不同血液净化方式对尿毒症患者高磷血症疗效的对比研究

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1、授予单位代码１００８９学号或申请号１３４５７Ｗ度钟＞？ＳＨｅｂｅｉＭｅｄｉｃａｌＵｎｉｖｅｒｓｉｔｙ硕ｄｒ学位论文在职科学学位不同血液净化方式对尿毒症患者窩磯血症疗效的对比研究学位申请人：郭更新导师：徐金升教授专业：内科学二级学院：第四医院２０１５年１０月巧北医科大学学位论文使用授权及知识产权归属承诺本学位论文在导师（或指导小组）的指导下，由本人独立完成。本学位论文研究所获得的研究成果，其知识产权归河北医科大学所有。河北医科大学有权对本学位论文进行交流、公开和使用。凡发表与学位论一、，试验材

2、料文主要内容相关的论文，第署名为单位河北医科大学原？始数据、申报的专利等知识产权均归河北医科大学所有。否则，承担相应法律责任。ｉ研究生签名；ｉｆ＿ｉ＾河北医科大学研究生学位论文独创性声明本论文是在导师指导下进行的研究工作及取得的研究成果，陈了文中特别加标注和致谢等内容外，文中不包含其他人已经发表或撰写的。，研究成果，指导教师对此进行了审定本论文由本人独立撰写文责自负。八研究生签名：押导师签章＾年月日目录中文摘要·····························································

3、·················1英文摘要··············································································3英文缩写··············································································5研究论文不同血液净化方式对尿毒症患者高磷血症疗效的对比研究前言··············································································

4、6材料与方法·····································································7结果··············································································13附表··············································································14讨论···················································

5、···························15结论··············································································19参考文献········································································20综述维持性血液透析患者磷代谢异常的综合治疗························22致谢·······················································

6、·····························39个人简历··············································································40中文摘要不同血液净化方式对尿毒症患者高磷血症疗效的对比研究摘要目的：近年来多家研究证实，钙磷代谢紊乱是尿毒症患者面临的主要并发症之一。血磷升高是需行维持性血液透析的终末期肾病患者的心血管事件和死亡的重大独立危险因素。而改善钙磷代谢紊乱将大大改善患者的生存预后。目前对于维持性血液透析的患者来说，降磷的治疗措施主要有限制磷摄入、充分透析、使用磷结合剂以及必要

7、时采用甲状旁腺切除术，几种方法各有优缺点。但究竟如何合理运用这几种方法，使得透析患者的血磷达标，仍是一个世界性的医学难题。目前的研究都显示，磷属于小分子尿毒素，单次普通血液透析、高通量血液透析、血液透析滤过、长时血液透析均能使血磷下降，但是究竟哪种透析方式的远期降磷效果好，并且能够显著改善患者的钙磷乘积、甲状旁腺激素水平，仍然没有定论。鉴于血液透析较为简便易行，尤其对于门诊透析患者来说，患者依从性较高，临床医生较易掌握，故此我们设计了本临床试验。本研究旨在探讨降低血磷的有效血液透