透析患者中枢系统并发症的诊断和治疗

透析患者中枢神经系统并发症临床非常常见,其中有些与尿毒症有关,有些与透析有关,还有一些与以上二者都无关.[第一段]     

肾功能衰竭合并严重出血患者的透析抗凝方法探讨

对３２例急慢性肾功能衰竭（肾衰）合并出血患者在活化全血凝固时间（ＡＣＴ）和肝素动力学严密监测下，根据临床出血危险性进行透析膜肝素处理高血液流量无抗凝剂透析和（或）个体化小剂量肝素透析。除１例外患者均安全渡过出血危险期。无抗凝剂透析法透析器凝血发生率为１５．５８％，未引起或加重出血。小剂量肝素化抗凝透析中ＡＣＴ延长控制在１０％～５０％，凝血发生率为４．５０％，加重出血发生率为１２．９６％。作者认为：活动性出血肾衰患者，特别是出血部位直接危及生命时，透析膜肝素处理结合高血液流量无抗凝剂血液透析是目前更安全的透析抗凝方法     

肾衰伴贫血患者实施透析期间输血治疗的临床疗效分析

目的探讨肾衰加贫血患者实施透析期间输血治疗的临床疗效。方法选取我院2017年1月～2018年1月在我院进行治疗的尿毒症贫血患者58例,根据输血时间差异分为观察组和对照组各29例。其中对照组采取透析后进行输血治疗,观察组实施透析期间进行输血治疗,对比两组患者透析前后各项生化指标与营养状况。结果观察组各项数据均优于对照组,差异有统计学意义(P<0.05);治疗后观察组营养状况显著优于对照组,差异有统计学意义(P<0.05);经过治疗后观察组生活质量单项评分均高于对照组,差异有统计学意义(P<0.05)。结论针对尿毒症透析的贫血患者,可采取透析期间输注红细胞悬液治疗,透析后输注洗涤红细胞,能有效改善患者生活质量,确保患者的治疗效果,后期临床可根据患者实际情况进行选择。     

妇产科出血性疾病的诊断与病因

选取2008年1月～2010年1月患有妇产科出血性疾病的患者300例,并依据这些患者的年龄、临床诊断和病理类型等进行相关分析。结果本组患者阴道出血的引起按照病种的不同可以依次排序为有排卵型功血、宫内妊娠流产、无排卵性功血、宫颈炎和宫外孕等。造成阴道出血的疾病病理类型依次是子宫内膜功能性改变、宫内妊娠异常、子宫内膜病理性增生、宫颈炎症和宫外孕等。通过本文探讨研究可得出当患者阴道出血量较大时,可能会危及生命,且造成患者妇产科出血性疾病的病因有多重,尽早确诊至关重要。     

血液透析中出现的问题及血液透析患者的整体治疗

我院2001～2004年共收治60例尿毒症患者，采取血液透析治疗。其中有一例女性患者在透析过程中突然血压下降，抢救无效而死亡；约有10％的病人在透析过程中出现恶心、呕吐；5％的病人有寒战、手足抽搐等低钙表现；约有20％的病人在追加抗凝剂“肝素”时有不适感；部分患者有肌肉刺痛。临床实践表明，在充分透析的基础上，要重视对透析患者的整体治疗，从而提高透析效率，延长患者的存活期和改善生存质量。     

出血与血栓性疾病的诊断和治疗进展

出血与血栓性疾病由于严重威胁人类健康,正日益受到临床各科的重视。本文就出血与血栓性疾病的发生机制以及近年来在诊疗方面有所进展的相关疾病,如遗传性出血性疾病、血栓性血小板减少性紫癜、血栓性疾病等作一综述。     

lgG4相关性疾病的鉴别诊断与治疗

IgG4相关性疾病（IgG4-RD）是新认识的一种慢性系统性自身免疫性疾病。该疾病的发病机制尚未明确,临床表现无特异性,因可累及全身各个系统,临床诊断时需与多种疾病相鉴别。目前,IgG4-RD的治疗以激素治疗为首选,出现耐药或复发时可考虑采用生物治疗或免疫抑制剂。     

急性上消化道出血的诊断与治疗新进展

急性上消化道出血是临床较为常见的内科急症,是指屈氏韧带以上的消化器官病变所引起的急性出血,其临床表现主要有头晕、心慌、口干、呕血以及血压降低等,甚至会出现休克,严重影响患者的生命安全.及时诊断急性上消化道出血,确定出血部位和出血原因,采取科学合理的治疗方案是救治成功的关键.因此,急性上消化道出血诊断的准确性和治疗方案制...     

维持性血液透析患者肝素诱导血小板减少症的研究进展

维持性血液透析（maintenance hemodialysis,MHD）是尿毒症患者的最主要治疗方法,肝素或低分子肝素是最常用的抗凝剂[1,2].肝素诱导血小板减少症（Heparin-induced thrombocytopenia,HIT）是由肝素或低分子肝素诱导的一种严重的免疫介导性疾病,常常引发血栓栓塞性疾病,甚至危及患者生命.本文综述了血液透析患者抗PF4/H抗体的阳性率、危险因素及其血栓栓塞事件的临床研究进展,希望对促进临床医生相关知识更新、提高HIT诊断率提供帮助.     

鼻-鼻窦炎性疾病嗅觉障碍的诊断与治疗

在鼻的诸多生理功能中嗅觉占据比较重要的位置,具有报警、识别、增加食欲和影响情绪的作用。嗅觉障碍可影响人的内脏反应和情绪活动,嗅觉障碍可能由多种原因引起,常见的原因有头部外伤、上呼吸道感染和慢性鼻及鼻窦炎。据统计,嗅觉障碍患者中有45．6％患有慢性鼻窦炎、鼻息肉,而慢性鼻窦炎患者中有66％存在嗅觉障碍。     

腹腔镜胆囊切除术9例并发症诊治分析

目的 探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)并发症的原因及处理方法.方法 回顾性分析1995～2007年9例LC并发症患者的临床资料.结果 胆管横断伤6例,其中3例行胆管空肠Roux-Y吻合.3例行胆管断端吻合,术后3例恢复良好,3例因胆管狭窄行二次以上手术.1例副肝管损伤仅做结扎,门静脉损伤和十二指肠损伤各1例,予以修补缝合.结论 熟悉Calot三角解剖,对困难病例及时中转开腹手术是避免LC并发症的关键.     

Transfusional iron overload in patients undergoing dialysis: treatment with erythropoietin and phlebotomy

Five patients undergoing long-term hemodialysis with transfusional iron overload received treatment for 18 weeks with a regimen of recombinant human erythropoietin (150 U/kg) and regular phlebotomy to maintain the hematocrit value at 25% and reduce the total body iron burden. In the 149 phlebotomy sessions performed in these patients, a mean of 228 +/- 8 ml (mean +/- SEM) of whole blood was removed; it had a hematocrit value of 27.7% +/- 0.2%. The iron content of the erythrocytes removed (erythrocyte iron concentration, 787 +/- 11 micrograms/ml in 133 samples) accounted for more than 99% of the total iron removal by phlebotomy. Serum iron (serum iron concentration, 1.57 +/- 0.09 micrograms/ml in 65 samples) accounted for an insignificant fraction of the total iron removed. The iron removed at each phlebotomy session averaged 49.1 +/- 2.0 mg, similar to the amount of iron removed with deferoxamine administration in patients undergoing dialysis who had iron overload, but without the potential for adverse side effects reported with long-term deferoxamine therapy. Total iron removal during the 18 weeks of this study ranged from 732 to 2797 mg. Mean serum ferritin level decreased from 3189 +/- 1076 micrograms/L to 1676 +/- 342 micrograms/L (p less than 0.02, Wilcoxon signed rank test). When compared with a group of five patients without transfusional iron overload who received recombinant human erythropoietin and did not undergo therapeutic phlebotomy, the patients with iron overload had much greater iron losses and a larger decrease in serum ferritin levels.(ABSTRACT TRUNCATED AT 250 WORDS)     

Pharmacokinetics of metronidazole in patients undergoing peritoneal dialysis.

After a single 500-mg intravenous dose of metronidazole, plasma and dialysate levels were measured over a 7.5-h period in five patients undergoing peritoneal dialysis for terminal renal failure. Approximately 10% of this dose was removed by dialysis during that period, and therapeutic levels were maintained in plasma. No routine adjustment in the dosage of metronidazole appears necessary in patients undergoing peritoneal dialysis.     

终末期肾病腹膜透析患者微炎症状态与营养状况的关系

目的 探讨终末期肾病（ESRD）长期腹膜透析患者血清C-反应蛋白（CRP）和白细胞介素-6（IL-6）水平变化及与营养状况的关系. 方法 检测山东中医药大学第二附属医院肾内科ESRD患者非透析组、腹膜透析组和对照组的CRP、IL-6、血清白蛋白（Alb）、血红蛋白（Hb）、转铁蛋白（TF）、血肌酐（Scr）水平.根据CRP水平将膜透析组分为CRP≤6mg/L组和CRP＞6mg/L组.并比较两组IL-6、Alb、Hb、TF、Scr的水平. 结果 腹膜透析组CRP、IL-6水平明显高于非透析组（P＜0.05）和对照组（P＜0.01）,腹膜透析组CRP、IL-6分别与Alb、Hb、TF呈负相关（r=-0.543～-0.379,P＜0.05）,与Scr无相关关系（r=0.258、0.245,P＞0.05）. 结论 ESRD腹膜透析患者体内存在微炎症状态,CRP、IL-6是终末期肾病腹膜透析患者微炎症状态较好的预测指标,并可反映腹膜透析患者的营养状况.     

Peritonitis-related mortality in patients undergoing chronic peritoneal dialysis.

Peritonitis is a well-known cause of mortality in peritoneal dialysis (PD) patients. We carried out a retrospective study to disclose the clinical spectrum and risk profile of peritonitis-related mortality. We analyzed 693 episodes of infectious peritonitis suffered by 565 patients (follow-up 1149 patient-years). Death was the final outcome in 41 cases (5.9% of episodes), peritonitis being directly implicated in 15.2% of the global mortality and 68.5% of the infectious mortality observed. In 41.5% of patients with peritonitis-related mortality, the immediate cause of death was a cardiovascular event. Highest mortality rates corresponded to fungal (27.5%), enteric (19.3%), and Staphylococcus aureus (15.2%) peritonitis. Multivariate analysis disclosed thatthe baseline risk of peritonitis-related mortality was significantly higher in female [relative risk (RR) 2.13, 95% confidence interval (CI) 1.24-4.09, p = 0.02], older (RR 1.10/year, CI 1.06-1.14, p < 0.0005), and malnourished patients (RR 2.51, CI 1.21-5.23, p = 0.01) with high serum C-reactive protein (s-CRP) levels (RR 4.04, CI 1.45-11.32, p = 0.008) and a low glomerular filtration rate (RR 0.75 per mL/minute, CI 0.64 -0.87, p < 0.0005). Analysis of risk after a single episode of peritonitis and/or subanalysis restricted to peritonitis caused by more aggressive micro-organisms disclosed that overall comorbidity [odds ratio (OR) 1.21, CI 1.05-1.71, p = 0.005], depression (OR 2.35, CI 1.14-4.84, p = 0.02), and time on PD at the time of the event (OR 1.02/month, CI 1.00-1.03, p = 0.02) were other predictors of mortality. In summary, the etiologic agent is a definite marker of peritonitis-related mortality but gender, age, residual renal function, inflammation (s-CRP), malnutrition, and depression are other significant correlates of this outcome. Most of these risk factors are common to cardiovascular and peritonitis-related mortality, which may explain the high incidence of cardiovascular event as the immediate cause of death in patients with peritonitis-related mortality.     

终末端肾病腹膜透析病人营养不良的护理进展

营养不良是终末端肾病腹膜透析病人发生严重并发症和主要死亡原因之一。综述导致终末端肾病腹膜透析病人营养不良的因素、营养状况评估方法以及营养不良的护理研究进展。