肾综合征出血热急性肾功能衰竭血液净化治疗

目的 探讨血液净化对肾综合征出血热急性肾功能衰竭的治疗效果。方法 12例肾综合征出血热急性肾功能衰竭患者分别给予血液透析或腹膜透析。结果 12例患者经血液透析或腹膜透析后随访半年至一年，尿量及肾功能均恢复正常。结论 早期血液净化是救治肾综合征出血热急性肾功能衰竭的有效治疗手段。     

11例药物致急性肾功能衰竭患者的腹膜透析治疗

１１例药物致急性肾功能衰竭患者的腹膜透析治疗江旭初江兴华余小燕药物致急性肾功能衰竭（急性肾衰）日益受到医护人员的关注，我院１９８６～１９９５年用腹膜透析（ＰＤ）方法治疗１１例药物致急性肾衰患者。报告如下。１病例与方法１．１病例：１１例患者中男８例，女...     

小儿心脏术后早期应用腹膜透析对预防急性肾功能不全的作用

目的:探讨小儿心脏术后早期应用腹膜透析术对肾脏的保护及治疗急性肾功能不全的作用.方法:本文回顾性分析2003年1月至2010年9月21例小儿心脏术后发生急性肾功能不全患儿.早期应用腹膜透析术的转归,比较术后开始应用腹膜透析术的时间对结果的影响.结果:术后4～8 h即应用腹膜透析术者15例,肾功能均恢复良好;迟至术后24～48 h应用腹膜透析术者6例,3例肾功能回复良好,3例未能控制肾功能衰竭.住院死亡5例,术后早期进行透析者死亡2例,死因与肾功能无关;术后较迟透析者死亡3例,与肾功能不全有一定关系.结论:小儿先天性心脏病术后早期发生肾功能不全者,早期进行腹膜透析对肾脏有一定保护作用,有助于肾功能恢复.     

先天性心脏病术后急性肾功能衰竭患儿腹膜透析疗效分析

目的探讨腹膜透析对先天性心脏病患儿术后急性肾功能衰竭的治疗效果。方法 :16例先天性心脏病心脏直视术后并发急性肾功能衰竭患儿行腹膜透析治疗,记录透析前、后血尿素氮、血清肌酐、血清K+及HCO3-浓度。结果腹膜透析1~3 d血钾恢复正常,3~6 d血HCO3-恢复正常,1~7 d尿量恢复正常,血肌酐及尿素氮下降明显;16例患儿均院内存活;透析期间出现腹透液外渗、引流不畅、低蛋白血症、血性腹腔积液等并发症,经及时处理后恢复正常。结论小儿先天性心脏病术后急性肾功能衰竭及时腹膜透析治疗可取得良好治疗效果。     

腹膜透析抢救小儿急性肾功能衰竭10例分析

腹膜透析是抢救急性肾功能衰竭主要方法之一。本院自1990年5月至1999年6月对10例急性肾功能衰竭患儿行腹膜透析治疗,疗效较满意,分析报告如下。1　资料与方法11　临床资料本组男5例,女5例,年龄6～13岁,体重17～41ｋｇ。所有患儿均符合小儿急性肾衰诊断标准[1]。原发病为:急性肾炎综合症5例,肾病综合征2例,急进性肾炎、青鱼胆中毒及氨基糖甙类抗菌素中毒各1例。所有患儿均表现为少尿型急性肾功能衰竭,透析前少尿达3～7天,其中4例已无尿2天以上。透析前血肌酐30940～114036ｕｍｏｌ/ｌ,尿素氮154～422ｍｍｏｌ/ｌ。其中伴有精神症状者6例,消化…     

小儿先天性心脏病术后并发急性肾功能衰竭腹膜透析16例观察与护理

对16例小儿先天性心脏病术后并发急性肾功能衰竭的临床资料进行分析,探讨提高此类患儿腹膜透析治愈率的方法。结果16例患者中,13例预后良好,肾功能恢复正常;死于顽固性低心排出量综合征1例,多器官功能衰竭1例,严重感染1例。认为腹膜透析是治疗小儿先天性心脏病术后并发急性肾功能衰竭的一种较有效的方法。     

腹膜透析中透析液引流不畅的原因分析和护理

腹膜透析是治疗急慢性肾功能衰竭及急性药物中毒的一项重要治疗措施,引流不畅是腹膜透析过程中常见的并发症,常因引流不畅而导致腹膜透析失败,现将我院1985～1986年间13例病人,24次引流不畅的原因及处理报告如下。一、临床资料本组13例,男7例,女6例,年龄16～7岁,平均39岁。12例为慢性肾功能衰竭,1例为毒蛇咬伤合并急性肾功能衰竭。13例中12例均采用持续性非卧床性腹膜透析(CAPD),每日4次,每次2000ml,每次保留腹腔3-4小时,夜间灌入2000ml,保留腹腔内12小     

小儿先天性心脏病术后并发急性肾功能衰竭腹膜透析16例观察与护理

对16例小儿先天性心脏病术后并发急性肾功能衰竭的临床资料进行分析,探讨提高此类患儿腹膜透析治愈率的方法.结果16例患者中,13例预后良好,肾功能恢复正常;死于顽固性低心排出量综合征1例,多器官功能衰竭1例,严重感染1例.认为腹膜透析是治疗小儿先天性心脏病术后并发急性肾功能衰竭的一种较有效的方法.     

血液透析和腹膜透析治疗蜂中毒引起的急性肾功能衰竭疗效观察

蜂中毒易出现急性肾功能衰竭 (acuterenalfailure ,ARF)和急性肝功能衰竭。血液透析和腹膜透析均为治疗急性肾功能衰竭的有效方法 ,我们对此类病例分组进行血液透析和腹膜透析 ,更进一步观察两种方法对蜂中毒的疗效。1　资料与方法1.1　病例选择　 1998～ 2 0 0 2年间收治蜂中毒患者 33例 ,男性 15例 ,女性 18例 ,年龄 2 9～ 5 1岁 ,平均 4 2 .5岁 ,病程 2～ 4天。所有病例均在毒蜂咬伤后出现少尿甚至无尿 ,并在当地经利尿剂治疗无效。入院后均急查肝肾功能、电解质、血尿常规和大便潜血等 ,结果显示 33例蜂中毒者血尿素氮 (BUN)、血肌酐…     

腹膜透析治疗小儿先心病术后急性肾功能衰竭

目的 探讨腹膜透析(PD)对小儿先天性心脏病术后急性肾功能衰竭(ARF)的治疗效果。方法 对36例先心病术后ARF行腹膜透析治疗患儿的临床资料进行透析效果、转归合并症进行回顾性分析。结果 单纯ARF的死亡率12.5％,显著低于合并其它系统器官衰竭组的45％(P<0.05),腹膜透析3～30天内肾功能恢复,其中1～2天内血钾[K~ ]恢复正常,2～5天内血碳酸氢根[HCO_3~-]恢复正常,4～6天内血尿素氮(BUN)下降49.2％,血肌酐(Cr)下降42.6％。结论 对小儿先心病术后ARF,及早进行腹膜透析具有较好的治疗效果。     

Acute hemodynamic effects of post cardiotomy peritoneal dialysis in neonates and infants

Objective: Evaluation of the acute hemodynamic changes during peritoneal dialysis in patients with low cardiac output syndrome and acute renal failure after open heart surgery.¶Patients: Three newborns and three infants after corrective surgery of congenital heart disease with post cardiotomy dialysis. Five of these had an open thorax during dialysis.¶Methods: Cardiac output measurements using the thermodilution technique on two consecutive days at four different times during the peritoneal dialysis cycle.¶Results: We did not find a deterioration of the cardiac index or systemic vascular resistance measured over two cycles in each of the six patients. Pulmonary artery pressure rose slightly after instillation of the dialysate solution in all patients. Changes in central venous pressure and left atrial pressure were not clinically meaningful. In all patients fluid removal by peritoneal dialysis was effective. All five surviving patients recovered renal function.¶Conclusions: Peritoneal dialysis can be performed in newborns and infants following cardiac surgery without causing acute hemodynamic imbalances. An open chest may have a significant impact on hemodynamic stability during peritoneal dialysis by blunting any possible negative alterations of increased intraabdominal pressure.     

先天性心脏病患儿手术后行腹膜透析的护理

目的了解先天性心脏病（先心病）惠儿手术后行腹膜透析（腹透）的监测指标及护理措施。方法2004年2月～2005年2月在我院行先心病纠治术患儿565例，其中8例患儿术后采用人工间歇性腹透治疗，通过对尿量的观察、血电解质的监测、容量负荷的计算以及肝肾功能的检测，及时把握腹透时机并积极处理并发症。结果8例患儿中1例因严重低心排出量而死亡。1例在完成腹透治疗后放弃治疗自动出院，余6例均在腹透支持下安全渡过急性肾功能衰竭少尿期后逐步恢复肾功能。顺利撤机，痊愈出院。结论复杂先心术后行腹透治疗能及时有效地纠正水电解质和酸碱平衡失调，帮助患儿渡过术后急性肾功能不全期，提高患儿的生存率。密切观察生命体征的变化，把握腹透的关键时机以及腹透期间的精心护理对患儿疾病的转归极为重要。     

慢性肾功能衰竭患者腹腔镜引导下腹膜透析置管术11例临床分析

目的:总结腹腔镜外科技术应用在放置Tenckhoff卷曲腹透管的经验。方法:选择11例慢性肾功能衰竭患者,在腹腔镜引导下将Tenckhoff卷曲腹透管置入腹腔并经皮下隧道引出。结果:11例患者腹透管均放置成功,手术时间约45min,均成功进行了腹膜透析,患者术后一周内出院。结论:腹腔镜引导下放置Tenckhoff卷曲腹透管具有腹透管放置定位准确,无手术切口,优于常规开腹手术,值得推广应用。     

Renal replacement therapy in congestive heart failure requiring left ventricular assist device augmentation

"Cardiorenal syndrome" is a term used to describe a dys-regulation of the heart affecting the kidneys, or vice versa, in an acute or chronic manner (1,2). Renal impairment can range from reversible ischemic damage to renal failure requiring short- or long-term renal replacement therapy (2). Patients who require mechanical circulatory support, such as a left ventricular assist device (LVAD), as definitive treatment for congestive heart failure or as a bridge to cardiac transplantation pose a unique challenge with respect to receiving dialysis, because they experience higher rates of morbidity and mortality from infection in the post-LVAD period (3-7). Acute dialysis access can pose an increased infection risk. In this article, we present a patient who required renal replacement therapy and a LVAD for management of acute-on-chronic cardiorenal syndrome while awaiting heart transplantation. A literature review to determine whether peritoneal dialysis or hemodialysis is superior for patients with profound hemodynamic dysfunction and the need to minimize risk of infection did not offer clear guidance about which modality is superior in patients with advanced congestive heart failure. However, there is clear evidence of the superiority of peritoneal dialysis in reducing the risk of systemic infection secondary to acute dialysis access. Given the high risk of LVAD infection, we therefore conclude that, to decrease mortality secondary to systemic infection, peritoneal dialysis should strongly be considered in patients who require renal replacement therapy before or after LVAD placement.     

体外循环心内直视术后急性肾功能不全患者的护理

笔总结体外循环术后发生急性肾功能不全的31例患的护理体会，认为体外循环术后并发急性肾功能不全最主要的原因是术后低心排和低血压，因此防止术后低心排和低血压的发生，能有效预防急性肾功能不全的发生，提高治愈率，一旦发生急性肾衰，宜早期透析治疗。     

Recombinant human atrial natriuretic peptide in ischemic acute renal failure: a randomized placebo-controlled trial

OBJECTIVE: Acute renal failure is associated with significant morbidity and mortality rates. Need for dialysis is an independent risk factor for early mortality after complicated cardiac surgery. Human atrial natriuretic peptide (h-ANP) is a potent endogenous natriuretic and diuretic substance. Exogenous administration of h-ANP increases glomerular filtration rate and renal blood flow in clinical acute renal failure. We have studied the effects of h-ANP on renal outcome in ischemic acute renal failure. DESIGN: A prospective, double-blind, randomized, placebo-controlled study. SETTING: Cardiothoracic intensive care units of two tertiary care centers. PATIENTS: Sixty-one patients with normal preoperative renal function suffering from postcardiac surgical heart failure requiring significant inotropic and vasoactive support. INTERVENTIONS: The patients were randomized to receive a continuous infusion of either recombinant h-ANP (50 ng.kg(-1).min(-1)) or placebo when serum creatinine increased by >50% from baseline. The treatment with h-ANP/placebo continued until serum creatinine decreased below the trigger value for inclusion or the patients fulfilled predefined criteria for dialysis. MEASUREMENTS AND MAIN RESULTS: The primary outcome variable was dialysis on or before day 21 after the start of treatment. Secondary renal outcome variables were dialysis-free survival at day 21 and creatinine clearance. Twenty-nine patients were assigned h-ANP and 30 placebo. Six (21%) patients in the h-ANP group compared with 14 (47%) in the placebo group needed dialysis before or at day 21 (hazard ratio, 0.28; 95% confidence interval, 0.10-0.73; p =.009). Eight (28%) patients in the h-ANP group compared with 17 (57%) in the placebo group suffered from the combined end point dialysis or death before or at day 21 (hazard ratio, 0.35; 95% confidence interval, 0.14-0.82; p =.017). h-ANP improved creatinine clearance in contrast to placebo (p =.040). CONCLUSIONS: Infusion of h-ANP at a rate of 50 ng.kg(-1).min(-1) enhances renal excretory function, decreases the probability of dialysis, and improves dialysis-free survival in early, ischemic acute renal dysfunction after complicated cardiac surgery.     

横纹肌溶解症并发急性肾功能衰竭患者的护理

目的探讨横纹肌溶解症(rhabdomyolysis,RM)合并急性肾功能衰竭(acute renal failure,ARF)患者的护理方法。方法回顾性分析2010年以来第二军医大学长征医院收治的7例RM致ARF患者的临床资料,并总结其护理方法。结果所有患者均于发病48～72h内接受透析治疗。通过治疗与护理,所有患者各项肾功能指标均恢复正常,尿量增多,痊愈出院。结论加强晚夜间血液透析(hemodialysis,HD)的护理,对ARF患者的治疗具有一定的必要性与积极意义。     

Cloxacillin-induced acute tubulo interstitial nephritis.

OBJECTIVE: To report a case of possible cloxacillin-induced acute tubulo interstitial nephritis (AIN). CASE SUMMARY: A 15-year-old male patient presented with hypertension, edema, lumbar pain, sterile pyuria, eosinophiluria (ten percent), and severe renal dysfunction three months after the ingestion of cloxacillin. A renal biopsy revealed diffuse edema and inflammatory infiltrate of the interstitium (five percent eosinophils). He received four sessions of peritoneal dialysis with dramatic improvement in urinary output and renal function. His biochemical parameters returned to normal values 21 days after admission, without the use of glucocorticosteroids. DISCUSSION: Published case reports on AIN induced by penicillin and related drugs are reviewed and compared. The role of interstitial edema in acute renal failure associated with drug-induced AIN is mentioned. CONCLUSIONS: AIN is a rare but significant complication of therapy with penicillin and related drugs. The clinical picture is similar for all of these drugs, but skin rash and fever are absent in AIN induced by cloxacillin and cloxacillin-related drugs. Dialysis improved the patient's urinary output and renal function. Beta-lactam antibiotics should be avoided in patients with cloxacillin-induced AIN.     

Integrated hemodynamic response to hemofiltration and peritoneal dialysis in patients with acute renal failure

Central hemodynamics was studied by integral polyrheography in 24 patients with acute renal failure (ARF) during hemofiltration (HF) and in 18 patients with ARF during peritoneal dialysis. All central hemodynamic parameters improved by the end of HF. However stroke volume decreased by 26.6%, stroke index by 24.4%, minute volume by 25.7%, and cardiac index by 24.8% as early as at the moment of extracorporeal contour filling. This was paralleled by an increase of total peripheral vascular resistance from 1321 +/- 124 to 1586 +/- 106 din/(cm*c-5) (by 16.7%). Hence, clear-cut signs of centralization of circulation were seen during the initial period of HF in patients with ARF. Peritoneal dialysis did not lead to centralization of circulation in patients with ARF; moreover, minute heart volume increased by 9% during some stages of the procedure, stroke volume increased significantly (p < 0.05), other parameters increased, but total peripheral vascular resistance was virtually unchanged. After removal of dialysis solution from the abdominal cavity all hemodynamic parameters returned to the initial values. Hence, both hemofiltration and peritoneal dialysis ameliorate the central hemodynamics. However peritoneal dialysis does not involve even temporary centralization of circulation, which has a positive impact on the course of acute tubular necrosis.