间歇性腹膜透析治疗尿毒症脑病的疗效观察

目的 探讨间歇性腹膜透析对长期维持腹膜透析患者尿毒症脑病的治疗效果。方法 选择2013年1月-2018年12月本院肾内科长期维持腹膜透析出现尿毒症脑病患者46 例,并随机分为持续性不卧床腹膜透析(Continuous ambulatory peritoneal dialysis,CAPD)组及间歇性腹膜透析(Intermittent peritoneal dialysis,IPD)组,在治疗前及治疗7 d后分别采血进行血肌酐(Scr)、尿素氮(BUN)、甲状旁腺激素(iPTH)、白细胞介素6(IL-6)、β2微球蛋白(β2-MG)、超敏C反应蛋白(CRP)水平的检测,采用阳性与阴性症状量表评分表(PAN - SS)评价患者的疗效。结果 CAPD组治疗后血BUN、Scr、iPTH、IL-6、β2-MG、CRP水平与治疗前比较无明显变化(P>0.05); IPD组治疗后血BUN、Scr水平与治疗前比较无明显变化(P>0.05),而iPTH、IL-6、β2-MG、CRP水平较治疗前明显下降(P<0.05); 治疗后IPD组iPTH、IL-6、β2-MG、CRP水平与CAPD组比较有明显差异(P<0.05); PAN-SS显示,IPD组与CAPD组阳性症状、阴性症状、一般精神症状等方面均有明显差异(P<0.05); CAPD组无效8例,好转12例,显著进步4例,基本痊愈2例; IPD组无效2例,好转14例,显著进步5例,基本痊愈5例。结论 规律腹膜透析患者出现尿毒症脑病时应用间歇性腹膜透析治疗效果优于持续不卧床腹膜透析     

血液透析治疗尿毒症顽固性高血压的疗效比较

〔摘 要〕 目的：分析在尿毒症顽固性高血压患者治疗过程中使用血液透析所取得的临床效果。方法：选取 2019 年 1 月 至 2020 年 3 月期间江门市人民医院血透室在透的 80 例尿毒症顽固性高血压患者作为研究对象，采用随机列表将 其分为对照组和观察组，各 40 例。观察组患者选取血液透析的方式进行治疗，对照组患者选取血液灌流的方式进 行治疗，对两组患者临床治疗效果进行分析。结果：观察组患者治疗总有效率高于对照组，差异具有统计学意义 （P ＜ 0.05）。治疗前，两组患者血压比较，差异无统计学意义（P ＞ 0.05）；治疗后，两组患者收缩压与舒张压均降低， 且观察组低于对照组，差异具有统计学意义（P ＜ 0.05）。两组患者均未出现严重不良反应，组间比较，差异无统计学意义 （P ＞ 0.05）。结论：在尿毒症顽固性高血压患者治疗过程中，通过血液透析疗法的应用，有利于提升患者治疗质量，对 于患者健康具有积极作用。     

尿毒症血液透析患者拔牙对策

目的　探讨尿毒症血液透析患者拔牙对策。方法　对 30例尿毒症血液透析患者拔牙术后情况进行回顾性分析。结果　 1例患者拔牙后出现出血并发症 ,2 9例患者拔牙后无并发症出现。结论　尿毒症血液透析患者可在控制并发症 ,病情稳定期 ,肾内科医师协作下 ,在透析 4 8h后或下次透析前 1d拔牙。     

腹腔镜与开腹腹膜透析置管术对机体炎症反应影响的临床研究

目的探讨腹腔镜与开腹腹膜透析置管术对机体炎症反应的影响。方法选取2018年10月至2019年1月于我院行腹膜透析的60例尿毒症患者,其中30例行腹腔镜下腹膜透析置管手术的设为腹腔镜组,30例行开腹腹膜透析置管手术的设为开腹组。比较两组术中、术后情况和机体炎症反应、并发症发生情况。结果腹腔镜组术中出血量、疼痛程度、术后3 d降钙素原(PCT)、C反应蛋白(CRP)、癌抗原125(CA125)、白细胞(WBC)计数和引流不畅、导管移位、腹膜炎发生率低于开腹组,肠道功能恢复时间长于开腹组,手术时间短于开腹组,差异有统计学意义(P0.05);两组住院时间比较,差异无统计学意义(P0.05)。结论尿毒症患者行腹腔镜腹膜透析置管术具有创伤小、失血量少、疼痛轻微、炎症反应轻、并发症少等优点,值得临床推广。     

腹膜透析和血液透析对尿毒症患者残余肾功能及并发症的影响分析

目的 探讨尿毒症患者采取腹膜透析和血液透析对残余肾功能及并发症影响。方法 选取2018年1月至2019年12月福州市第一医院肾内科收入尿毒症患者190例,按照随机数字表法分为两组,每组各95例,对照组采用血液透析治疗,观察组采用腹膜透析治疗,比较两组干预前后肾功能及并发症。结果 治疗前,两组肾功能水平比较,差异无统计学意义(P0.05),治疗后,两组肾功能水平比较,差异无统计学意义(P0.05),两组治疗前后组内比较,差异有统计学意义(P0.05);治疗前,两组炎症水平比较,差异无统计学意义(P0.05),治疗后,观察组炎症水平低于对照组,差异有统计学意义(P0.05),两组治疗前后炎症水平组内比较,差异有统计学意义(P0.05);观察组并发症率为6.32%,低于对照组的15.79%,差异有统计学意义(P0.05)。结论 血液透析与腹膜透析均是保护残余肾功能有效透析模式,但腹膜透析降低炎症指标水平更为显著,且并发症发生率偏低,可考虑作为尿毒症患者首要透析方式。     

前列地尔注射液在尿毒症患者动静脉内瘘成形术后的应用

目的 通过观察前列地尔注射液对预防动静脉内瘘成形术后血栓形成及血管内皮细胞（vascular endothelial cell,VEC）功能的影响.方法 84例维持性血液透析患者,拟行动静脉内瘘成形术前采用随机数字表分为治疗组44例和对照组40例.对照组在动静脉内瘘成形术后常规给予抗血小板聚集治疗,口服拜阿司匹林100 mg,治疗组在动静脉内瘘成形术后予以前列地尔注射液20 μg,加入0.9％生理盐水注射液100 ml中静脉滴注,每日1次,连用7d.分别于治疗前后检测全血黏度、血浆黏度、红细胞聚集指数、纤维蛋白原（fibrinogen,Fib）、凝血酶原时间（prothrombin time,PT）、血浆内皮素（plasma endothelin,ET）及一氧化氮（nitric oxide,NO）水平.术后观察内瘘杂音和震颤及有无出血征象,术后4周用多普勒超声测定内瘘头静脉内径、壁厚、每分钟血流量、内瘘成熟后血管进行初次透析使用的时间及透析时血流量.结果 前列地尔治疗后内瘘成熟率（90％）明显优于对照组（72％）,全血黏度[（4.92±0.42） mPa,s比（5.04±0.58） mPa,s、血浆黏度[（1.82±0.12） mPa,s比（2.12±0.14） mPa·s]、红细胞聚集指数[（2.74±0.57）比（2.92±0.46）、Fib[（3.14±0.14） g/L比（3.28±0.16） g/L]等血液流变学指标的变化均比治疗前有所降低,疗效优于对照组.且前列地尔组在ET[（48.15±16.19） ng/L比（52.34±17.35） ng/L]、NO[（37.31±3.10） μmol/L比（34.26±2.18） μmol/L]水平的改善方面也优于对照组,术后4周,治疗组内瘘成熟率高于对照组（90％o比72％）、头静脉内径[（6.18±0.20） mm比（5.50±0.25） mm]、壁厚[（0.72±0.05） mm比（0.63±0.04） mm、血流量[（815.50±65.68） ml/min比（610.62±75.82） ml/min]均优于对照组,透析时血流量明显大于对照组[（254.71±24.44） ml/min比（204.58±32.25） ml/min,并且其初次血透使用时间缩短[（25.42±5.26）d比（36.26±8.28）d].结论 ?     

血液透析配合血液灌流治疗尿毒症顽固性高血压疗效观察

目的：探讨血液透析配合血液灌流治疗尿毒症顽固性高血压的疗效。方法64例尿毒症顽固性高血压患者根据治疗方法不同分成观察组和对照组两组。对照组采用单纯血液透析治疗,每周3次,观察组采用血液透析联合血液灌流治疗,每周1次。比较两组治疗后的降压效果。结果观察组的总有效率显著高于对照组（90.6% vs 71.9%,P ＜0.05）。观察组和对照组患者治疗后的 SBP、DBP 均较治疗前明显降低,且观察组患者的 SBP、DBP 较对照组降低更显著（P ＜0.05）。结论血液透析配合血液灌流治疗尿毒症顽固性高血压疗效确切,值得推广和应用。     

输尿管镜下超声与气压弹道碎石术治疗输尿管上段结石并急性梗阻性尿毒症的比较

目的 比较输尿管镜下超声碎石术与气压弹道碎石术治疗并发急性梗阻性尿毒症的输尿管上段结石的临床疗效及其优缺点.方法 回顾性分析我院2009年5月至2012年5月的104例输尿管上段结石并发急性梗阻性尿毒症患者的临床资料.采用输尿管镜下超声碎石术（组1）和输尿管镜下气压弹道碎石术（组2）治疗的患者各52例,统计并比较两组的住院时间、手术时间、术中出血量、结石清除率及并发症发生情况.结果 两组患者术后肾功能均在短期内恢复正常,组1与组2相比较,组1结石清除率高、手术时间短、住院时间短、术后感染率低,组间比较差异有统计学意义（P＜0.05）.两组均无输尿管穿孔、撕脱等并发症.结论 输尿管镜下超声碎石术治疗输尿管上段结石并发急性梗阻性尿毒症是一种安全、有效的理想手术方法,不增加手术并发症.     

Effects of different treatment methods on renal anemia in maintenance hemodialysis patients with hyperparathyroidism secondary to uremia

Objective To observe the effects of three treatment methods on renal anemia in maintenance hemodialysis patients with hyperparathyroidism secondary to uremia and analyze the influencing factors of erythropoietin (EPO) dosage. Methods A total of 55 maintenance hemodialysis patients with secondary hyperparathyroidism at the hemodialysis center of Huashan Hospital affiliated to Fudan University from January 2015 to December 2016 were retrospectively divided into three groups according to different treatment methods, parathyroidectomy +forearm transplantation group (surgery group, n=16), cinacalcet treatment group (n=6), and calcitriol treatment group (n=33), respectively. The hemoglobin level and erythropoietin dosage were measured before treatment and in the 3rd month, the 6th month and the 12th month after treatment. The changes of hemoglobin and erythropoietin dosage in the three groups before and after treatment were observed, and the mixed effect model was used to analyze the difference of the change of hemoglobin and erythropoietin dosage among three groups. Multiple linear regression analysis was used to analyze the influencing factors of EPO dosage after one year. Results The levels of intact parathyroid hormone (iPTH) in the surgery group and the cinacalcet group before treatment were significantly higher than that in the calcitriol group (both P＜0.05). In the 12th month after treatment, the levels of iPTH decreased significantly in the patients of surgery group and the cinacalcet group compared with those before treatment (both P＜0.05). The levels of serum alkaline phosphatase, serum calcium and serum phosphorus in the surgery group also decreased significantly compared with those before treatment (all P＜0.05). The mixed effect model analysis showed that the hemoglobin level of surgery group was on an upward trend after the treatment, and the overall level was significantly higher than cinacalcet and calcitriol treatment group (P=0.007). There was no significant difference in the dosage change of erythropoietin (EPO) in the three groups over time. However, the intra-group comparison of the mixed effect model showed that the dosage of EPO in the 12th month was significantly lower than that of before the treatment in surgery group (P=0.007). Multiple linear regression analysis showed that dialysis vintage (B=-0.064, P=0.012) and ferritin ≥ 500 μg/L (B=0.645, P=0.032) were independent influencing factors of EPO dosage. The longer the dialysis vintage, the less EPO dosage, and more EPO dosage were observed in patients with ferritin ≥ 500 μg/L. Conclusions Parathyroidectomy and forearm transplantation is more effective in reducing EPO dosage and improving renal anemia in maintenance hemodialysis patients with secondary hyperparathyroidism. Dialysis vintage and ferritin are independent influencing factors for the dosage of EPO.     

The use of multi-detector computed tomography venography and three dimensional reconstruction image in evaluating the central venous occlusive disease of hemodialysis patients

Objective To evaluate the feasibility and value of multi-detector computed tomography venography (MDCTV) and three dimensional reconstruction image in the assessment of central venous occlusive disease in hemodialysis patients, and in the value of guiding interventional treatments. Methods Sixty hemodialysis patients with swelling of upper limbs were scanned by Toshiba 128-multislice spiral computed tomography (128-MSCT) and totally 80-100 ml non-ionic contrast media was injected into each of the patients via the peripheral veins of the contralateral limb with the rate of 4 ml/s. MSCT scanning was taken by the technique of intelligent triggering after setting scanning triggering threshold, with the monitoring?point?set in the development of the lumen of inferior vena cava, to detect the position and degree of vascular stenosis. The images were reformed as maximum intensity projection (MIP), volume rendering (VR), curved planar reformation and three-dimensional image reconstruction technique. Results MDCTV clearly demonstrated the lesion location in all cases enrolled. Seventy-five occlusive lesions were detected in the total of 60 hemodialysis patients with swelling of upper limbs by MDCTV, of which the lesions of brachiocephalic vein was 47, superior vena cava 15 and subclavian vein 13. Among the 75 stenosis lesions, the number of complete occlusive, severe, moderate and mild stenosis was 31, 24, 19 and only 1, respectively. MDCTV provided information coincident with that of digital?subtraction?angiography (DSA), which the correlation index was 0.401, while DSA showed that number of complete occlusive, severe, moderate and mild stenosis was 49, 7, 14 and 5, respectively. Percutaneous transluminal angioplasty was performed in 53 patients, and stent placement was done in 40 patients. After interventional treatments, swelling of upper limbs were obviously relieved and vascular accesses got functional recovery to?the?extent?that?they could meet the requirement of hemodialysis. Conclusions MDCTV is the first choice to evaluate the condition of central?venous?occlusive diseases of hemodialysis patients with advantages of non-invasion, high definition and three-dimensional?reconstruction. It can provide accurate evaluations of the conditions of occlusive lesions, which can be of great clinical significance to subsequent interventional therapy.