维持性血透患者10大常规检查，你都知道吗？

2018-08-03 佚名郑州大学第一附属医院肾脏病医院

部分血液透析患者在规律治疗情况明显好转后，即认为只要按时透析就行，没必要做一些化验检查。而实际上，却犯了一个很大的错误，因为透析并不能解决疾病本身带来的所有问题，有些问题必须应用药物去干预，而且应定期调整药方案。

部分 IBD%E8%AF%8A%E6%B2%BB%E8%BF%87%E7%A8%8B%E4%B8%AD%E7%9A%84%E8%AF%84%E4%BC%B0-Part%202" target="_blank">血液透析患者在规律治疗情况明显好转后，即认为只要按时透析就行，没必要做一些化验检查。而实际上，却犯了一个很大的错误，因为透析并不能解决疾病本身带来的所有问题，有些问题必须应用药物去干预，而且应定期调整药方案。所以，维持性血透患者非常有必要定期进行一些化验检查，一般每个月检查1次，有的项目可以每2-3个月检查1次，IBD%E8%AF%8A%E6%B2%BB%E8%BF%87%E7%A8%8B%E4%B8%AD%E7%9A%84%E8%AF%84%E4%BC%B0-Part%202" target="_blank">血液化验应在透析前取血，主要包括以下内容：

1. 血常规

主要观察血红蛋白，目标值为100-110g/L，如果不达标，应调整促红细胞生成素的用量，检查有无缺铁或失血的情况，如果过高，可能会出现血液粘稠度增加，反而增加危险性，所以每月需要化验1次。

2. 肾功能

包括尿素氮、肌酐、二氧化碳结合力。尿素氮、肌酐绝对值受很多因素的影响，需结合患者情况个体化分析。透析前尿素氮、肌酐值并不是越低越好，过低常是营养摄入不足的表现。还要结合透析后的尿素氮、肌酐的下降比率来判断透析是否充分。每月化验1次。

3. 血钙和血磷

钙和磷的化验非常重要，钙磷絮乱会引起很多不良后果，高血钙的患者应使用低钙透析液，高血磷患者应采用低磷饮食，并服用磷结合剂。应每月检测1次。

4. iPTH

维持性血液透析患者血PTH水平应维持在150-300 pg/ml，常规口服活性维生素D治疗的患者可3个月化验1次PTH，但是活性维生素D冲击治疗的患者需要每月化验1次，根据结果及时调整用药剂量。

5. 血清蛋白

是营养的一个指标，与病人预后密切相关，一般3个月应检查1次。

6. 血脂、血糖

心血管合并症是威胁透析病人生命的重要因素，应重视透析病人的高血脂，积极加以防治，常规1-3个月应检查1次，正在降脂治疗的病人，应每月监测。血糖检查常规1-3个月应检查1次。

7. CRP

许多基层医生对这项化验的意义不是很了解。CRP是一种炎性蛋白，可反映体内的慢性炎症状态。与心血管疾病的发病以及病人的预后相关，建议每3个月检测1次。

8. 铁蛋白、转铁蛋白饱和度

开始促红细胞生成素治疗的患者，应评估铁储备和利用，若促红细胞生成素疗效好，血红蛋白达到目标值，不必常规化验，一旦出现血红蛋白下降，应及时化验铁蛋白、转铁蛋白饱和度。常规应3个月检查1次。

9. 肝功能检查

透析患者免疫力低下、常服用很多药物，会影响肝脏功能，常规应个1月检查1次。

10. 病毒学检查

常规透析患者至少1年化验1次，对一些高危患者比如近期输过血或肝炎患者有密切接触者应3个月到半年检查1次。检测传染病项目血透不满6个月需要1-3个月化验1次。超过6个月以上的维持性血透患者应每6个月检测1次。

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2018-08-08 txqjm

谢谢了，学习

64 0
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2018-08-05 luwei02

#血透#

29 0
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2018-08-04 lyh994

学习了谢谢分享

58 0
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2018-08-04 kafei

了解一下谢谢

63 0
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2018-08-04 1209e435m98(暂无昵称)

学习了，谢谢分享

68 0
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2018-08-03 医者仁心5538

学习了

49 0
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2018-08-03 惠映实验室

学习了，谢谢分享。

26 0
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2018-08-03 天地飞扬

了解一下，谢谢分享！

33 0
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2018-08-03 清风拂面

谢谢分享学习

30 0

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