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1.
慢性肾脏病(chronic kidney disease,CKD)的患病率在全球范围内呈明显上升趋势,已经成为全球性的公共健康问题。我国CKD患病率高达11.8%~13.0%。心血管疾病(CVD)是CKD5期透析患者主要并发症和致死原因。研究表明,35%-50%的终末期肾脏病(ESRD)患者死于CVD,且ESRD患者的CVD的死亡率是正常人群的10-30倍;  相似文献   

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韦洮  王梅 《中国血液净化》2008,7(4):210-212
据美国和其他国家透析登记数据表明患心血管疾病的终末期肾病(ESRD)患者是非透析人群的6-10倍。许多研究表明ESRD患者有许多产生心血管疾病的高危因素如交感神经系统活性增强、氧化应激增加以及广泛的动脉钙化。研究表明交感神经系统(SNS)和肾脏有很强的联系,2005年JianchaoXu等研究发现肾脏分泌一种新的蛋白质,被称之为“renalase”。是依赖黄素腺嘌呤二核苷酸(FAD)的单胺氧化酶,其可降解循环中的儿茶酚胺从而降低交感神经系统的活性,调节心血管的功能及外周血压。  相似文献   

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王宓 《中国血液净化》2008,7(5):275-279
心血管疾病(CVD)是终末期肾脏病(end stage renal disease,ESRD)患者的主要并发症及死亡原因,占总死亡的大约50%。血管钙化(vascular calcification,VC)是慢性肾脏病(chronic kidney disease,CKD)尤其是ESRD患者的一个常见并发症,  相似文献   

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目前,血液透析(HD)是终末期肾脏疾病(ESRD)患者最常用的替代治疗方法之一,但ESRD患者心血管并发症是影响其生存的主要原因。据报道维持性血液透析(MHD)患者80%以上患有心血管疾病,其死亡率高出一般人群10~20倍。研究发现,血管内皮细胞(VEC)损伤是触发和(或)促进动脉粥样硬化、高血压、心肌梗死和心力衰竭的关键因素,而VEC功能障碍普遍被认为是ESRD患者的基本特点,并且参与了心血管疾病发生发展。本文就血液透析对VEC的影响作一综述。  相似文献   

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透析患者心血管疾病的防治   总被引:2,自引:1,他引:1  
随着透析技术的发展,透析在治疗尿毒症过程中出现的并发症已明显减少,但是心血管并症仍有很高的发病率,这也是造成透析患者死亡的主要原因。美国肾脏数据库(USRDS)显示终末期肾病(ESRD)患者中,38%死于心血管疾病(CVD),而其中接受肾脏替代治疗的患者CVD死亡率显著升高,65岁以上人群中,接受透析的患者CVD死亡率是普通人群的5倍.  相似文献   

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心血管疾病(CardiovascularDisease,CVD)是终末期肾脏病(End—stageRenalDisease,ESRD)患者死亡的首要原因。尽管以血液净化技术为代表的肾脏替代疗法已能使ESRD患者摆脱尿毒症的威胁,但是,与普通人群相比,ESRD患者因CVD而死亡的人数仍居高不下。国内外流行病学调查结果均表明逾半数的ESRD患者死于CVD^[1]。ESRD患者高CVD发病率严重削弱了血液净化的疗效,在造成医疗资源浪费的同时亦成为沉重的社会负担。临床和实验研究表明,ESRD高CVD发病率与钙磷代谢紊乱及其与之相关的血管钙化(vascularcalcification)密切相关。  相似文献   

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1972年美国社会保险立法修订案决定为终末期肾病(ESRD)治疗提供基金,并开始对其发病和患病情况进行监测。1988年美国建立了肾脏病数据系统(USRDS),使监测数据更为准确。美国大学的Rosansky教授着眼于ESRD开始透析时机,对美国ESRD管理系统进行了回顾,并对美国未来几十年ESRD的发病和患病趋势进行了预测。慢性肾脏病(CKD)时患者肾功能逐渐下降,达到什么程度就能被叫做ESRD?在美国初始覆盖肾脏替代治疗(RRT)时,残余肾功能(RRF)下降到原始值的5%时,患者被称为ESRD,可以接受RRT。之后用作ESRD定义的RRF值逐渐提升到原始值的10%、15%。从1996年到2009年,RRF还剩超过10%的患者即开始RRT的患者占全部开始RRT治疗患者比例从19%上升到54%。但是,最新发表的一系列观察性研究均表明了早开始透析对患者的长期存活是有害的。也许是由于这些研究结果的发布,美国ESRD发病率白2010年后呈下降趋势,同时没有观察到RRT患者死亡率的增加,提示了避免过早透析的安全性和益处。美国ESRD治疗在1981年耗资仅16亿,而2011年高达近340亿元,花费骤增的原因与治疗人数的增加不无关系。较早开始RRT是ESRD发病率和患病率升高的一个重要原因,或许延迟透析会降低RRT发病和患病率,从而降低ESRD治疗成本。据USRDS统计,75岁以上ESRD患者多较早开始透析治疗,预计至2030年该人群患者人数将翻倍。相应的,美国ESRD报销计划纳入了排除RRT的保守治疗方案,这有利于十分危重的老年患者选择保守治疗,而减少RRT的使用。  相似文献   

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终末期肾脏病(end—stage renal disease,ESRD)患者存在着异乎寻常的心血管疾病的高发病率和病死率,其五年生存率甚至比限多癌症还低。研究显示,高血压是心血管事件的重要风险因素,而心血管疾病又是ESRD患者的首要死因,因此控制高血压的发生发展对改善ESRD患者的长期预后至关重要.  相似文献   

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终末期肾病(end-stage renal disease,ESRD)是一种不可逆的慢性渐进性疾病,是各种原因所致慢性肾功能衰竭(chronic renal failure,CRF)的最严重阶段。据国际肾脏病协会统计,CRF在自然人群中的年发病率为98/100万-198/100万,而目前我国ESRD患者的患病率已超过300/100万。ESRD患者的主要治疗手段依赖透析,其巨额费用给家庭带来了沉重的家庭负担。  相似文献   

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慢性肾脏病发病率逐年增高,进入终末期肾脏病(ESRD)的患者逐年上升。而透析病人心血管疾病的发病率和死亡率高且预后极差[1],其中约50%患者死于心血管并发症。尽管传统的心血管疾病(CVD)危险因素如高血压、血脂异常、抽烟和糖尿病相当普遍,  相似文献   

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Tiotidine and cimetidine kinetics and dynamics were compared to assess mechanisms of the longer duration of effect of tiotidine in man. Both drugs has similar lag times for absorption. Tiotidine with a meal was more slowly absorbed than when fasting and was also more slowly absorbed than cimetidine with a meal. The elimination rates for both drugs did not differ; they were both approximately 2 to 3 hr. Oral doses of cimetidine achieved areas under the plasma concentration curve approximately three times that of tiotidine but these concentrations were only 1/10 as potent. The cimetidine concentration inducing 50% inhibition of food-stimulated gastric acid secretion was 0.41 +/- 0.04 whereas it was 0.04 +/- 0.003 microgram/ml for tiotidine. The effect of tiotidine lasted longer than that of cimetidine because the doses recommended for use in man resulted in higher concentrations in plasma relative to effective concentration than clinical doses of cimetidine.  相似文献   

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The goal of this study was to identify an injectable anesthetic protocol that provides sedation sufficient for peripheral vascular catheterization, intubation, and transport while minimizing cardiovascular changes in Yorkshire and Yucatan pigs with and without cardiovascular injury and intervention (CI). Phase 1 examined the safety and efficacy of acepromazine–ketamine, diazepam–ketamine, midazolam–ketamine, and medetomidine–ketamine in 5 healthy Yorkshire pigs. For each drug combination, we obtained multiple measurements of heart rate, blood pressure, respiratory rate, temperature, sedation score, ability to catheterize and intubate, and recovery score. Phase 2 evaluated and refined the dose of the most effective Phase 1 anesthetic combination (midazolam–ketamine) in healthy and CI Yorkshire pigs (n = 53 trials). Phase 3 mirrored Phase 2 but tested midazolam–ketamine in healthy and CI Yucatan pigs (n = 34 trials). Midazolam (0.5 mg/kg)–ketamine (25 to 27 mg/kg) was the most effective anesthetic combination in healthy Yorkshire pigs, but this dose was less effective in healthy Yucatan pigs and CI Yorkshire and Yucatan pigs. Midazolam–ketamine resulted in tachycardia and apnea more frequently in CI pigs than healthy pigs. This combination also caused vomiting in one CI Yucatan pig. Overall, midazolam–ketamine provided safe and effective sedation for catheterization and intubation of both healthy and CI pigs. This study suggests Yucatan pigs may require a higher dose midazolam–ketamine to achieve the same level of sedation as that in Yorkshire pigs. Although anesthetic complication rates were higher in CI pigs, our results indicate that midazolam–ketamine can be safely used for sedation of both pig breeds with and without CI.Abbreviation: CI, cardiovascular injury and interventionPigs (Sus scrofa) are common models of cardiovascular injury and intervention (CI) that largely have replaced traditional canine cardiology models. Advantages of swine compared with dogs include anatomic and physiologic characteristics similar to humans, such as similar coronary artery distribution and effective collateralized blood flow to the myocardium after coronary artery blockage.23 However, pigs are difficult to restrain and anesthetize due to their size and resistance to sedative drug combinations, including those with morphine.24 Injectable sedative drugs may result in cardiovascular and respiratory effects such as increased cardiac work and oxygen consumption, tachycardia, bradycardia, apnea, hypertension, and hypotension.5,6,8-12,14,19,20,25-29 These side effects can pose considerable problems for CI pigs, and anesthesia protocols with minimal effects on cardiovascular function are needed. A literature review revealed no published studies of anesthetic protocols in swine with existing cardiovascular injury; published research is limited to investigating anesthesia protocols for experimental induction of CI or determining in vitro and in vivo drug effects on healthy cardiovascular systems.4-6,8-12,14,19-21,25-29 Other published studies have limited investigations to studying sedative and physiologic effects in healthy Yorkshire, Yucatan, mixed-breed, Landrace, and Gottingen miniature swine.2,3,10,13,17,18,20-22We conducted the current study to address the need for a systematic investigation of anesthetic protocols in CI Yorkshire and Yucatan pigs. The goals of this study were to determine an injectable-only anesthetic protocol for both Yorkshire and Yucatan pigs that yielded sufficient sedation for peripheral vascular catheterization, sufficient duration for transport, and minimal cardiovascular effects while being safe and effective for CI pigs.  相似文献   

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