不同钙浓度透析液对维持性血液透析患者影响的对照研究

王成; 娄探奇; 陈珠江; 彭晖; 唐骅; 余学清; 尹培达

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中国血液净化 ›› 2006, Vol. 5 ›› Issue (9) : 663-666.

论著

不同钙浓度透析液对维持性血液透析患者影响的对照研究

王成1 娄探奇1 陈珠江1 彭晖1 唐骅1 余学清2 尹培达2

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摘要

目的观察不同钙浓度(1.25mmol/L和1.75mmol/L)透析液治疗6个月对患者血压、钙、磷和甲状旁腺素影响。方法选择中山大学附属第三医院肾内科维持性血液透析患者20例，首先接受钙离子1.75mmol/L(高钙)透析液治疗6个月，而后接受钙离子1.25mmol/L(低钙)透析液治疗6个月，其它治疗不变。检测两种治疗组入组时、后3个月和6个月患者透析前后血压、血清钙、磷、甲状旁腺素、碱性磷酸酶的水平。结果使用低钙透析液单次治疗4h后血压下降(P＜0.05)，血钙下降7.5% (P＞0.05)，甲状旁腺素升高（P＜0.05)；而高钙透析液治疗后血压和血钙均升高(P＜0.05)，甲状旁腺素有所下降 (P＞0.05)；治疗6个月后，使用低钙透析液，患者血压下降(P＞0.05)，血钙下降(P＞0.05)，血磷和钙磷乘积显著下降 (P＜0.05)，甲状旁腺素升高 (P＞0.05)，碱性磷酸酶升高(P＜0.05)；两种钙离子浓度透析液应用后收缩压、甲状旁腺素和碱性磷酸酶的变化相比差异有显著性(P＜ 0.05)。结论单次应用低钙透析液进行透析，透析后甲状旁腺素升高，血压下降；与使用高钙透析液相比，长期应用(6个月)低钙透析液进行透析，钙负荷减轻，血钙磷乘积和收缩压下降，血清甲状旁腺素和碱性磷酸酶升高。

Abstract

Objective To investigate the changes of blood pressure, serum calcium, phosphate and parathyroid hormone in hemodialysis patients after being treated with different calcium dialysate (1.25mmol/L and 1.75mmol/L) for 6 months Methods Twenty patients were enrolled in this study. These patients firstly received high calcium dialysate(1.75mmol/L) for 6 months, then accepted low calcium dialysate (1.25mmol/L)therapy for 6 months while other therapy remained.Unchanged blood pressure, serum calcium, phosphate, parathyroid hormone and alkaline phosphatase were measured before and after one dialysis session at the beginning,3 and 6 months later. Results Serum calcium level decreased 7.5 percent(P＞0.05), blood pressure decreased (P＜0.05)and parathyroid hormone increased(P＜0.05)in post-dialysis compared with pre-dialysis for single low calcium dialysis; While blood pressure and serum calcium increased (P＜0.05) and parathyroid hormone decreased(P＞0.05) in post-dialysis for single high calcium dialysis. During 6 months with low calcium dialysate, serum calcium and blood pressure gradually dicreased, while serum parathyroid hormone gradually increased. However these changes didn’t show statistical difference(P＞0.05). But serum alkaline phosphatase increased remarkedly (P＜0.05),serum phosphate and calcium-phosphate product decreased remarkedly(P＜0.05). The changes of systolic blood pressure, parathyroid hormone and alkaline phosphatase due to different calcium dialysate showed statistical difference(P＜0.05). Conclusion Serum parathyroid hormone increased with single low calcium dialysis. Calcium load, systolic blood pressure and serum calcium-phosphate decreased, serum parathyroid hormone increased, serum alkaline phosphatase increased remarkedly after 6 months dialysis with low calcium dialysate contrasted with high calcium dialysate.