L)和高通量血液透析治疗。均使用F60透析器，隔日1次，连续3次，其余治疗条件相同。对皮肤瘙痒症状定量计分，比较三组病人治疗前后皮肤瘙痒症状积分的改变以及血磷和甲状旁腺激素(PTH)的变化。结果：高置换液量HDF组治疗后皮肤瘙痒积分明显下降，有统计学意义。其余两组无差异。以皮肤瘙痒积分下降50％为有效计算，高置换液量HDF组7例有效，有效率70％；低置换液量HDF组3例有效。有效率30％；透析组1例有效，有效率10％。三组间比较有统计学差异。三组透析后血磷均明显下降，有统计学意义；PTH亦有下降，HDF组有统计学差异，HD组无统计学差异。结论：增加置换液量可以提高HDF治疗尿毒症皮肤瘙痒的疗效；HDF治疗尿毒症皮肤瘙痒疗效优于高通量血液透析；HDF清除PTH的效果高于HD。

Observation of the Effect of Hemodiafiltration with Different Amount of Substitute Fluid on Uremic Cutaneous Pruritus in Hemodialysis Patients

Objective:To observe the effect of hemodiafiltration(HDF) with different amount of substiute fluid on uremic cutaneous pruitus in hemodialysis patients.Methods:30 cases of maintenance hemodialysis patients who complained of refractory uremic pruitus were randomly divided into three groups. The patients were received high volume of substitute fluid post-dilution HDF (substitute fluid 20L), low volume post-dilution HDF (substitute fluid 10L) high-flux and hemodialysis respectively. F60 dialysers were employed for the three groups. Three times of treatment were given continuously at interval of one day. After quantitative integral of pruritus, the changes of pruritus integral ,serum inorganic phosphorus and PHT were compared before and after the treatment in the three groups.Results:The quantitative integral of pruritus in the high volume of substitute treated group was lower than that in other two groups statistical significantly. The dropped 50% integral of pruritus patients was taken as the effectiveness. The effectiveness in the high volume HDF group was 70%, while effectiveness in the low volume HDF group was 30% and in the hemodialysis group was 10% respectively. The difference of responsive rates among these threegroups were statistically significant.Conclusion:Incresing the amount of substitute fluid could improve the effect of HDF on uremic pruitus. HDF is more effective than high-flux hemodialysis for uremic pruritus, and more superior than HD in clearing PHT.