不同频率血液灌流联合血液透析治疗尿毒症皮肤瘙痒的观察与护理

    Observation of treatment of uremic skin pruritus with different-frequency hemoperfusion combined with hemodialysis and nursing during treatment

    • 摘要: 目的 探讨采用不同频率血液灌流联合血液透析治疗尿毒症皮肤瘙痒的临床疗效及护理。方法 收治尿毒症皮肤瘙痒患者80例,随机分为4组,每组20例。对照组(A组)给予每周常规血液透析治疗3次,其余3组在此基础上联合不同频率血液灌流,B组1次/周,C组2次/周,D组1次/2周。对各组治疗前及治疗后的皮肤瘙痒程度进行评分,测量血清中磷(P)、钙(Ca)和甲状旁腺素(PTH)的浓度以及钙磷乘积并进行比较分析。结果 各实验组患者的皮肤瘙痒程度治疗后均有改善(P<0.05);B组、C组改善程度优于D组(P<0.05),B组与C组之间差异无统计学意义(P>0.05);实验组患者血清中的PTH浓度治疗前后差异具有统计学意义(P<0.05),B组、C组优于D组,B组与C组之间差异无统计学意义(P>0.05)。各实验组患者血清中P浓度和钙磷乘积总体呈下降趋势(P<0.05),但患者血清中的Ca浓度治疗前、后无明显差异(P>0.05)。结论 采用每周1次血液灌流频率,既能改善尿毒症患者的皮肤瘙痒症状,对PTH能达到有效清除,又能明显减少治疗费用,值得临床推广应用。

       

      Abstract: Objective To investigate the clinical efficacy and nursing of different-frequency hemoperfusion combined with hemodialysis (HP+HD) for treatment of uremic skin pruritus. Methods A total 80 patients with uremic skin pruritus were enrolled and divided into 4 groups, with 20 cases for each group. The control group (group A) was treated with routine hemodialysis (HD) 3 times per week; the other 3 trial groups (group B, C and D) were treated with the combination of hemoperfusion at different frequencies with hemodialysis (HP+HD), once per week for group B, twice per week for group C, and once per two weeks for group D. Skin pruritus severity for each group before and after treatment was scored, and concentrations of phosphorus, calcium and parathyroid hormone (PTH), and calcium-phosphorus product were determined and compared between them. Results The severity of skin pruritus in the trial groups was improved after treatment (P<0.05); the improvement outcome in group B, C was more significant than that in group D (P<0.05), but there was no significant difference between group B and group C (P>0.05). Serum PTH decreased after the treatments in all of the trial groups (P<0.05), but the decrease was greater in groups B and C than in group D (P<0.05). There was no significant difference between group B and group C (P>0.05). The serum phosphorus and calcium-phosphorus product in each trial group showed an overall decreasing trend (P<0.05), but there was no significant difference in serum calcium concentration before and after treatment (P>0.05). Conclusions The use of weekly hemoperfusion can not only improve uremic skin pruritus of uremia and achieve the clinical efficacy for PTH clearance, but also significantly reduce the cost of treatment, which is worthy of promotion in clinical practice.

       

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