摘要
目的居家血液透析(home hemodialysis,HHD)在国际上是终末期肾病(end stage renal disease,ESRD)患者肾脏替代治疗方法之一,临床疗效已获得认可,但中国尚缺乏相关研究。本研究旨在初步探讨HHD治疗中国ESRD患者的疗效和安全性,为在中国开展HHD治疗提供依据。方法前期准备工作包括组建HHD培训中心,制定相应规章制度、管理规范、应急预案。选取在上海交通大学医学院附属仁济医院透析中心规律血液透析(hemodialysis,HD)的符合入排标准的患者,由专职医护人员、工程师对患者进行在中心内的培训和考核,考核通过后患者回家独立进行HHD。在家中,采用互联网实时监控和传统24h电话在线服务相结合的监控方法,专职医护人员、工程师定期进行家访,最大程度保障患者的医疗安全。收集患者临床资料、生化指标。结果纳入4例患者,均接受HHD培训并通过考核。培训过程中HHD透析方式为血液透析滤过(hemodiafiltration,HDF),患者返家后开始为普通HD治疗,逐渐过渡至HD与HDF相结合的模式。HHD过程中患者内瘘流量稳定,无明显改变。患者白蛋白、血磷、透析充分性、血红蛋白、甲状旁腺素、脑钠肽水平总体保持稳定。治疗过程中患者共发生2次不良事件,分别为血管通路及透析用水相关,经过重建动脉隧道及加装活性炭罐得到解决。研究随访期间未报告与治疗相关的不良事件。结论本研究初步显示,在中国开展HHD治疗可行且安全,但需要大规模长期研究进一步证实。
Objective Home hemodialysis(HHD)is one of the most important treatment methods for endstage renal disease(ESRD)in the world.The purpose of this study was to investigate the efficacy and safety of HHD in Chinese ESRD patients,and to provide evidence for HHD treatment in China.Methods The preliminary preparations include the establishment of HHD training center,the formulation of corresponding rules and regulations,management norms,and emergency plans.We selected ESRD patients from our dialysis center.The patients were trained and assessed regularly by specific medical staff and engineers.After passing the examination,patients could go home for HHD independently.A monitoring method that combines realtime Internet monitoring and traditional 24-hour telephone online services is adopted for patients.Full-time medical staff and engineers conduct regular home visits to patients to ensure their safety to the greatest extent.Collect clinical data and biochemical indicators of patients in this process.Results Four patients were included,and they received HHD training and passed the examination.After 15.0(15.0~18.0)months of training,albumin(Alb),blood phosphorus(P),patients’dialysis adequacy and brain natriuretic peptide(BNP),hemoglobin(Hgb)and parathyroid hormone(PTH)remained stable.The fistula function was monitored by ultrasound.After the patients injected the arteriovenous fistula by themselves,the fistula flow was stable without obvious change.Two adverse events occurred during the treatment.One was that the puncture of the artery tunnel was not smooth.This was solved by reconstructing the artery tunnel and guiding the fistula online.The other was that the chlorine content of tap water increased suddenly,and the technicians solved this by installing activated carbon tank.No treatment-related adverse events were reported during the follow-up period.Conclusion This study preliminarily shown that the development of HHD treatment in China is feasible and safe,but large-scale long-term studies need to be further confirmed.
作者
倪兆慧
周懿君
陆任华
沈剑箫
赵莉
金海姣
章海芬
张斌
李振元
方燕
方炜
王琴
顾乐怡
张伟明
张继东
牟姗
李卫平
NI Zhao-hui;ZHOU Yi-jun;LU Ren-hua;SHEN Jian-xiao;ZHAO Li;JIN Hai-jiao;ZHANG Haifen;ZHANG Bin;LI Zhen-yuan;FANG Yan;FANG Wei;QANG Qin;GU Le-yi;ZHANG Wei-ming;ZHANG Ji-dong;MOU Shan;LI Wei-ping(Department of Nephrology,Ren Ji Hospital,School of Medicine,Shanghai Jiaotong University,Shanghai 200127,China;Administration department,Ren Ji Hospital,School of Medicine,Shanghai Jiaotong University,Shanghai 200127,China)
出处
《中国血液净化》
CSCD
2021年第4期224-228,共5页
Chinese Journal of Blood Purification
基金
居家血液透析短期小样本安全性及有效性临床研究,居家血液透析中长期安全性及有效性临床研究,促进市级医院临床技能与临床创新能力三年行动计划(SHDC2020CR3029B)。
关键词
居家血液透析
终末期肾病
肾脏替代治疗
可行性
Home hemodialysis
Endstage renal disease
Renal replacement therapy
Feasibility
