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1.
目的分析维持性血液透析患者发生结核感染的影响因素及临床特点。方法回顾性调查2018年5月-2019年8月北京清华长庚医院肾内科收治的长期规律血液透析患者共150例,收集患者的年龄、性别、合并疾病、血常规、生化、透析充分性等检验结果和影像学资料,归纳分析血液透析患者发生结核感染的影响因素。结果150例血液透析患者,男性91人,女性59人,平均年龄(62.7±14.2)岁,发生结核感染者共11例(7.33%),其中肺外结核比例高(54.5%),以浆膜腔积液为主要表现(54.5%),血红蛋白(94.7±11.6)g/L、血清白蛋白(34.6±2.0)g/L、血肌酐(593.6±221.4)umol/L低于无结核感染者,差异具有统计学意义(P<0.05);血小板(228.7±103.5)×109/L高于无结核感染者,差异具有统计学意义(P<0.05)。两组患者年龄、透析充分性、淋巴细胞、血糖、血脂、血钙、血磷、全段甲状旁腺激素无统计学差异。结论血红蛋白<110g/L、白蛋白<35g/L是MHD患者发生结核感染的高危因素,MHD患者发生结核感染以肺外结核为主,临床表现具有隐匿性和不典型性,临床工作应提高警惕避免漏诊。 相似文献
2.
《Nefrología : publicación oficial de la Sociedad Espa?ola Nefrologia》2022,42(2):163-170
IntroductionChronic inflammation and the underlying cardiovascular comorbidity are still current problems in chronic hemodialysis patients. There are few studies comparing the “dialysis dose” (Kt/V) with the degree of inflammation in the patient. Our main objective was to determine whether there is a relationship between serum C-reactive protein (CRP) levels and the Kt/V using ionic dialysance.MethodsMulticenter cross-sectional study. A total of 536 prevalent chronic hemodialysis patients were included. CRP levels, neutrophil-lymphocyte ratio and platelet-lymphocyte ratio were collected. Kt was obtained by ionic dialysance and urea distribution volume was calculated from the Watson's formula. The sample was divided into 2 groups, taking the median CRP as the cut-off point. Dialysis adequacy obtained in each group was compared. Finally, a logistic regression model was carried out to determine the variables with the greatest influence.ResultsMedian CRP was 4.10 mg/L (q25-q75: 1.67-10) and mean Kt/V was 1.48 ± 0.308. Kt/V was lower in the patients included in the high inflammation group (P = .01). In the multivariate logistic regression, the “high” levels of CRP were directly correlated with the Log neutrophil-lymphocyte ratio (P < .001) and inversely proportional with serum albumin values (P = .014), Kt/V (P = .037) and serum iron (P < .001).ConclusionThe poorer adequacy in terms of dialysis doses (lower Kt/V values) may contribute to a higher degree of inflammation in chronic hemodialysis patients. 相似文献
3.
A new extracorporeal circuit for hemodialysis was designed with the goal of improving the middle and high molecular weight toxins removal. A recirculation pathway was added to the hemodialysis circuit and relevant pressure regulation was performed along the circuit in order to keep the ultrafiltration rate as zero. The influence of increasing the recirculation to dialysate flow rate ratio on the removal of urea, vitamin B12, and hemoglobin was investigated. This removal was also modeled by an analytical method and solved by MATLAB software. A significant increase in removal of vitamin B12 (34%) and especially hemoglobin (228%) was achieved using the recirculation flow in an adjusted hemodialysis circuit. The model showed an acceptable agreement with the experimental results which shows its applicability for prediction of different toxin removal in this circuit. 相似文献
4.
目的 通过Meta分析了解留置中心静脉导管的血液透析患者发生导管相关血流感染的危险因素。 方法 计算机检索中国期刊全文数据库、万方数据库、维普数据库、中国生物医学文献数据库、Cochrane Library、PubMed、Web of Science、Embase数据库,检索时限为建库至2020年12月31日,使用RevMan 5.3进行Meta分析。结果 共纳入20篇文献,包括29项相关危险因素,有统计学意义的危险因素包括合并糖尿病(OR=2.55)、血清白蛋白<30 g/L(OR=2.35)、CD4+细胞<200个/μl(OR=3.02)、急性生理与慢性健康评分Ⅱ≥20分(OR=2.41)、股静脉置管(OR=1.94)、导管留置时间≥14 d(OR=3.20)、使用带隧道带涤纶套导管(OR=2.83)。 结论 合并糖尿病、低血清白蛋白、CD4+细胞<200个/μl、急性生理与慢性健康评分Ⅱ≥20分、股静脉置管、导管留置时间≥14 d、使用带隧道带涤纶套导管是留置中心静脉导管的血液透析患者易发生导管相关血流感染,护理人员应充分关注该类患者。 相似文献
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7.
目的 探讨血液透析病人并发脑出血预后的影响因素。方法 回顾性分析2013年7月至2018年7月收治的48例血液透析并发脑出血的临床资料。根据发病30 d改良Rankin量表(mRS)评分评估预后,0~2分为预后良好,3~6分为预后不良。采用多因素Logistic回归分析检验预后影响因素。结果 48例中,预后良好22例,预后不良26例。多因素Logistic回归分析显示年龄≥60岁、脑出血≥30 mL、入院时GCS评分≤12分、平均动脉压≥130 mmHg、白蛋白水平<30 g/dl是预后不良的独立危险因素(P<0.05)。结论 血液透析病人并发脑出血的预后较差,需要全面评估脑出血风险,采用及早、有针对性的干预,积极控制脑出血量,稳定血压和白蛋白水平,以期减少并发症和改善预后。 相似文献
8.
Anthony J. Bleyer Vincent A. Scavo Samuel E. Wilson Barry J. Browne Brian L. Ferris C. Keith Ozaki Timmy Lee Eric K. Peden Bradley S. Dixon Rick Mishler Timothy P. OConnor Kendrah Kidd Steven K. Burke 《Journal of vascular surgery》2019,69(2):507-515
Objective
Arteriovenous fistulas created in patients with chronic kidney disease often lose patency and fail to become usable. This prospective trial evaluated the efficacy of vonapanitase, a recombinant human elastase, in promoting radiocephalic fistula patency and use for hemodialysis.Methods
PATENCY-1 was a double-blind, placebo-controlled trial that enrolled 349 patients on or approaching hemodialysis and being evaluated for radiocephalic arteriovenous fistula creation. Of these, 313 were randomized and 311 treated. Patients were assigned to vonapanitase (n = 210) or placebo (n = 103). The study drug solution was applied topically to the artery and vein for 10 minutes immediately after fistula creation. The primary and secondary end points were primary patency (time to first thrombosis or corrective procedure) and secondary patency (time to abandonment). Tertiary end points included use of the fistula for hemodialysis, fistula maturation by ultrasound, and procedure rates.Results
The Kaplan-Meier estimates of 12-month primary patency were 42% (95% confidence interval [CI], 35-49) and 31% (95% CI, 21-42) for vonapanitase and placebo (P = .25). The Kaplan-Meier estimates of 12-month secondary patency were 74% (95% CI, 68-80) and 61% (95% CI, 51-71) for vonapanitase and placebo (P = .048). The proportions of vonapanitase and placebo patients were 39% and 25% (P = .035) with unassisted use for hemodialysis and 64% and 44% (P = .006) with unassisted plus assisted use.Conclusions
Vonapanitase treatment did not significantly improve primary patency but was associated with increased secondary patency and use for hemodialysis. Further research is needed to evaluate these end points. 相似文献9.
10.
BackgroundOur aim was to elucidate whether Hb variability affects nutritional status in HD patients.MethodsThis study included chronic HD patients (n = 76) with available monthly Hb levels up to 24 months prior to the body composition monitoring (BCM) measurement. The parameters obtained in the BCM included body mass index (BMI), lean tissue index (LTI), fat tissue index (FTI), body cell mass index (BCMI), overhydration/extracellular water ratio (OH), and phase angle (PhA). The coefficient of variation (Hb-CV), standard deviation (Hb-SD), and range of Hb (Hb-RAN) were used as indexes of Hb variability. In addition, minimum (Hb-Min), maximum (Hb-Max), average (Hb-Avg), and median (Hb-Med) Hb levels (g/dL) were analyzed.ResultsThere were no significant differences in clinical, biochemical, and nutritional indexes based on the Hb-CV level. Compared to patients with an Hb-Med ≤ 10.77, those with an Hb-Med >10.77 had higher albumin levels, total iron-binding capacity (TIBC), and PhA and lower average weekly prescribed darbepoetin. Age, female sex, OH, and darbepoetin dosage were negatively correlated with PhA. Serum albumin, phosphorus, TIBC, Hb-Med, and Hb-Avg were positively correlated with PhA. In multiple linear regression analysis, PhA was positively associated with Hb-Med and serum albumin level, whereas PhA was negatively associated with age and female sex. The area under the curve (AUC) of Hb-Med was 0.665 (p = 0.040) in predicting PhA >5.00°ConclusionsPhA was not affected by indexes of Hb variability, whereas PhA was associated with Hb-Med in chronic HD patients. 相似文献