ABSTRACT
Objective To observe the efficacy of sequential dialysis combined with hydroxyethyl starch in the treatment of patients with refractory edema of nephrotic syndrome.Methods Eighty-eight patients with refractory edema of nephrotic syndrome were randomly divided into control group (n =44) and combination group (n =44)according to the digital table.The control group was treated with hydroxyethyl starch,and the combination group was treated with sequential dialysis combined with hydroxyethyl starch.The levels of urinary NAG,urinary KIM-1 and serum ICAM-1,TNF-,IL-6 were compared.And the clinical efficacy of the two groups was evaluated.Results The improvement time of clinical symptoms in the observation group was significantly shorter than that in the control group,and the average weight loss of the observation group was significantly higher than that of the control group(t =7.099,9.279,all P ＜ 0.05).Before treatment,the 24h urine,24h urine protein,Scr and BUN between the two groups had no statistically significant differences (all P ＞ 0.05).Compared with before treatment,24h urine of the two groups after treatment was increased (tcombination group =36.266,P ＜ 0.05;tcontrol group =7.906,P ＜ 0.05),and the 24h urine protein,Scr and BUN levels of two groups were decreased after treatment (tcombination group =21.031,25.629,26.099,P ＜0.05;tcontrol group =9.263,6.544,5.716,all P ＜ 0.05),and the improvement of the above indicators of the combination group was more significant (t =28.672,17.639,19.057,16.507,all P ＜ 0.05).The effective rate of the combination group was higher than that of the control group(x2 =8.494,P ＜ 0.05).Compared with before treatment,the urinary NAG enzyme and urinary KIM-1 of the combination group were statistically significantly decreased (tcombination group =29.146,19.256,all P ＜ 0.05).There were no statistically significant differences in urinary NAG and urinary KIM-1 between before treatment and after treatment in the control group (all P ＞ 0.05).After treatment,the serum levels of ICAM-1,TNF-and IL-1 β in the combination group were significantly lower than those before treatment and those in the control group (tcombination group=15.655,16.882,16.091,all P ＜ 0.05),while there were no statistically significant differences in the serum levels of ICAM-1,TNF-and IL-1β between before treatment and after treatment in the control group (all P ＞ 0.05).Conclusion Sequential dialysis combined with hydroxyethyl starch in the treatment of refractory edema of nephrotic syndrome can improve the clinical curative effect and improve the renal function of patients.It is worthy to be further promoted.
ABSTRACT
Objective To compare the clinical effects between the two-level ladder ultrafiltration and sequential dialysis for hemodialysis patients with excessive water retention.Methods According to our hospital standard,23 patients with water retention during treatment with dialysis from January 2010 to September 2011 were selected.And they conducted a total of 198 dialysis.Both the two-level of high-level segment and sequential ultrafiltration step dialysis were set for 1 hour.Ultrafiltration accounted for one-third of the total,and the remaining two-thirds of the amount of ultrafiltration was completed in the remaining time.The blood pressure,ultrafiltration volume completed,plasma osmotic pressure,detection of vascular access pressure,and other observed indicators during dialysis were compared.Results The occurrence of hypotension and muscle spasms in two-level ladder ultrafiltration was slightly more than that in sequential dialysis,ultrafiltration volume completed actually in two-level ladder ultrafiltration was a little less than sequential dialysis.However,the difference was not statistically significant ( P ＞ 0.05 ).It took more time during sequential dialysis simple ultrafiltration,occasionally dialysis fluid stopped flowing and dialyzer and the trail tube lack of incubation,and some patients could not adapt to it.Amount of heparin( [7.48 ± 1.73 ] mg/h vs[6.25 ± 1.36] mg/h,t =5.374,P ＜ 0.01 ),venous pressure ( [ 128.62 ± 10.53 ] mm Hg vs [ 96.35 ± 11.84 ] mm Hg,t =20.166,P ＜ 0.01 ),trausmembrane pressure( [ 236.84 ± 23.65 ] mm Hg vs [ 175.94 ± 24.72] mm Hg,t =17.516,P ＜ 0.01 ) were significantly higher than those in the high level of ultrafiltration period.Mean arterial pressure ( MAP ) ( [ 100.48 ± 5.78 ] mm Hg vs [ 102.54 ± 5.39 ] mm Hg,t =2.571,P ＜ 0.05 ) and plasma osmotic pressure ( [ 311.42 ± 7.36] mOsm/( kg · H2O ) vs [ 3 1 7.31 ± 6.89 ] mOsm/( kg · H2O ),t =5.774,P ＜ 0.01 ) in high level period were significantly lower than those in the singal ultrafiltration period,and the MAP difference was higher than that in the singal ultrafiltration period ( [ 11.46 ± 6.53 ] mm Hg vs [ 9.42 ± 5.46 ] mm Hg,t =2.385,P ＜ 0.05 ).There is less symptomatic hypotension and other adverse reactions.Conclusion Two dialysis ultrafiltration method can both be used for patients with excessive water retention,they can reduce the ultrafiltraion complications and achieve ultrafiltration targets.Two-level ladder ultrafiltration with dialysis and ultra.filtration unity is more likely to be adopted by the clinic.