维持性血液透析患者运动模式的研究进展

正终末期肾脏病(end stage renal disease,ESRD)是各种原因导致的慢性肾衰竭的最严重阶段,意味着患者的肾功能完全或接近完全丧失,是一种威胁生命的疾病。随着高血压、糖尿病等慢性疾病的发生率增高及人类寿命的延长,ESRD患病率也越来越高~([1]),截止到2007,北京市民每百万人口就有486例的ESRD患病者,预计到2020年,在我国每百万人口就有1200例ESRD患者~([2])。     

针对透析患者的营养不良应深入研究及规范性治疗

维持性透析治疗的终末期肾脏病患者逐年增加已成为世界性的公共卫生和社会问题。2002-2003年世界各地统计数据显示，澳大利亚、欧洲、美国每百万人的终末期。肾脏疾病（ESRD）患病率分别达658、700、1403人。随着我国经济水平的提高，透析技术的不断发展，维持性透析患者长期生存率大大提高，但营养不良的问题日趋突出。不仅影响患者的生活质量，也是并发症和病死率增加的一个重要因素，因此防治透析患者营养不良是肾脏病工作者面临的重要课题。     

上海市透析登记及其结果分析

目的通过上海市透析登记及其结果分析,反映上海市终末期肾病患者透析治疗的总体现状。方法上海市血液透析质量控制中心通过上海市"透析登记网络"系统,将2010年1月1日到2010年12月31日接受到的全市60家医院登记资料(其中开展血液透析共60所医院63家血液透析室,开展腹膜透析共38家医院),对所登记的资料进行统计分析。结果 2010年全年新增透析患者1621例(每百万人口发病率114.8pmp),较上一年度增加9.2%;其中血液透析占75.8%,腹膜透析占24.2%。2010年12月31日年末透析患者10508例(每百万人口点治疗率744.0pmp),较上一年度增加14.6%;其中血液透析占80.6%,腹膜透析占19.4%。透析患者主要原发病因仍然是慢性肾小球肾炎(46.2%),新增透析患者中,糖尿病占第2位(19.5%)。全年透析患者主要死亡原因依次为脑血管意外(22.4%)、感染(19.6%)和心血管事件(15.2%);年末透析患者中透析龄5年以上的占30.8%。患者透析充分性、贫血治疗状况、乙型肝炎和丙型肝炎病毒感染控制不断改善和提高。结论上海市终末期肾脏病(ESRD)透析患者逐年增加,主要原发病因为肾小球肾炎,新增患者中,糖尿病患者逐年增加,血液透析仍是目前上海市ESRD患者主要透析治疗模式。     

血液净化模式选择专家共识

正前言近年来,我国终末期肾病(end-stage kidney disease,ESRD)发病率逐年增长并增幅加快,增长速度远远高于人口增速(1.1%),每年约有2%的患者进入ESRD,据CKD-NET报告,我国接受肾脏替代治疗的尿毒症发病率为122.19/百万人口,患病率已达442.13/百万人口~([1])。慢性肾脏病(chronickidneydisease,CKD)患者肾功能下降到什么程度需要开始肾脏替代治疗(renal replacement therapy,RRT)?随着年代的推     

维持性血液透析患者体力活动水平研究现状

终末期肾脏病（End-stage Renal Disease,ESRD）是慢性肾脏病的最后一期,是患者死亡的主要原因,与生活质量下降、病死率高、疾病负担重有关,在全球的发病率和患病率显著增加[1-2]。目前,维持性血液透析（MHD）是应用最广泛的替代疗法。Jain Ak等[3]对全球130个国家透析患者数量分析显示，血液透析占患病的87．6％。     

血液透析患者生存质量的研究进展

正终末期肾脏病(end stage renal disease,ESRD)是指肾脏不可逆地完全丧失过滤人体代谢废物、盐和水的功能,是一切进展性肾脏疾患的最终结局~[1]。血液透析(HD)是终末期肾脏病肾脏替代治疗的重要方式。由于肾脏功能丧失,毒素在体内蓄积,终末期肾脏病患者如不进行透析治疗,将在数日内死亡。按照患病率除以年新发病率计算,我国终末期肾脏病患者的平均生存期只有2.5年,如进行规范透析治疗,平均生     

维持血液透析患者血清超敏C反应蛋白水平与营养状态、心血管疾病的相关性研究

正近年来,我国慢性肾脏病的发病率有逐年升高的趋势,流行病学调查表明我国慢性肾脏病的患病率高达10.8%[1],其中部分患者病情进展、肾功能减退,最终发展至终末期肾病(ESRD)需要接受维持性血液透析(MHD)等肾脏替代治疗技术以维持生命。心血管疾病(CVD)是引起MHD患者死亡的首要原因[2],而MHD广泛存在的微炎症及营养不良状态与患者的不良预后密切相关[3]。本研究旨     

基于蛋白质-能量消耗谈老年维持性血液透析患者体医结合管理的必要性

正终末期肾脏病(end stage renal disease,ESRD)是慢性肾脏病(chronic kidney disease,CKD)的终末阶段,需要接受肾脏替代疗法如腹膜透析、血液透析或肾移植才能得以长期生存。其中维持性血液透析(maintain hemodialysis,MHD)的应用最为广泛~([1])。据美国肾脏病数据系统(USRDS)报道,近年来老年MHD的患病率和发病率呈逐年增长     

维持性血液透析患者发生脑血管意外的危险因素分析及护理措施

我国终末期肾脏病的发病率达10人/10万人口,年增长率8.7%,维持性血液透析(MHD)是终末期肾衰竭(ESRD)患者替代治疗的主要方法之一[1]。随着血液透析技术不断提高和血液透析方法的不断改进,患者的平均生存期和生存质量逐步提高,但脑血管意外的发生率和病死率仍然居高不下,严重影响MHD患者的长期存活,是患者的主要致死原因之一。本文对我院血液透析中心2008年1月～2011年12月并发脑     

自体动静脉内瘘的建立对终末期肾病患者心脏功能影响的研究进展

正慢性肾脏病(chronic kidney disease,CKD)严重影响人类健康,全球人口患病率已高达14.3%。2012年,我国CKD横断面流行病学研究显示18岁以上人群患病率为10.8%[1]。全球接受治疗的终末期肾病(end stage renal disease,ESRD)患者为320万,并以每年6%的速度增长,增长速度高于人口增速(1.1%)[2]。尽管肾移植是ESRD患者最好的替代治疗方法,但由于供体因素限制,维持性血液透析(maintenance hemodialysis,MHD)仍是多数ESRD患者首选的替代治疗方式。     

An epidemiological survey of hemiplegic migraine

The objective of the present study was to use systematic nation-wide case-finding methods to establish the prevalence and sex ratio of hemiplegic migraine (HM) in the entire Danish population of 5.2 million inhabitants. Affected patients were identified from three different recruitment sources: the National Patient Register, case records from private practising neurologists and advertisements. Based on the observed number of affected patients from each case-finding method, it was attempted to estimate the total number of affected patients by means of the statistical method known as capture-recapture. Two hundred and ninety-one affected patients were identified; 147 were familial HM from 44 different families, 105 were sporadic HM and 39 were unclassifiable HM. The HM sex ratio (M:F) was 1:3. Based on the identified number of affected patients the prevalence of HM at the end of 1999 was estimated to be 0.01% in Denmark, where the familial and sporadic form were equally frequent.     

Prevalence and severity of symptoms in terminal cancer patients: a study in Taiwan

 This paper reports a prospective study conducted between September 1997 and July 1998 in 232 consecutive patients with terminal cancer. A structured data collection form was used daily to evaluate symptoms, which were analyzed at the time of admission, 1 week after admission and 48 h before death. Terminal cancer patients in this study were polysymptomatic. There were no statistically significant differences in the prevalence of most symptoms with the primary site of cancer. The majority of symptoms improved at the end of the 1st week after admission, but many symptoms worsened just before death. The high prevalence of symptoms and lack of significant difference among primary tumor sites may be related to shorter survival times caused by late referral, which is common in Taiwan. Published online: 17 January 2000     

The size of the pressure-sore problem in a teaching hospital

A series of three prevalence surveys were undertaken in a teaching hospital (where medical students are taught) in the West Midlands of England to identify the numbers of patients at risk of developing pressure sores and the actual number of patients with pressure sores, prior to the purchase of pressure-relieving equipment. All in-patients were assessed using the Waterlow score. Full details of all pressure sores and any pressure-relieving equipment in use was recorded. There was a mean pressure sore prevalence of 7.32%, the prevalence for each survey being 8.77%, 5.1% and 8.1% respectively. Grades 2 and 3 were the most commonly reported grades and the sacrum was the most frequent position. It was anticipated that there would be a difference in dependency between the patient populations in each of the three surveys. This was not so and, when using the Waterlow score, the numbers of patients found to be at no risk, at risk and at high risk remained remarkably stable. Only those in the very high risk category fluctuated. It is postulated that the difference between the prevalence in the three surveys is related to the difference in the numbers of patients seen to be at very high risk. These surveys have provided a basis for selecting pressure-relieving equipment and baseline information for monitoring the efficacy of the prevention programme.     

广西桂平市2004～2008年血液透析状况及其变化调查

目的了解桂平市2004～2008年血液透析状况及其变化。方法收集2004年1月～2008年12月桂平市登记血液透析的数据,回顾性研究桂平市终末期肾脏疾病（ESRD）血液透析（HD）患者发病者数、患病者数和死亡人数,原发病症构成及其相关因素的变迁。结果桂平市HD患者年发病者数、患病者数逐年增加,年死亡人数也逐年增加。各年度患者男性均多于女性,但男女比例有逐年下降趋势;各年龄组相对稳定。慢性肾炎导致的ESRD的比例虽然在逐年下降,但仍然是ESRD血液透析的主要原因。糖尿病和高血压所占比例逐年上升。HD患者透析龄的构比,〈1年组占绝大多数,1～2年组、2～3年组相对稳定。肾移植数无变化,改作腹膜透析人数没有变化。心血管事件居死亡原因之首,占28.6%,第二为脑血管意外占11.9%,第三、第四位为感染性疾病和呼吸衰竭各占4.8%。结论桂平市HD患者数量在逐年增加,年龄组相对稳定。慢性肾炎仍然是主要原因,糖尿病和高血压所占比例在逐年上升。HD患者长期存活率没有提高。首要死亡原因为心血管事件。     

Quantitation of red cell-bound IgG by an enzyme-linked antiglobulin test in human immunodeficiency virus-infected persons

Anemia, thrombocytopenia, and neutropenia have been observed in patients with acquired immune deficiency syndrome (AIDS) and AIDS-related complex. To investigate whether red cells (RBCs) of patients with human immunodeficiency virus infection were coated with IgG and/or complement (C3), blood samples of 239 patients were tested. The prevalence of a positive direct antiglobulin test on RBCs was 16.7 percent. By use of an enzyme-linked antiglobulin test (ELAT) to measure more accurately the number of IgG molecules per RBC in a group of 67 patients, 30 of the 67 individuals were observed to have increased numbers (mean, 155) compared to normal controls and to patients with hypergammaglobulinemia due to multiple myeloma or chronic liver disease. Hemoglobin level was correlated with the number of IgG molecules per RBC (p = 0.008), but no correlation could be demonstrated between those numbers and serum immunoglobulin (p = 0.10) or circulating immune complexes (p = 0.38). Our results with ELAT suggest that some AIDS patients may have specific binding of IgG on the surface of their RBCs, rather than nonspecific uptake; further clinical correlations are necessary to confirm these findings.     

Implications of National Guidance for Implantable Cardioverter Defibrillation Implantation in the United Kingdom

PLUMMER, C.J., et al. : Implications of National Guidance for Implantable Cardioverter Defibrillation Implantation in the United Kingdom . To determine the number of patients fulfilling recently issued national guidelines on the use of ICDs in patients with arrhythmias, the authors undertook two observational audits of clinical records. The first audit included patients investigated and treated at a tertiary referral cardiothoracic center during a 1-month period, and the second included patients admitted to the three coronary care units serving a circumscribed district population during a second month. Patient records were audited against the recommendations for ICD implantation made by the National Institute for Clinical Excellence to determine if the patient fulfilled the criteria for ICD implantation. The audit was repeated with the same patient records against the MADIT 2 selection criteria. The audit identified underprovision of ICD therapy in the United Kingdom for a variety of reasons. It also demonstrated that the number of patients fulfilling selection criteria defined by the national guidelines for ICD implantation is far in excess of the numbers predicted. The annual incidence of patients fulfilling national criteria is about 150/million, with an additional "prevalence" of at least 41/million. Applying the less restrictive MADIT II criteria to select patients for ICDs as a primary prevention increased the numbers to 504/million ("new incidence") and 311/million ("prevalence") per year, in excess of the predictions by a factor of between 10 and 25. (PACE 2003; 26[Pt. II]:479–482)     

Effects of Flavophospholipol on Resistance in Fecal Escherichia coli and Enterococci of Fattening P

A "plasmid-curing effect" of multiresistant Escherichia coli by flavophospholipol, an antibiotic used as an antimicrobial growth promoter (AMGP) in animal feeds, has been reported to occur in vitro and in vivo under experimental conditions. In this study, the effect of flavophospholipol under field conditions was studied. The prevalence and degree (proportion of resistant strains to the total numbers present per gram of feces) of resistance of indicator bacteria, E. coli and enterococci, was determined in fecal samples from three groups of pigs that were fed a commercial finisher feed without any AMGP. Group A was the negative control group without any AMGP, group B received the same feed with 9 mg of flavophospholipol/kg of feed (study group), and group C received the same feed with 15 mg of avoparcin/kg (positive control). Fecal samples from each pig were collected at the start and at the end of the study and assessed for the prevalence and degree of resistance against antibiotics commonly used either for therapy in pig medicine or as an AMGP. Before the start of the study, all pigs were colonized with multiresistant E. coli by mixing three resistant pig isolates through their feed after disturbance of the colonization resistance of the intestinal flora by a 3-day course of lincomycin and spectinomycin. At the end of the study, the overall prevalence and degree of resistance of E. coli in the fecal flora had increased significantly in groups A and C but remained at the same level as at the start of the study in group B. The prevalence of vancomycin resistance was 44 and 41% in groups A and B, respectively, but only very low numbers of vancomycin-resistant enterococci (VRE) per gram of feces were found. In the avoparcin-fed group, the prevalence was 72%, and in 57% of the samples, more than 50% of all enterococci present were vancomycin resistant. The prevalence of resistant Enterococcus faecalis increased only in the flavophospholipol-exposed group, from 23% before the start of the study to 43% at the end of the study. It was concluded that flavophospholipol effectively suppressed the augmentation and dissemination of multiresistant E. coli in the intestinal flora of fattening pigs. Avoparcin use strongly selected for VRE carriage and excretion. Therefore, as neither flavophospholipol nor any related molecule is used therapeutically, no cross-resistance with therapeutic antibiotics exists and no transmissible resistance has been shown; the major decrease in resistance in intestinal E. coli of flavophospholipol-fed animals seemed to outweigh the small increase in the risk of transfer of flavophospholipol-resistant E. faecalis from animals to humans via the food chain.     

A national survey of prevalence of cardiopulmonary resuscitation training and knowledge of the emergency number in Ireland

Aim

The aim of this survey was to establish prevalence of cardiopulmonary resuscitation (CPR) training within the last 5 years and reasons preventing training and initiation of CPR in Ireland as well as awareness of the emergency numbers.

Methods

An in-home omnibus survey was undertaken in 2008 with quota sampling reflecting the age, gender, social class and geography of Ireland.

Results

Of the 974 respondents, 23.5% had undergone CPR training in the previous 5 years with lower social class and age 65 years and older significantly less likely to be trained. The workplace was both a major source of awareness as well as training for those trained. In the untrained group lack of awareness of the need for CPR training was the most significant reason for non-training. Cost was not cited as a barrier. 88.9% of people gave a correct emergency number with geographical variation. Notably, the European emergency number 112 was not well known.

Conclusion

Previous Irish and American population targets for CPR training have been surpassed in Ireland in 2008. New internationally agreed targets are now required. Meanwhile older people and those in lower socio-economic groups should be targeted for training. Awareness of at least one emergency number is very high in Ireland. Some geographical variation was found and this should be studied further.     

B型脑钠肽与慢性充血性心力衰竭预后的研究

目的探讨B型脑钠肽（BNP）与慢性充血性心力衰竭预后的关系。方法2008年1月-10月收治的慢性充血性心力衰竭患者100例,均符合美国心脏病协会分级标准（NYHA）Ⅲ～Ⅳ级,快速检测BNP,观察心血管事件发生组与未发生组患者血浆BNP浓度差异。结果发生心血管事件患者血浆BNP浓度显著升高,未发生心血管事件患者血浆BNP浓度下降。血浆BNP浓度与心血管事件发生有密切关系。结论BNP水平可以指导心力衰竭患者的治疗,并可以预测失代偿期充血性心力衰竭患者的预后。