尿毒症合并上消化道出血30例临床分析

目的探讨尿毒症合并上消化道出血的临床特点及治疗。方法对30例尿毒症合并上消化道出血患者的临床资料进行回顾性分析。结果患者胃镜下表现糜烂性出血性胃炎18例(60.0%),十二指肠球部溃疡8例(26.7%),胃溃疡4例(13.3%);综合止血治疗5d后,紧急血液透析组20例中15例(75.0%)出血停止,非紧急血液透析组10例中5例(50.0%)出血停止;最终分别有3例(15.0%),4例(40.0%)死亡。两组治疗5d后止血率及死亡率比较有显著差异(P<0.05)。结论尿毒症合并消化道出血以胃肠粘膜糜烂及十二指肠球部溃疡为主,共24例(86.7%),它的治疗较困难,紧急血液透析可改善预后,降低病死率。     

尿毒症血液透析病人不典型脑缺血病变的临床分析

目的探讨尿毒症血液透析病人不典型缺血性脑病变的临床特点，以引起临床注意，利于早期诊断，及时治疗．方法回顾性分析14例经颅脑CT、经颅多普勒脑血流（TCD）检查证实的尿毒症血液透析病人不典型脑缺血病变的临床特点．结果血透过程中，干体重测试不佳，超滤过多，血压降低，血脂、血糖升高，使血粘度增加，血液浓缩是引发脑缺血性病变的原因；病人发生行走不稳、吞咽呛咳、意识一过性障碍等表现；脑CT、脑TCD检查证实。结论尿毒症血液透析病人不典型脑缺血临床表现少见，发病隐匿，易被疏忽，延误治疗；血粘度增高、血压偏低，引起低灌注，是该病的发病机制；病人存在着脑卒中的风险，降低了血透病人的生活质量，增加了死亡率。     

益肾解毒方配合血液透析治疗尿毒症28例临床观察

目的:进一步提高终末期尿毒症维持性血液透析(血透)患者的透析效果及生活质量。方法:采用益肾解毒方配合血透治疗终末期尿毒症患者28例,并设对照组28例,仅予常规血透。两组疗程均为1个月,连续观察3个月。结果:治疗组28例中所测得的平均时间尿素氮浓度(TACurea)、蛋白质分解率(PCR)及G—S指数(KT/V值)均明显优于对照组(P<0.05)。结论:益肾解毒方配合血透在提高透析充分性及患者生活质量方面优于单纯的血透。     

血液灌流联合血液透析治疗尿毒症皮肤瘙痒临床观察

目的：探讨血液灌流联合血液透析治疗尿毒症的临床疗效。方法：维持性血液透析患者24例,随机分为两组,治疗组12例,采用血液灌流联合透析治疗;对照组12例,单纯透析治疗。两组均采用肝素抗凝,血流量200～250ml/min,透析液流量500ml/min。检测治疗前后血肌酐、尿素氮、甲状旁腺激素、β2微球蛋白、血压及临床症状。结果：治疗组皮肤瘙痒减轻及甲状旁腺激素、β2微球蛋白清除显著高于对照组（P〈0.05）。结论：血液灌流联合血液透析治疗尿毒症病人,可清除中分子物质,可有效减轻皮肤瘙痒。     

左旋卡尼汀对尿毒症腹透患者心功能不全的治疗作用

目的探讨左旋卡尼汀对尿毒症腹透患者心功能不全的治疗作用。方法选择维持性腹膜透析患者30例，分为对照组15例和治疗组15例，对照组给予维持性的腹膜透析，治疗组在维持性腹膜透析同时予左旋卡尼汀治疗．疗程均为30d。分别于治疗后评价疗效。结果治疗组心功能改善有效率为93．7％，明显高于对照组的73．3％（P〈0．01）。治疗前后心率、血压、心输出量及左室射血分数均有显著改善（P〈0．05）。治疗组与对照组比较差异有统计学意义（P〈0．05）。结论维持性腹膜透析的尿毒症患者同时使用左旋卡尼汀，心功能明显改善。     

Roentgenological signs in the skeleton of uremic children

The roentgenological signs encountered in the skeleton of uremic children, some treated by hemodialysis and others untreated, are described and related to histological studies. There is a discrepancy in behaviour between cortical and cancellous bone. Under the influence of parathormone cortical bone is eroded from the periosteal, endosteal and Haversian system surfaces. In contrast, cancellous bone is dense (osteosclerosis). The epiphyseal growth plate is narrow in end-stage renal failure; the histological equivalent of the radiolucent area in the growing zone is primary spongiosa consisting of undermineralised woven bone devoid of chondroid.     

Effects of hemodialytic treatment on uremic polyneuropathy

Summary The involvement of the peripheral motor and sensory nerve, at least on a subclinical level, is a nearly constant event with chronic renal failure. The study of the motor and sensory propagation velocity indicates that a widespread functional lesion of the axon with a peripheral point of attack and secondary demyelination, may be the basic pathogenetic event of uremic polyneuropathy. Prolonged hemodialytic treatment is substantially unable to influence the evolution of uremic polyneuropathy. The electrophysiological follow-up study of the peripheral nerve does not seem to be an index of adequate dialysis.

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Zusammenfassung Die Beteiligung des peripheren motorischen und sensiblen Nerven, zumindest subklinisch, ist bei chronischer Niereninsuffizienz Regel. Die Untersuchung der motorischen und sensorischen Erregungsleitungsgeschwindigkeit spricht dafür, daß bei der urämischen Polyneuropathie als wesentliches pathologisches Geschehen das Axon besonders distal ausgedehnt betroffen ist mit einer sekundären Demyelinisation. Auch langdauernde Hämodialyse scheint nicht in der Lage zu sein, die Entwicklung der urämischen Polyneuropathie zu beeinflussen. Die elektrophysiologische fortlaufende Kontrolle des peripheren Nerven scheint nicht ein brauchbarer Parameter für eine wirksame Dialyse zu sein.

     

Oxidant Stress in Hemodialysis Patients: What Are the Determining Factors?

Oxidant stress contributes to morbidity in hemodialysis patients. Three possible causes of oxidant stress have been suggested: the uremic state, the dialyzer membrane, and bacterial contaminants from the dialysate. Oxidant stress occurs in uremia before dialysis therapy is initiated, as evidenced by increased production of reactive oxygen species, increased levels of oxidized plasma proteins and lipids, and decreased antioxidant defenses. It has been proposed that increased production of reactive oxygen species during hemodialysis is also an important contributor to oxidant stress. Hemodialysis is associated with a transient increase in production of reactive oxygen species, particularly with cellulose membranes. In addition, surveys have shown widespread contamination of dialysate by endotoxin, which may cross membranes and prime production of reactive oxygen species by phagocytic cells. Recent studies, however, show a decrease in protein oxidation from pre- to post-dialysis and a normalization of neutrophil reactive oxygen species production. Taken together, these data suggest that uremia, per se, is the most important cause of oxidant stress in hemodialysis patients. Dialysate quality may also contribute to oxidant stress, but evidence that the dialyzer membrane plays a role is weak.     

联机血液透析滤过治疗尿毒症的临床应用研究

目的：探讨联机血液透析滤过（On-line hemodiafiltration,On-line HDF)对尿毒症患不同分子量物质的清除率、患耐受性及临床疗效。方法：回顾性分析18例伴有血透并发症及不适症状的尿毒症患行后稀释法On-line HDF 231例次，并与23例仍行常规血液透析（HD）治疗的患（887例次）进行比较，观察Kt/V，血清肌酐（Scr)、尿素氮（BUN）、血磷（SP）、β2－微球蛋白（β2－M）下降率及治疗中患血透常见并发症和不良反应发生率。结果：患对联机HDF治疗效果和耐受性显优于HD，透析并发症和不适症状发生率显低于HD（P＜0．01），联机HDF治疗后血清Scr、BUN、SP、β2－M水平显降低，KT／V明显增高。结论：后稀释法联机HDF能有效清除尿毒症患血中大、中、小分子物质，透析效果显提高，患对该法治疗的耐受性明显提高，适用于易出现血透并发症及不适症状的尿毒症患。