| Background: L-carnitine is one kind of water-soluble amino acids whichcould carry long-chain fatty acids into the mitochondria to participate in thereaction and offer energy as the form of adenosine triphosphate (ATP). Due toinadequate of food intake, nausea, vomiting, poor digestion and absorption,decreased in synthesis and lost in dialysis, maintenance hemodialysis (MHD)patients always appeared L-carnitine deficiency. Loss of L-carnitine can affectthe oxidation of free fatty acids in mitochondrial, resulting in the aggregation oflipid in the cytoplasm instead of turning in the citric acid cycle. Thisaggregation lead to a lack of energy. At the same time, acetyl coenzyme Agather in the mitochondria which produce the cell toxic effects manifesting ofskeletal muscle disease, cardiomyopathy, arrhythmia and dyslipidemia. Acetylcoenzyme A gathering in the mitochondria can aggravate malnutrition. Clinicalperformances always reveal the nausea, loss of appetite, muscle cramps,cardiac arrhythmia and hypotension, leading to tolerance reduce of dialysispatients and the serious impact on patients quality of life and survival.Objective: To observe the clinical treament effect Of levocarn in Patientson Maintenance Hemodialysis.discuss the impossible mechanism.Methods: Selected40uremia patients who has been dialysis regular morethan1year (hemodialysis three times a week,4h one time; Hb≦90g/L, Hct≦30%; no iron or folic acid or vitamin B12deficiency; no refractoryhypertension; no severe secondary hyperparathyroidism, no bleeding orinfection or malignancy).40cases were randomly divided into treatment groupand control group. Each group had20cases. Two groups were subcutaneousinjected three times erythropoietin hormone100~150U/kg a week at the same time. Patients in these two groups added iron, folic acid, vitamin B12supplements. Both groups used antihypertensive drugs to control bloodpressure. The treatment group added1g of L-carnitine intravenous injectionafter each dialysis. The control group without any treatment. This kind oftreatment lasted for3months. Testing hemoglobin (Hb), hematocrit trace Hct),total cholesterol (Tch), triglyceride (TG), high-density lipoprotein cholesterol(HDL), low-density lipoprotein cholesterol (LDL), serum total protein (TP),albumin (Alb) before and after the treatment. Use the echocardiography tomonitored left atrial diameter (LAD), left ventricular ejection fraction (LVEF),left ventricular end-diastolic diameter (LVDd) and E/A. To measure theanthropometric dry weight, the midpoint of the non-fistula side of the upperarm circumference (MAC) and triceps skinfold thickness (TSF) were used. Tocalculate the arm muscle circumference (AMC) according to the formula: AMC=MAC–3.14×the TSF. Two groups of patients with clinical symptoms andsigns were recorded before and after treatment, such as physical, mental status,chest tightness, dialysis hypotension, arrhythmia, angina, loss of appetiteanorexia. Record drug use during the adverse reactions, include nausea,vomiting, diarrhea, abdominal pain and other related cases of new symptoms.Record drug use during the adverse reactions, include nausea, vomiting,diarrhea, abdominal pain and other related cases of new symptoms.Results:(1)There were statistically significant difference of Hb and Hctbetween the treatment group and control groups before and after treatment(both P <0.05). The correct levels of Hb and Hct were significantly higherwhen we compared the treatment group and control groups before and aftertreatment.(2)After treatment, total cholesterol and triglyceride decreased in thetreatment group before and after treatment (P <0.05). There were statisticallysignificant difference compared with the control group (P <0.05).(3)In thetreatment group, when compared with before and after treatment, the levels of LAD, LVDd were significantly decreased （both P <0.05）, and the levels ofLVEF, E/A were significantly increased （both P <0.05）, respectively.Compared with control group, there was statistically significant difference (P<0.05).(4)In the treatment group, the patient nutrition indicators such as dryweight and Hb, TP, Alb, MAC, TSF and AMC were significant increasedcompared with before treatment and after treatment (P <0.05). Compared withcontrol group, there was also statistically significant difference (P<0.05).(5)The symptoms of chest tightness, dialysis hypotension, arrhythmia,angina and anorexia’s symptoms in both groups of patients had been improved,but the treatment group was significantly higher efficiency than the controlgroup (P <0.05).（6）In L-CN use process，clinical tolerance good, no seriousadverse reaction.Conclusion:1. L-CN can promote maintenance hemodialysis patients thecorrection of anemia, improve blood fat, improve nutrition, improve heartfunction, reduce dialysis complications.2. External sex L-CN, clinical tolerance, slightly adverse reactions. |
PDF Full Text Request