目前血液透析需要在医院进行，由专业的医护人员进行操作。图/CFP

目前血液透析需要In the医院进行,Operated by professional staff.Photo/CFP

　　●国人开始透析时间普遍偏晚，担心一旦开始透析就会产生依赖

●国人开始透析时间普遍偏晚,Worry that once you start dialysis tends to rely on

　　●国外患者出现肾病后随时与医院沟通，适当时机即开始透析

●国外患者出现肾病后随时与医院沟通,Appropriate time to start dialysis

　　近年，我国慢性肾病患者以每年10%左右的速度递增，多数患者初诊时已为末期，此时的治疗选择只有肾脏移植和透析。由于肾源有限，透析便成为主要的治疗方式。不少人认为透析会产生依赖性，越晚开始越好等。事实真的如此吗？

近年,Patients with chronic kidney disease in China is increasing at the rate of about 10% per year,Most patients have to begin with to the end,At this point the only kidney transplant and dialysis treatment options.Due to renal source co., LTD,Dialysis has become the main treatment.Many people think dialysis will produce dependence,The later start, the better.This really the case?

　

　糖尿病为慢性肾衰竭主要原因 糖尿病为慢性肾衰竭主要原因

　　北京大学人民医院肾内科副主任医师赵慧萍在接受采访时表示，正常人有两个肾脏，其实只要一个肾脏的功能正常，也是可以维持正常生活的。进入透析的患者，其实其肾功能已经不足正常人肾功能的10%，肾脏的代偿功能较强，所以在肾脏病变早期，一些化验难以发现病情。

北京大学人民医院肾内科副主任医师赵慧萍In the接受采访时表示,People have two kidneys,In fact as long as a normal kidney function,Also can maintain a normal life.In dialysis patients,Actually the renal function is less than 10% of normal renal function,Kidney compensatory function is stronger,所以In the肾脏病变早期,Some tests are difficult to find the illness.

　　北京大学第三医院肾病内科副主任医师韩庆烽介绍，其实很多因素都会导致终末期肾病，具体来说，在我国绝大部分地区，较常见的是慢性肾炎。相对来说，慢性肾衰竭的分布呈现一定的地域性，在北京、上海等比较发达的城市，如生活方式相关的疾病更高发，如糖尿病、高血压、动脉硬化等，这些疾病导致慢性肾衰竭的可能性也相应增加。

北京大学第三医院肾病内科副主任医师韩庆烽介绍,Many factors can lead to end-stage renal disease,In particular,In the我国绝大部分地区,Is one of the more common chronic nephritis.relatively,The distribution of the chronic renal failure presents certain regional,In the北京/A relatively developed cities such as Shanghai,Such as lifestyle diseases is higher,Such as diabetes/High blood pressure/Hardening of the arteries, etc.,These diseases cause the possibility of chronic renal failure also increases accordingly.

　　总的来说，会导致慢性肾衰竭的原因主要包括慢性肾炎、糖尿病及高血压等，一些其他疾病，如遗传性疾病等也会导致慢性肾衰竭，但由于其发病率较低，并不是引起慢性肾衰竭的主要原因。在临床进行透析治疗的病人中，由糖尿病引起的肾衰竭，即糖尿病肾病所占的比例是非常大的，值得特别关注。

总的来说,Can lead to chronic renal failure reason mainly includes the chronic nephritis/Such as diabetes and high blood pressure,Some other diseases,Such as genetic diseases can lead to chronic renal failure,But because of its low incidence,并不是引since慢性肾衰竭的主要原因.In the临床进行透析治疗的病人In the,由糖尿病引since的肾衰竭,The diabetic nephropathy proportion is very big,Worthy of special attention.

　　药物因素为肾衰竭重要原因 药物因素为肾衰竭重要原因

　　另外，药物因素也是导致肾衰竭的一个重要原因。一种情况是服用药物过量引起的毒性作用。

另外,Drug factors is an important reason leading to kidney failure.一种情况是服用药物过量引since的毒性作用.

　　以阿司匹林为例，该药对心血管疾病有良好的控制作用，通常情况下，100mg/天的用量对肾脏而言是比较安全的，但实际情况中，有些人为了镇痛，用药量会远超过人体耐受量，也就可以导致对肾脏的严重损害。

以阿司匹林为例,It has good control effect to cardiovascular diseases,Is often the case,100 mg/day dose for renal is safer,但实际情况In the,Some people to pain,Dose will be far more than human tolerance,Can result in serious damage to the kidney.

　　另外一种情况便是免疫机制造成的身体损害，而且药物过敏所导致的肾衰竭多为急性肾衰竭。如果这种过敏刺激持续反复发生，便有可能成为慢性肾衰竭。如果患者已经确诊为尿毒症，就需要长期的肾脏替代治疗。

另外一种情况便是免疫机制造成的身体损害,And drug allergy caused by kidney failure for acute renal failure.If this kind of allergic stimulation continues to happen again and again,It has the potential to be chronic renal failure.If the patient has been diagnosed with uremia,Requires long-term renal replacement therapy.

　　■ 时机把握 ■ 时机把握

　　透析开始越晚，体内毒素存留越长 透析开始越晚,The longer the body toxins remaining

　　很多人认为透析应该开始得越晚越好，担心一旦开始透析便需长期依赖。对此，赵慧萍解释，这种想法是不正确的，而且从临床情况来看，中国人开始透析的时间均偏晚。其实透析开始越晚，对患者残余肾功能的影响越大，虽然此时患者肾功能仅为正常情况的10%，但残余肾功能仍可帮助患者排出一些水分及毒素，减轻通过机器或腹膜排出毒素及水分的负担，而且本身有残余肾功能的患者在后期的透析治疗中情况往往更理想。透析开始较晚，毒素在体内存留时间越长，对各脏器的损害越大，各种并发症也更明显。在国外，有些患者在肾脏病尚未引起肾衰竭的情况下便与医院沟通，并随时进行随访以便在适当时机开始透析。

很多人认为透析应该开始得越晚越好,Worry that once you start dialysis will need to rely on a long time.For this,Zhao Huiping explain,The idea is not correct,And from the clinical case,In the国人开始透析的时间均偏晚.The late actually dialysis initiation,The greater the influence of residual renal function of patients,While the patient is only 10% of that in the normal renal function,Residual renal function but still can help patients get rid of some water and toxins,Reduce by machine or peritoneal eduction toxin and moisture of the burden,而且本身有残余肾功能的患者In the后期的透析治疗In the情况往往更理想.Dialysis started relatively late,毒素In the体内存留时间越长,The more damage to various organs,All sorts of complications also more obvious.In the国外,有些患者In the肾脏病尚未引since肾衰竭的情况下便与医院沟通,并随时进行随访以便In the适当时机开始透析.

　　【提示】 [prompt]

　　参考肾小球滤过率把握透析时机 参考肾小球滤过率把握透析时机

　　至于如何把握合适的时间开始透析，赵慧萍介绍，一般来说，会将肾小球滤过率作为参考，当肾小球滤过率在10ml/min以下时，患者就应该考虑进行透析。但也存在特殊情况，如糖尿病肾病患者在透析前蛋白尿较多，水肿明显，往往更早就开始透析。建议患者适时或尽早开始透析，避免在比较紧急的情况下开始透析。

至于如何把握合适的时间开始透析,Zhao Huiping introduction,In general,Glomerular filtration rate will be used as a reference,当肾小球滤过率In the10ml/min以下时,Should be considered in patients with dialysis.但也存In the特殊情况,Such as diabetes肾病患者In the透析前蛋白尿较多,Swelling significantly,Tend to be more early to start dialysis.Suggest that patients with timely or start dialysis as soon as possible,避免In the比较紧急的情况下开始透析.

　

　结肠透析治疗肾衰竭“不靠谱” 结肠透析治疗肾衰竭"unreliable"

　　目前，有不少医院仍在进行结肠透析治疗，韩庆烽表示，从国际上普遍认同的观点来看，这种做法并不可取。

目前,有不少医院仍In the进行结肠透析治疗,Han Qingfeng said,From a universal point of view in the world,This kind of practice is not recommended.

　　对患者来说，尤其是一些经济条件比较困难的患者，与血液透析及腹膜透析相比，结肠透析的费用较低，结肠透析短时间内或许有一定效果。但这并不被认可为一种长期的治疗方式，而且目前已经有很多医院不再采用结肠透析。

对患者来说,Especially in some patients with difficult economic conditions,Compared with hemodialysis and peritoneal dialysis,Colon dialysis of low cost,Colon dialysis in a short period of time may have certain effect.But it is not recognized as a treatment for a long time,And there are a lot of hospitals are no longer using colon dialysis.

　

　1 血液透析 1 血液透析

　　每周3次，每次4至5小时 每周3次,4 to 5 hours at a time

　　需提前手术形成动静脉漏 需提前手术形成动静脉漏

　　在进行血液透析之前，患者身体需先形成一个通路将血液引出。由于动脉位置较深，一般来说会在患者前臂处通过手术形成动静脉漏，使得深层的动脉与浅表的静脉形成回路，漏也被称为“血透病人的生命线”。赵慧萍介绍，漏形成后，病人要修养3个月以上才能进行下一步的透析，临床中，有些患者在开始透析时病情较急，可以直接将透析管插入血管。一般来说需要每周进行3次，每次持续4-5个小时。

In the进行血液透析之前,The patient's body to form a pathway will blood lead.Due to location deep artery,In general会In the患者前臂处通过手术形成动静脉漏,Make deeper artery and superficial veins forming circuit,Also known as the leakage"The lifeline of hemodialysis patients".Zhao Huiping introduction,After the formation of leakage,Patients for 3 months or more to get to the next step of dialysis,临床In the,有些患者In the开始透析时病情较急,Can be directly to the dialysis tube inserted into the blood vessels.In general to 3 times a week,Last 4 to 5 hours every time.

　　目前血液透析需要医院进行，由专业的医护人员进行操作，国外已经允许患者进行家庭血透。

目前血液透析需要医院进行,Operated by professional staff,Abroad have allow home hemodialysis patients.

　　糖尿病患者一般无法血液透析 糖尿病患者一般无法血液透析

　　临床中，15%-20%的患者由于自身原因无法进行血液透析，如血管情况较差的患者，如糖尿病患者是无法做漏的；而由于每次血液透析会在4个小时内将人体存积两天的毒素及水分排出，对心脏功能的要求比较高；血液透析中需要加入抗凝剂，如果病人本身有出血症状，抗凝剂会增加出血的风险，即便在正常情况下，抗凝剂的使用也有可能对患者产生不良影响。中山大学附属第一医院副院长余学清教授表示，如果病人血管条件不好，心脑血管功能比较差，尤其是不能耐受血流动力学变化的，这些原则上不太适合做血液透析。

临床In the,15% - 20% of patients due to their own reasons to hemodialysis,Such as blood vessel is poor patients,Such as diabetes can not do the leakage;而由于每次血液透析会In the4个小时内将人体存积两天的毒素及水分排出,Demand for cardiac function is higher;血液透析In the需要加入抗凝剂,If the patient is bleeding symptoms,Anticoagulants increases the risk of bleeding,即便In theUnder normal circumstances,The use of anticoagulants is also likely to produce adverse effects on the patients.In the山大学附属第一医院副院长余学清教授表示,If the patient blood vessel condition is not good,Cardiovascular function is bad,Especially the intolerance to the hemodynamic changes,These principles don't fit for hemodialysis.

　　■ 透析原理 ■ 透析原理

　　排出水分及 排出水分及

　　血液中有毒物质 血液In the有毒物质

　　“正常情况下，水分及毒素应经肾以尿的形式排出体外。形象地说，透析就是通过借助机器或其他方式将患者体内的毒素及水分排出，血液透析需在医院进行，需要利用透析机、透析器及管路，将血液从病人动脉中引出，经过透析器后将其中的毒素和水分滤过，经静脉返回人体，同时通过透析液使有益的物质进入人体，而血液中的毒素、水分等则进入透析器。”赵慧萍告诉记者。

"Under normal circumstances,Water and toxins have renal excretion in the form of urine.Figuratively speaking,Dialysis patients is through with the help of a machine or other way will be the toxin inside body and water discharge,血液透析需In the医院进行,Need to use a dialysis machine/Dialyser and piping,将血液从病人动脉In the引出,经过透析器后将Among them的毒素和水分滤过,The venous return to the human body,At the same time that beneficial substances enter the body through the dialysate,而血液In the的毒素/Water entering a dialyzer, etc."Zhao Huiping told reporters.

　　韩庆烽说，从原理上来看，血液透析与腹膜透析大体上是一致的。这两种透析方法都是通过一层膜将血压与透析液隔开，患者血液中毒素的浓度较高，所以毒素可透过膜而进入透析液中，并被排出体外。血液透析中的膜是人工的，而在腹膜透析中，则利用人体自身的腹膜进行。

韩庆烽说,On the principle of it,By and large, hemodialysis and peritoneal dialysis is consistent.The two dialysis method is through a membrane to separate blood pressure and the dialysate,患者血液In the毒素的浓度较高,所以毒素可透过膜而进入透析液In the,And was out of the body.血液透析In the的膜是人工的,而In the腹膜透析In the,With the body's own peritoneum.

　　透析的另一目的是清除水分，因为患者不排尿导致体内水分无法排出。血液透析主要通过负压吸引来清除血液中的水分，而腹膜透析则是利用在透析液中加入葡萄糖使得渗透压增高，吸引血液中的水分至透析液中，使之排出体外。此外，透析过程还可以使一些具有治疗作业的药物成分进入人体，从而纠正体内的电解质、酸碱平衡失调。赵慧萍介绍，血液透析与腹膜透析，两者之间并不是完全对立的关系，两者之间互为补充，可以相互转换。

透析的另一目的是清除水分,Because patients do not urinate to moisture in the body is unable to discharge.血液透析主要通过负压吸引来清除血液In the的水分,而腹膜透析则是利用In the透析液In the加入葡萄糖使得渗透压增高,吸引血液In the的水分至透析液In the,Make it out of the body.In addition,Dialysis process can also make some drug ingredients into the human body has the treatment assignments,Thus correction of electrolytes in the body/Acid-base balance disorders.Zhao Huiping introduction,Hemodialysis and peritoneal dialysis,Between the two is not completely antagonistic relations,Between the two complement each other,Can transform each other.