Menghini针在经皮肺活检中的应用

本文介绍了44例经皮肺活检的经验,40例诊断正确,占90.9%;气胸发生率6.8%,作者认为 Menghini 针具有操作简单,无气栓发生,更换注射器方便等优点。同时对导向的选用及穿剌方法的改进也做了介绍。     

体外无肝素连续性肾脏替代治疗的相关因素对人凝血功能的影响

【目的】体外探讨无肝素连续性肾脏替代治疗（CRRT）过程中相关因素时人凝血功能的影响。【方法】以健康人血样本为研究对象，等比例加入置换液、聚砜膜空心纤维后通过恒温旋转的方式体外模拟CRRT过程中相关因素对血液凝血功能的影响，根据影响因素不同实验分为碳酸氢钠、聚矾膜空心纤雏及血流切应力三个组，分别检测PT、APTT及血小板计数值三个指标。【结果】随着碳酸氧钠浓度的增加，其对应实验小组血样本的PT、APTT及血小板计数值均较正常对照组显著有显著性（P〈0．05）；随着空心纤维数目的增加，对应的实验小组PT、APTT值及血小板计数值均较正常对照组显著有显著性（P〈20．05）；随着旋转速度的增加，对应实验小组的血小板计数值与正常对照组差异有显著性（P〈0．05）。【结论】随着CRRT置换液中碳酸氢钠浓度、聚砜膜面积及血流切应力的改变，机体凝血功能可以受到显著影响。     

鹿角状肾结石开放取石的术式选择

目的:探讨鹿角状肾结石开放取石的术式选择、预防术中意外切肾和术后失肾的措施。方法:术中根据结石形态与肾脏解剖关系选择术式。对23例鹿角状肾结石患者行开放取石术治疗,左肾鹿角状结石9例,右肾10例,双肾4例。手术前后加强防治感染,术后充分引流,以预防术后失肾。结果:手术均顺利完成,结石均于术中取尽。术中无一例意外切肾。术后1个月随访全部患者的术侧肾脏功能恢复良好。结论:对鹿角结石,根据结石的形态、分布、肾盂类型、肾积水状态和肾实质厚度等因素综合判断,选择合理的术式,能保障手术安全、干净取石。     

影响终末期肾衰竭患者心脏扩大的因素

目的了解成都铁路分局医院血液进化中心终末期肾衰竭并维持性血液透析患者心脏扩大的影响因素,以便提高患者的血液透析质量和生存率。方法回顾本血液净化中心收治的216例终末期肾衰竭并维持性血液透析2月以上患者,根据心脏彩色多普勒检查,分为心脏扩大与心脏未扩大2组,对可能影响心脏扩大的因素:年龄、血液透析病程、每周血液透析时间、高血压、容量超负荷、血红蛋白水平、低蛋白血症等用SPSS10.0软件作Logistic回归分析。结果终末期肾衰竭并维持性血液透析患者216例,心脏扩大者183例,未扩大者33例,心脏扩大的发生率为84.72%。心脏扩大与容量超负荷呈显著正相关,P=0.002,OR值42.619;心脏扩大与高血压呈正相关,P=0.026,OR值15.353;心脏扩大与血红蛋白水平呈负相关,P=0.043,OR值0.934。心脏扩大与年龄、血液透析病程、每周血液透析时间和低蛋白血症无相关关系。结论终未期肾衰竭并维持性血液透析患者心脏扩大发生率高,而容量超负荷、高血压、血红蛋白水平是影响它的关键,高血压及容量超负荷是促进心脏扩大的独立危险因素,血红蛋白水平下降亦是促进心脏扩大的独立危险因素。     

939例慢性肾衰竭患者中医证候临床调查研究

通过对939例慢性肾衰竭患者临床调查,总结分析慢性肾衰竭的辨证分型规律,归纳出慢性肾衰竭的主要证型为脾肾气虚,兼湿热瘀血。     

Individualized Mycophenolate Mofetil Dosing Based on Drug Exposure Significantly Improves Patient Outcomes After Renal Transplantation

Efficacy and safety of mycophenolate mofetil (MMF) may be optimized with individualized doses based on therapeutic monitoring of its active metabolite, mycophenolic acid (MPA). In this 12-month study, 137 renal allograft recipients from 11 French centers receiving basiliximab, cyclosporine A, MMF and corticosteroids were randomized to receive either concentration-controlled doses or fixed-dose MMF. A novel Bayesian estimator of MPA AUC based on three-point sampling was used to individualize doses on posttransplant days 7 and 14 and months 1, 3 and 6. The primary endpoint was treatment failure (death, graft loss, acute rejection and MMF discontinuation). Data from 65 patients/group were analyzed. At month 12, the concentration-controlled group had fewer treatment failures (p = 0.03) and acute rejection episodes (p = 0.01) with no differences in adverse event frequency. The MMF dose was higher in the concentration-controlled group at day 14 (p < 0.0001), month 1 (p < 0.0001) and month 3 (p < 0.01), as were median AUCs on day 14 (33.7 vs. 27.1 mg*h/L; p = 0.0001) and at month 1 (45.0 vs. 30.9 mg*h/L; p < 0.0001). Therapeutic MPA monitoring using a limited sampling strategy can reduce the risk of treatment failure and acute rejection in renal allograft recipients 12 months posttransplant with no increase in adverse events.     

Thrombotic Micro‐Angiopathy with Sirolimus‐Based Immunosuppression: Potentiation of Calcineurin‐Inhibitor‐Induced Endothelial Damage?

Thrombotic microangiopathy is a rare but important finding in the context of organ transplantation. Acute renal insufficiency in the setting of hemolysis and thrombocytopenia, a triad that constitutes 'hemolytic uremic syndrome', can be associated with, or triggered by, conditions such as verocytotoxin-producing Escherichia coli, viral infections, malignant hypertension, scleroderma, allograft rejection, lupus erythematosus, pregnancy, and medications including mitomycin C, calcineurin inhibitors, and oral contraceptives. After renal transplantation, it can occur, as either a de novo episode, or recurrent disease. Calcineurin inhibitors have long been associated with post-transplantation thrombotic microangiopathy. Sirolimus has been used as a primary immunosuppressant in patients transplanted with a history of earlier hemolytic-uremic syndrome, and also as rescue therapy in patients with calcineurin-inhibitor-associated thrombotic microangiopathy. We describe four cases where there was significant thrombotic microangiopathy in the context of contemporaneous or contiguous calcineurin inhibitor and sirolimus usage. As the intrarenal cyclosporin concentration is thought to be significantly elevated when cyclosporin and sirolimus are used together, this may explain these findings, and mandates caution in their co-administration.     

针刺对肾血管性高血压大鼠的降压效应

目的　探讨针刺对肾血管性高血压大鼠的降压作用及其神经 -内分泌调节机制。方法　采用二肾一夹法制备高血压大鼠模型 ,测定实验各组大鼠血浆内皮素 (ET)、一氧化氮 (NO)含量和心率变异性 (HRV)的动态变化。结果　与模型组相比 ,针刺组血压 (BL 2 3:19.1± 1.1k Pa,ST36:18.1± 2 .5 k Pa)及 ET水平明显下降 (P<0 .0 1) ,其中针刺肾俞组血浆 ET水平 (91.3± 9.45 pg/ ml)较足三里组 (10 8.48± 13.0 6pg/ ml)下降更明显 (P<0 .0 5 ) ;针刺治疗组血浆 NO水平 (BL 2 3:5 0 .3±12 .7μmol/ ml,ST 36:49.71± 8.49μm ol/ m l)显著升高 (P<0 .0 5 )。足三里组针刺后 L F/ HF比值与模型组无明显差异 ,而肾俞组 L F/ HF值 (0 .5 7± 0 .13)明显低于模型组及足三里组 (0 .86± 0 .2 5 )。结论　针刺能降低肾血管性高血压模型大鼠动脉血压 ,肾俞与足三里两穴无明显差异 ,其作用机制可能与自主神经系统、NO及 ET参与的神经内分泌调节作用相关。     

Peritoneal dialysis patient survival: a comparison between a Swedish and a Korean centre.

BACKGROUND: Dialysis patient mortality remains high, and this high mortality may be due to many factors. In peritoneal dialysis (PD) patients, old age, co-morbid diseases, malnutrition, low residual renal function (RRF) and a high peritoneal transport rate have been shown to influence survival, but the relative importance of these factors may differ between different patient populations. Besides, centre practice patterns may differ between centres and may influence patient survival. In addition, the literature suggests that dialysis patient survival may be better in Asian than in Caucasian patients. METHODS: The influence of centre and patient characteristics on patient survival was investigated in 132 Korean and 106 Swedish incident PD patients, who underwent initial biochemical measurements and assessment of adequacy of dialysis, nutritional status, RRF and peritoneal transport characteristics. RESULTS: At the start of PD, Korean patients had a higher prevalence of diabetes, peritoneal Kt/V(urea), peritoneal creatinine clearance and peritoneal fluid removal, and lower body mass index, RRF and dialysate to plasma creatinine concentration ratio (D/P Cr) compared with Swedish patients. Significantly more patients from Korea were placed on temporary haemodialysis before PD (100 out of 132) when compared with Swedish patients (21 out of 106). During the follow-up, there was a significantly higher rate of transfer to other units in Korea and a significantly higher rate of kidney transplantation in Sweden. On Kaplan-Meier analysis, overall patient survival did not differ and relative risk for death was also not different between the two centres even after adjustment for age, diabetes, cardiovascular disease, RRF and D/P Cr. On Cox proportional hazards multivariate analysis, age, diabetes, RRF and D/P Cr were found to be independent predictors of mortality in the combined cohort of patients. While age, diabetes and D/P Cr were independent predictors of mortality in Korean patients, age and RRF independently predicted mortality in Swedish patients. CONCLUSION: Although there were significant differences in centre and patient characteristics, we were unable to confirm a survival advantage for Korean over Swedish PD patients. The results of this study suggest that the reported difference in survival between Asian and Caucasian dialysis patients may have been due, in part, to differences in centre and patient characteristics rather than to race as such. The genetic influence on patient characteristics remains, however, to be elucidated.     

氟伐他汀对老年动脉粥样硬化所致肾动脉狭窄的临床疗效观察

目的观察氟伐他汀对老年肾动脉粥样硬化所致肾动脉狭窄(ARAS)的治疗作用及其抗炎机制。方法将在我院门诊及住院的54例老年ARAS患者,随机分为治疗组及对照组,对照组给予常规降压治疗,治疗组每晚加服氟伐他汀40 mg。比较两组治疗前及治疗后尿蛋白排泄率(UAER)、血肌酐(Scr)、C反应蛋白(CRP)及肾脏血管多普勒超声中肾动脉收缩期峰值速度(PSV)、肾动脉血流加速度时间(AT),肾动脉峰值流速与肾动脉开口处腹主动脉流速之比(RAR)等指标。结果观察期间,两组上述指标均呈下降趋势,治疗组UAER,PSV,AT,RAR下降较对照组明显(P<0.05,P<0.01),治疗组CRP下降明显(P<0.05,P<0.01),对照组CRP变化不明显(P>0.05)。而且在两组血脂正常的老年ARAS所致肾动脉狭窄的患者进行比较分析也得出类似结果。结论氟伐他汀因降低CRP的致炎效应而改善肾动脉狭窄,且不依赖氟伐他汀的降血脂作用。