心脏手术后急性肾功能衰竭的治疗

目的 探讨提高心脏手术后急性肾功能衰竭(ARF)疗效的措施。方法 心脏手术病人发生ARF29例，术前心功能Ⅲ级9例，Ⅳ级20例。术前肾功能正常21例，氮质血症8例。全组采用早期强化利尿治疗，最后需要透析治疗的患者应用早期或晚期腹膜透析或血液透析治疗。结果 全组药物治愈14例，透析治疗15例。透析治疗存活8例，死亡7例。透析治疗病例中，腹膜透析8例，存活6例，死亡2例；其中早期腹透7例，存活6例，死亡1例，晚期腹透1例，死亡。血液透析7例，存活2例，死亡5例；其中早期血透3例，存活2例，死亡1例，晚期血透4例，全部死亡。结论 提高心脏手术后ARF疗效的方法是及时诊断、尽早治疗、强化利尿和积极透析治疗。     

血清铁蛋白及甲状旁腺素在肾功能衰竭中的应用

目的 :探讨血清铁蛋白及甲状旁腺素在急、慢性肾功能衰竭 (肾衰 )中的应用价值。方法 :随机选取使用血透治疗的急、慢性肾衰患者各 30例 ,分为急性肾衰组 (ARE) (A组 ,30例 )和慢性肾衰组 (CRF) (B组 ,30例 ) ,并选择 30名健康体检者 (C组 )作为对照组 ,检测血清铁蛋白 (SF)、甲状旁腺素 (PTH)、血清铁 (SI)、血清尿素 (Urea)、肌酐(Cr)、尿酸 (U A) ,并进行相关的统计学分析。结果 :A组 SF水平明显高于 B组和 C组 (P<0 .0 1) ,B组与 C组 SF比较差异无显著性 (P>0 .0 5 ) ;B组 PTH水平明显高于 A组和 C组 (P<0 .0 1) ,A组与 C组 PTH比较差异无显著性 (P>0 .0 5 )。结论 :急性肾衰患者血清铁蛋白明显增高 ,慢性肾衰患者血清铁蛋白无明显变化 ;慢性肾衰患者血清甲状旁腺素明显增高 ,急性肾衰患者血清甲状旁腺素无明显变化。     

46例鱼胆中毒并急性肾衰的临床分析

目的　总结鱼胆中毒并急性肾衰的临床特点及治疗体会。方法　对 46例鱼胆中毒并急性肾衰患者的临床资料进行回顾性分析 ,并分别对就诊时间与预后、血透次数 ,以及对死亡病例的相关因素进行观察。结果　 41例痊愈 ,5例死亡。其中出现少尿后 3天内来就诊者 3 2例 ,死亡 2例 ,3 0例痊愈患者平均血透次数为 2 .9次 ;3天以上来就诊 14例 ,死亡 3例 ,11例痊愈患者平均血透次数为 5 .7次。两者相比 ,差异有显著性 ,P <0 .0 5。 5例死亡病例 ,或服食鱼胆过多 ,或 (和 )就诊时间过晚。结论　鱼胆中毒患者预后与服毒剂量、就诊时间的早晚相关 ,早期洗胃、输液 ,应用地塞米松、山莨菪碱、维生素B6 并血液透析可减少血透次数和病死率。     

183例急性肾功能衰竭治疗分析

目的　总结探讨急性肾功能衰竭 (ARF)的治疗经验。方法　对 183例ARF患者进行内科综合治疗联合血液净化治疗的方法及效果进行分析。结果　所有病例严重并发症均得到不同程度纠正 ,自觉症状缓解 ,治愈 15 7例 (5 8.79% ) ,死亡 2 1例 (11.48% ) ,其中 19例死于多脏器功能衰竭 (MSOF) ,5例 (2 .73 % )转为慢性肾功能衰竭 (CRF)需长期维持血透治疗。结论　积极的内科综合治疗和早期血液充分净化治疗对抢救ARF有意义。     

颈椎牵引治疗中间歇时间对疗效的影响

目的　探讨颈椎牵引治疗中间歇时间对牵引效果的影响。方法　将 172例患者随机分为A、B 2组 ,分别用不同的间歇时间 ( 10s、3s)进行颈椎牵引以观察疗效。结果　A组 98例 ,治愈 3 4例 ,显效 4 0例 ,好转 2 1例 ,总有效率为 96.94 % ;B组治愈 18例 ,显效 2 6例 ,好转 2 0例 ,总有效率为 86.4 9%。A组疗效优于B组(P <0 0 5 )。结论　适当的间歇时间 ( 10s)有利于提高颈椎牵引治疗的效果     

重症急性胰腺炎的早期非手术治疗

目的探讨重症急性胰腺炎 (SAP)的早期非手术治疗。方法分析 1 986-2 0 0 1年收治的SAP1 0 3例的临床资料 ,按各个阶段治疗方法不同分为 2组 :A组 1 986-1 994年以手术治疗为主 5 1例 ,B组 1 995 -2 0 0 1年以非手术治疗为主 5 2例。结果A组死亡率为 3 1 .3 % (1 6/ 5 1 ) ,休克、肾衰、继发感染等并发症发生率为 5 7.9% (2 7/ 5 1 ) ,B组则分别为 7.8% (4 / 5 2 )及 1 3 .6% (7/ 5 2 )。两者相比均有显著性差异 (P <0 .0 1 )。结论早期非手术治疗重症胰腺炎优于手术治疗     

肝素疗法治疗肾病综合征并急性肾功能衰竭的临床观察

为探讨肝素在肾病综合征 (NS)并急性肾功能衰竭 (ARF)中的治疗作用 ,将 38例NS并ARF患者随机分为对照组(A组 ) 18例 ,治疗组 (B组 ) 2 0例 ,A组常规综合治疗 ,B组在A组治疗基础上静脉滴注肝素钠 1个疗程 10天 ,观察两组仍少尿例数 ,需血透例数 ,尿蛋白、血脂、肾功能、肾有效血流量以及B组用药前后血液流变学指标变化。结果显示 :B组比A组少尿及需血透例数 ,血尿素氮、血肌酐显著减少 ,肾有效血流量显著增加 (P均 <0 .0 5 ) ,尿蛋白、血脂的差异无显著性(P >0 .0 5 )。B组治疗后比治疗前除红细胞比容外血液粘滞性下降差异有高度显著性 (P <0 .0 1)。认为肝素疗法治疗NS并ARF有明显疗效 ,优于常规疗法     

腹膜透析与血液透析治疗急性肾功能衰竭的比较

目的评价腹膜透析(PD)治疗急性肾功能衰竭(ARF)的疗效及适应征.方法66例急性肾衰患者分为两组,腹透组24例,血透组42例,比较两组患者的临床资料、治疗方法和预后.结果腹透组和血透组少尿期持续时间分别为(23.1±14.4)天和(19.8±10.4)天(P＞0.05),病死率分别为25%和31%(P＞0.05),其中"高分解代谢"病死率分别为27.2%和25%(P＞0.05),腹透组和血透组肾功能完全恢复者分别为63%和64%(P＞0.05).结论腹膜透析是治疗急性肾功能衰竭的有效方法之一,且也适用于"高分解代谢"及有并发症的急性肾衰.     

脑卒中并发急性肾功能衰竭

目的 :探讨脑卒中并发急性肾功能衰竭的相关因素及对策。方法 :观察脑卒中并发急性肾衰 (ARF组 ) 30例 ,不伴急性肾衰 4 5例 (对照组 )的甘露醇用量、时间、血渗透压、血钠值变化 ,并作比较。结果 :ARF组所用甘露醇剂量为 2 10 .6± 4 0 .2 g/d ,≥ 2 0 0 g/d 2 6例 ,占 86 .7% ,血渗压 342 .3± 36 .1mOsm/kg/H2 O ;对照组甘露醇用量为 15 0 .3± 5 5 .2g/d ,≥ 2 0 0 g/d 10例 ,占 2 2 .2 % ,血渗压 30 5 .2± 32 .6mOsm/kg/H2 O ,二组比较差异有显著性。结论 :大剂量使用甘露醇是脑卒中并发急性肾衰的主要原因。高龄、高血压为其危险因素。小剂量、间歇使用甘露醇是预防脑卒中并发急性肾衰的重要环节。     

切开减压联合血浆置换治疗挤压伤

目的探讨切开减压联合血浆置换治疗伴有肌红蛋白尿挤压伤的疗效.方法伴有肌红蛋白尿挤压伤的病人为研究对象,共68例,随机分成A、B两组.A组36例行切开减压术后联合血浆置换.B组32例行传统方法治疗.比较两组的尿素氮、肌酐、急性肾功能衰竭发生率、伤口感染率及死亡率.结果A组有4例发生急性肾功能衰竭,为11.1%,无1例死亡.B组有10例出现急性肾衰,为31.396(P＜0.05),4例死亡,为12.5%.A组尿素氮、肌酐平均值低于B组(P＜0.05).A、B两组的感染率分别为19.4%(7例)和3.1%(1例).结论与传统方法相比,切开减压联合血浆置换治疗伴有肌红蛋白尿的挤压伤病人能够降低急性肾功能衰竭发生率及死亡率,在急性肾功能衰竭的预防和治疗中起着重要的作用.     

低分子右旋糖酐、肝素钠、速尿治疗肾病综合征水肿临床观察

目的观察在常规治疗肾病综合征的基础上加用低分子右旋糖酐、肝素钠、速尿后患者水肿变化情况。方法将100例肾病综合征患者随机分为对照组（A组）和治疗组（B组），两组均在常规治疗基础上，A组予静滴白蛋白后推注速尿；B组予低分子右旋糖酐250ml＋肝素钠1mg／kg＋速尿20mg静脉滴注，20滴／min，每天1次，观察两组患者水肿消退时间、出现多尿时间、血清白蛋白及胆固醇、24小时尿蛋白变化及停药后水肿复发情况。结果两组各项指标比较，差异均有统计学意义（P〈0．05），B组显示了良好的疗效和安全性。结论低分子右旋糖酐、肝素钠、速尿联合治疗肾病综合征，既防止了肾病的高凝状态，减少血栓形成，又起到降脂、减少尿蛋白作用，利尿、消肿效果好，经济实用。     

Experiences with High Doses of Furosemide in Renal Disease and Resistant Edematous States

Six cases of edema, three due to the nephrotic syndrome, one to congestive heart failure and two to chronic renal failure, are reported in which furosemide was administered in oral doses higher than those usually prescribed (up to 720 mg. a day), in order to obtain a satisfactory diuresis. In one case of severe prerenal failure secondary to cardiogenic shock and in one case of acute tubular necrosis secondary to hypotension at the time of operation, intravenous doses up to 990 and 1400 mg. per day respectively were able to reverse the oliguria. In eight additional patients who were on chronic hemodialysis, furosemide was administered to the amount of 1000 mg. per day orally in divided doses for two weeks, and produced a moderate diuretic response.

The use of high doses of furosemide in edema and renal failure resistant to the usual therapeutic measures appears to be safe and effective.

     

PERITONEAL DIALYSIS AFTER REPAIR OF CONGENITAL HEART DISEASE IN CHILDREN

Objective. To investigate the effect of peritoneal dialysis on fluid balance and outcome in children who receive cardiac operation.Methods. From July to Dec. 2000, 12(2.08%) patients of 576 consecutive children who underwent heart operation required peritoneal dialysis because of acute renal failure. The mean age of these 12 patients was (2.9-2.0) years (range, 5 months-7 years) and the mean body weight was (12+3) kg (range, 7.4-18.5 kg ).Results. The interval between the operation and the initiation of peritoneal dialysis was (21.2+11.4) hours (4.4-42 hours). The duration of peritoneal dialysis was (6.3+4.8) days (0.47-15 days). Mortality in these 12 patients was 25%. Fluid removed by peritoneal dialysis was(34.7+17.8) ml . kg-1 . day-1. Asymop-tomatic hypokalemia, thrombocytopenia and hyperglycemia were frequent complications, which were easily managed. Hemodynamics and pulmonary function improved during the study period.Conclusion. The early initiation of peritoneal dialysis is an effective and safe     

烧伤并发少尿型急性肾功能衰竭43例临床分析

目的:探讨烧伤并发少尿型急性肾功能衰竭(Acute Renal Failure ARF)的防治方法。方法:对近20年收治的43例烧伤并发ARF病例资料,总结分析其发病特点和治疗结果。结果:本组发病年龄1.5-87岁,均为重度和特重度烧伤,于48 h内7 d内确诊者分别占48.8％和81.45％,2 h后开始接受液体复苏者,ARF发病率明显高于2 h内者,合并休克、色素尿、吸入性损伤和脓毒症(sepsis)者分别占72.1％、67.4％、51.2％和37.2％。死亡42例,死亡率97.7％。12例接受透析治疗,1例为腹膜透析,11例行血液透析,治愈1例采用连续性肾替代治疗(CRRT),11例透析死亡病例平均存活8.7 d,明显长于其余31例未透析全部死亡者的4.3 d(P<0.05)。结论:少尿型ARF多发生于严重烧伤早期(1周内),伤情越重,入院时间越晚,发病率越高;合并休克、色素尿、吸入性损伤和脓毒症是诱发ARF的高危险因素。透析治疗虽未能明显提高存活率,但可延长生存时间,为去除ARF原发病因如切痂植皮创造机遇,CRRT因对血流动力学干扰小,能平稳清除毒素和内毒素,可能是治疗烧伤并发ARF较有前景的手段之一。     

心脏术后并发急性肾功能衰竭行腹膜透析的护理

目的了解心脏术后并发急性肾功能衰竭行腹膜透析的护理监测及应对措施。方法2005年1月～2010年12月期间我院行心脏手术872例,其中12例并发急性肾功能衰竭,7例术后行腹膜透析治疗,通过尿量的观察、血电解质的监测、容量负荷的计算以及肾功能的检测,及时把握腹透时机并积极处理并发症。结果7例患者中2例因严重低心排出量而死亡。余5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。结论心脏术后并发急性肾功能衰竭患者及时腹透治疗并精心护理能及时有效地纠正水电解质和酸碱平衡失调,顺利渡过术后急性肾功能不全期,提高生存率。     

Furosemide and acute renal failure.

High dose of intravenous furosemide (2 g/24 hr) was given to six patients with acute renal failure due to leptospirosis. The results, based on urine flow, changes in serum creatinine and creatinine clearance, were compared with a control group of eight patients with the same disease and comparable degree of renal failure. Excellent diuresis was observed following furosemide therapy but renal function and the clinical course of the disease were unaltered. The duration of renal failure was the same in both groups.     

The Clinical Spectrum of Renal Insufficiency During Acute Glomerulonephritis in the Adult

Twenty-seven adults with acute poststreptococcal glomerulonephritis were divided into two groups according to the severity of reduction in renal function: (1) 14 patients with mild depression of renal function, and (2) 13 patients with more severe renal insufficiency. In the first group the outcome was favourable, with complete clinical recovery in 11 patients. Only two patients in the second group have recovered. Five have died of renal failure and in six the chronic stage has developed. The most notable histopathological lesion observed in this group of patients was severe proliferative glomerulonephritis with a large number of epithelial crescents. According to the mode of development and time of onset of renal failure, these 13 patients could be divided into three sub-groups: (1) early renal failure without oliguria (three patients), (2) early renal failure with severe oliguria or anuria (three patients) and (3) delayed renal failure (seven patients).

Although there are exceptions, the development of renal insufficiency in an adult patient suffering from acute glomerulonephritis is usually associated with a guarded prognosis.

     

日间持续血液滤过用于妊娠合并心功能衰竭剖宫产术后的治疗

目的探讨血液透析技术在妊娠合并心功能衰竭患者剖宫产手术后的治疗作用,以降低合并心功能衰竭孕产妇的病死率.方法9例妊娠合并心功能衰竭需要血液滤过患者为研究对象,对其剖宫产术后近期处理方法进行总结.结果妊娠合并心脏病出现心功能不全,不能继续妊娠或自然分娩而进行剖宫产手术,术后出现少尿患者及时进行日间持续静-静脉血液滤过（CVVH）、强心等支持治疗,9例患者均康复转出ICU.结论妊娠合并心功能衰竭患者出现急性肾功能不全或肾脏排水量不能满足纠正心功能衰竭的要求时,应尽早应用CVVH进行治疗.     

乌拉地尔、多巴胺、多巴酚丁胺、速尿合用治疗急性左心衰临床对比观察

目的:观察乌拉地尔与多巴胺、多巴酚丁胺、速尿组成的新强心利尿合剂治疗急性左心衰的临床疗效和安全性。方法:95例急性左心衰患者,分为A、B、C 3组,A组31例,为对照组,予吸氧、镇静、强心、利尿等常规治疗;B组32例,为酚妥拉明组,在常规治疗的基础上,加予酚妥拉明、多巴胺、多巴酚丁胺、速尿合用;C组32例,为乌拉地尔组,在B组的基础上以乌拉地尔代替酚妥拉明。结果:A组显效8例,有效13例,无效10例,总有效率67.7%;B组显效16例,有效10例,无效6例,总有效81.3%;C组显效28例,有效3例,无效1例,总有效率96.9%。A组与B组比P<0.05;A组与C组比P<0.01;B组与C组比P<0.05。结论:乌拉地尔与多巴胺、多巴酚丁胺、速尿合用的新强心利尿合剂治疗急性左心衰,能改善心功能,效果更显著,起效更迅速,使用更安全,可作为急诊科治疗急性左心衰的常规治疗。     

THERAPEUTIC EFFECTS OF ct-hANP ON HYPERTENSIVE HEART DISEASE WITH HEART FAILURE AND OLIGURIA

a_hANP (a-human atrial natriurctic polypeptide) is one of the potent peptide hormones produced by Iwman atrium, which has been proved to have hypotensive, cardio depressive, natriuretic and diure- tic effects experimentally in vivo. However, there has been no reports so far concerning the clinical use of a-hANP for the treatment of heart failure patients with edema and oliguria. Not long before, we had conducted an investigation on the effects of synthetic a-hANP given intravenously to three normal volunteers under close clinical observations and monitoring without any side effects. On this basis, on September 28, 1985, we administered a-hANP to a patient diagnosed as having severe hypertensive heart disease with failure, with renal arteriosclerosis, oliguria and azotemia. The patient had received sodium nitroprusside and furosemide for several days without any improvement. After the administration of a-hANP, his cardiac functions and pulmonary edema improved, diuresis was prominent, and Na output increased, but there were no marked changes in blood pressure and serum K and Cl. This is the first case report in our country. We believe that a-hANP has somewhat similar effects as shown in animal experiments.