人造血管内瘘及自体动静脉内瘘用于血液透析患者的临床比较

目的探讨人造血管内瘘在维持性血液透析患者中的临床应用。方法分析比较自体动静脉内瘘（148例）及人造血管内瘘（37例）的维持性血液透析患者一般临床资料、术后并发症发生率、瘘成熟时间、1年通.率的差别等。结果人造血管内瘘患者的年龄较大,原发病为糖尿病肾病的比例较高,CRP水平较高,与自体动静脉内瘘比较差异有统计学意义（ P＜0.05）。人造血管内瘘术后并发症发生率较自体动静脉内瘘高,差异有统计学意义（ P＜0.05）。两组的1年通.率分别为90.54％、83.78％,差异无统计学意义（ P＞0.05）。结论人造血管内瘘是维持性血液透析患者在自体动静脉内瘘失功后良好的血管通路选择。     

100例血液净化患者动静脉内瘘的建立与保护

临床上行血液净化患者需要建立动静脉内瘘（AVF）．尤其是慢性肾功能衰竭（CRF）患者。近10年．我院对行血液净化治疗的100例患者建立了AVF,并采取一系列保护措施,减少了并发症的发生．延长了AVF的使用时间。     

腔内血管成型术治疗动静脉内瘘狭窄

目的:探讨经皮穿刺腔内血管成型术治疗血液透析用动静脉内瘘狭窄的效果. 方法:经血管造影或CT血管造影检查,慢性维持血液透析患者的动静脉内瘘狭窄超过50%,或狭窄部位血管内径<2.5mm作为治疗对象.按扩张后的目标血管内径与球囊直径1∶1.1的比例,选用相应直径的扩张球囊.局麻下,经皮穿刺建立血管通道,在放射监测下将扩张球囊置于狭窄部位,缓慢充气至目标值后,保留30s后缓慢放气.21例符合上述条件的患者共进行46例次治疗. 结果:技术和临床成功率均为100%.狭窄部位血管内径均扩张至与之相连的正常血管内径.近动脉吻合处狭窄的患者,血流量由扩张前的(157.46 ±26.43)ml/min增加至(353.26 ±16.73)ml/min.静脉吻合口狭窄的患者,在血流量为250 ml/min时,静脉压由扩张前的(211.33±14.18)mmHg降至扩张后的(102.12±12.42)mmHg.无血管破裂、出血和血栓形成并发症出现. 结论:用扩张球囊经皮穿刺腔内血管成型术是治疗动静脉内瘘狭窄安全、有效的方法,它的临床应用将会显著提高血液透析用动静脉内瘘开通率.     

动静脉内瘘在老年透析患者中的应用

<正>透析患者人群逐步进入老龄化~([1]),据报道,美国>75岁的老年终末期肾脏病患者2000~2013年增长了44%,远远大于20~44岁(增长率为14%)和45~64岁(增长率为19%)~([2])。我国近10年内的血液透析患者血管通路仍主要以动静脉内瘘(AVF)为主,同时长期性中心静脉导管(CVC)也得到了广泛应用,透析用血管通路出现多元化趋势,在这种背景之下,老年患     

滋养血管在自体动静脉内瘘静脉内膜增生中的作用

自体动静脉内瘘(AVF)是终末期肾病血液透析患者的"生命线".静脉流出道狭窄是导致AVF失功最常见的原因,其病理改变主要为新生内膜增生(NIH).目前NIH发生机制尚未阐明.滋养血管位于血管壁的中外层,是由微小血管组成的网状结构,可为血管壁供氧及补充营养物质,同时排出代谢废物.本综述重点阐述滋养血管参与NIH发生发展的...     

自体动静脉内瘘在血液透析中的应用

目的分析慢性肾功能不全尿毒症期患者自体动静脉内瘘在血液透析中的应用,并探讨其使用时间、初期成熟影响因素、并发症及透析充分性.方法回顾分析182人188例次自体内瘘手术的慢性肾功能不全尿毒症期患者的临床资料,探讨性别、年龄、原发病、术前血白蛋白、血色素、血肌酐、尿素氮、血脂、术后抗凝剂用量与内瘘初期成熟相关性以及1年内并发症和透析充分性.结果 182例慢性透析患者中男性93例,女性89例, 平均年龄52.4岁±8.52岁(18～89)岁,原发病为糖尿病肾病31例(17%).172例内瘘成熟,10例患者16例次失败;Logistic回归分析显示血压低于100/60mmHg患者与内瘘初期成熟成负相关(P<0.001),术后应用抗凝治疗与内瘘初期成熟成正相关(P<0.02);内瘘成熟后1年,通畅率为97.6%(168/172例次),栓塞率为2.3%(4/172例次),感染率为0.每例内瘘平均透析次数为(140.2±10.6)次,平均透析时间为(560.8±42.4)小时, 透析血流量200～250ml/min,KT/V为1.2～1.5, 再循环率R为3.2～3.4%.结论自体内瘘为1种永久性血液透析通路,其并发症主要为栓塞;血压低于100/60mmHg的患者内瘘初期成熟机率较低,术后应用抗凝治疗可减少内瘘阻塞的发生机率;自体内瘘作为血液透析通路,透析充分性好.     

循证护理在透析病人动静脉内瘘管理中的应用

动静脉内瘘术足医生采用显微外科手术将患者邻近的动静脉吻合起来,使之成为血流通道,为血液透析提供长期而有效的并能进行体外循环的血管通路。内瘘的优点是无外瘘导管脱落的危险,患者活动不受限制,感染和血栓的发生率也大为减少,如保护得当,可长期使用。因此,动静脉内瘘可作为维持血液透析患者的主要通路。     

动静脉内瘘重建术与经皮球囊扩张术在老年自体动静脉内瘘狭窄患者中的临床应用

目的 对比研究动静脉内瘘重建术与经皮球囊扩张术(PTA)在自体动静脉内瘘(AVF)狭窄的老年高血压透析患者中的临床应用。方法 回顾性分析2019年2月至2020年2月于内蒙古自治区人民医院血管外科因需进行血液透析治疗而实施AVF手术、术后发生AVF狭窄的老年高血压肾病23例患者的临床资料,根据手术方式不同分2组。对照组患者10例,行动静脉内瘘重建术;试验组患者13例,行PTA术。对比2组患者的一般资料、手术成功率及术后6个月AVF重建率等指标。采用SPSS 22.0统计软件进行数据分析。组间比较分别采用t检验、Mann-Whitney检验及χ²检验。结果 对照组成功率80.00%(8/10),试验组成功率84.61(11/13),差异无统计学意义(P＞0.05);试验组与对照组AVF重建率[61.54%(8/13)和40.00%(4/10)]、手术创口长度[(3.10±1.76)和(35.00±11.60)mm]、手术时间[(0.90±0.60)和(1.50±0.40)h]、术中出血量[10(9,11)和30(20,50)ml]、造影剂使用量[(50.00±25.17)和(8.13±3.34)ml]比较,差异均有统计学意义(均P＜0.05)。结论 PTA在治疗老年高血压肾病患者AVF狭窄的疗效不劣于动静脉内瘘重建术,PTA血运重建率更高。     

动静脉内瘘术后血管痉挛21例报告

建立良好的血管通路是维持性血液净化的关键.目前,自身动静脉内瘘已成为首选的血液净化血管通路并被广泛使用.然而,术中和术后均可出现血管痉挛及血栓而影响维持性血液净化的顺利进行.2009年7月～2010年12月,我们共实施动静脉内瘘术39例,发生血管痉挛21例.现报告如下.     

动静脉内瘘成形术308例临床分析

目的探讨终末期肾病患者动静脉内瘘(AVF)建立的手术方式及手术经验,提高对动静脉内瘘手术的认识。方法对2009年5月至2013年5月在我院行动静脉内瘘成形手术的308例患者的手术方式选择、操作要点、成功率及并发症等进行总结分析。结果动静脉内瘘成形手术总体成功率为98.70%,共行前臂自体动静脉内瘘成形术305例、肘窝部自体动静脉内瘘成形术3例。术后并发症主要有吻合口血栓形成,血流量不足,手术切口渗血。结论动静脉内瘘首选前臂自体动静脉内瘘,其次是肘窝部自体动静脉内瘘。充分的术前评估及准备、手术方法的正确选择、及时处理术后各种并发症是成功建立内瘘的保证。     

Effect of Blood Pump Flow and Arteriovenous Fistula Blood Flow on the Blood Pressure and Cardiac Function in Patients Undergoing Maintenance Hemodialysis

The effect of blood pump flow rate on the cardiac functions of hemodialysis patients with arteriovenous fistula (AVF) is largely unknown. This study aimed to investigate if blood pump flow rate (Qb) and AVF access flow rate (Qa) can affect the cardiac function of Chinese hemodialysis patients. A total of 72 patients undergoing AVF hemodialysis were included from March 2010 to June 2014 and dichotomized into the high‐ and low‐flow groups using the medians of Qb (220 mL/min) and Qa (1000 mL/min) as the cutoffs. The cardiac function parameters were measured by ultrasound dilution technique within the first (t + 30) and the last (t ? 30) 30 min of dialysis. At t + 30, Qb‐high group had significantly higher systolic blood pressure (SBP) and mean arterial pressure (MAP) than Qb‐low group. At t ? 30, Qb‐high group had higher SBP, diastolic blood pressure (DBP), and MAP than Qb‐low group. Qa‐high group had higher SBP, MAP, cardiac output (CO), cardiac index (CI), central blood volume (CBV), and lower peripheral resistance than Qa‐low group. Multiple linear regression showed that at t ? 30, Qb was positively correlated with SBP and MAP. Qa was positively correlated with CO, CI, CBV, and PR but negatively correlated with heart rate. Although Qb > 220 mL/min and Qa >1000 mL/min would elevate some parameters, the means of SBP, DBP, MAP remain within the normal range, indicating that appropriate increase in blood pump flow rate has little effect on the cardiac function of hemodialysis patients.     

第二届全国人工肝及血液净化学术年会会议纪要

由中华医学会肝病学分会重肝与人工肝学组、中国肝炎防治基金会人工肝及血液净化科技攻关基金委员会、全国人工肝及血液净化攻关协作组联合主办、大连市第六人民医院协办的第二届全国人工肝及血液净化学术年会于2005年9月1日至4日在辽宁大连举行。会议共收录论文228篇，来自中国、美国、德国、日本的700余名代表参加本次会议。卫生部、科技部、中华医学会、中华医院管理学会、大连市的有关领导出席了会议。国内外肝病内外科、传染病、消化、血液净化、肾病、生物医学工程等领域的多位知名专家主持会议并做了专题发言。大会开设的自由论坛还使每位代表都有机会发言、交流，会场气氛热烈。会议就重型肝炎肝衰竭的机制、诊断、内科药物治疗、人工肝、血液净化、肝移植、细胞移植等方面进行了广泛、深入的探讨与交流。会议期间还举行了《实用人工肝及血液净化操作手册》发行仪式，中国肝炎防治基金会人工肝及血液净化科技攻关基金共资助7项2006-2007年度人工肝及血液净化科研课题。与会专家介绍了有关重型肝炎、人工肝及血液净化技术的多项最新进展。     

血液净化治疗118例毒蜂蜇伤致急性肾损伤的临床疗效

目的:探讨血液净化治疗毒蜂蜇伤致急性肾损伤的疗效。方法:回顾性分析我科10年来收治的118例毒蜂蜇伤的临床资料,观察对症支持治疗配合不同血液净化治疗对毒蜂蜇伤的疗效。结果:入院后6h内,在常规对症支持治疗的基础上,62例行血液透析,28例行血液透析滤过,28例行血液灌流/透析(HP+HD)联合治疗;单用HD治疗组总治愈好转率为95.2%,治愈率79.1%,病死率为4.8%;HDF治疗组总治愈好转率为96.4%,治愈率85.7%,病死率为3.6%;HP+HD联合治疗组的总治愈好转率为100%,治愈率96.4%。3组间无统计学差异(P>0.05)。结论:血液净化治疗方式均可有效治疗毒蜂蜇伤所致急性肾功能不全;毒蜂蜇伤同时伴有心、肝、血液、神经系统等组织器官的损伤,应尽早行血液净化。     

In Vitro Cell Culture Systems as the Basis for an Extracorporeal Blood Purification Strategy In Multiorgan Failure Treatment

Multiorgan failure (MOF) based on septic processes is very common but prognostically an extremely severe disease that has to be treated exclusively under intensive care conditions. Extracorporeal blood purification (ECBP) using specific and efficient systems such as the microspheres based detoxification system (MDS) (Artif Organs 1996;20:420) could improve significantly the situation of MOF in terms of the efficient removal of endotoxins as well as key mediators such as tumor necrosis factor alpha (TNFα). The purpose of the study was to test the effectiveness of endotoxin and cytokine removal to blunt cellular response. In terms of the in vitro principle methodology, isolated peripheral blood mononuclear cells (PBMC) were incubated with endotoxins and a selective endotoxin adsorbent, which was added at various times (immediately or 30, 60, 120, 240, or 360 min) after the onset of incubation. TNFα release of monocytes was measured following a standard procedure after 20 h. Human TNFα was incubated with cultured human endothelial cells with and without a specific TNFα adsorbent (polyclonal antibodies coated on polystyrene particles). The results showed that after the initial addition of endotoxins, the activation of monocytes can be stopped within 120 min by addition of endotoxin adsorbents. In addition, specific TNFα adsorbents are able to prevent intercellular adhesion molecule 1 (ICAM-1) expression of endothelial cells, therefore avoiding activation of endothelial cells. In conclusion, cell culture models are suitable to simulate cell interaction in MOF. Specific adsorbents are able to reduce or block pathophysiologically relevant cell interactions, and the time frame for effective ECBP seems to be very short, and therefore, efficiency must be high.     

连续性血液净化治疗多器官功能障碍综合征的应用进展

多器官功能障碍综合征(MODS)发病率高、病死率高,目前早期、有效的治疗仍是一大难题。近几年,连续性血液净化技术在MODS的治疗中表现出极其重要的作用,能有效缓解患者病情、降低病死率、改善预后,现将其应用进展综述如下。     

连续性血液净化治疗重症急性胰腺炎的临床观察

目的探讨应用连续性床旁血液净化(CBP)治疗重症急性胰腺炎的临床效果,以有效防止并发症的恶化及减少死亡率的发生。方法回顾性分析2007～2009年我院应用床旁连续性静脉-静脉血液滤过(CVVH)净化方法治疗重症急性胰腺炎或暴发性胰腺炎28例的临床资料。结果重症急性胰腺炎28例,其中暴发性胰腺炎21例。所有患者均在综合治疗的基础上进行CVVH净化治疗,病情好转26例,死亡2例。结论应用CBP治疗重症急性胰腺炎或暴发性胰腺炎,可阻断机体的炎症介质的瀑布式炎症反应,明显的改善了各脏器的功能,病死率显著降低,显示出了其独特的功效。     

Effects of Different Blood Purification Methods on Serum Cytokine Levels and Prognosis in Patients With Acute Severe Organophosphorus Pesticide Poisoning

The aim of the present study was to investigate the impact of three different blood purification methods, hemoperfusion (HP), continuous blood purification (CBP), and on‐line high‐volume hemodiafiltration (OL‐HDF), on the survival rate of patients with acute severe organophosphorus pesticide poisoning (ASOPP), as well as on major pro‐inflammatory (interleukin [IL]‐1, IL‐6, tumor necrosis factor‐α [TNF‐α]) and anti‐inflammatory (IL‐10) cytokines in the serum. Eighty‐one ASOPP patients were randomly divided into three groups: HP (N = 23), HP + CBP (N = 26), HP + OL‐HD (N = 32). Serum IL‐1, IL‐6, TNF‐α, and IL‐10 levels were assessed by ELISA before treatment and at 24 and 48 h post‐treatment and survival rates were determined. Patient survival rate was significantly higher in OL‐HDF and CBP treated patients compared with HP group (P < 0.05). A significantly greater clearance effect in serum IL‐1, IL‐6, and TNF‐α levels at 24 and 48 h post‐treatment was observed in CBP and OL‐HDF groups compared with the HP group (P < 0.05). The levels of serum anti‐inflammatory cytokine IL‐10 increased significantly in CBP and OL‐HDF groups compared with the HP group (P < 0.05 at 48 h post‐treatment). In addition, OL‐HDF treatment achieved similar changes in serum TNF‐α, IL‐1, IL‐6 and IL‐10 levels as CBP (P > 0.05). Compared with the HP method, CBP or OL‐HDF combined with HP can rapidly clear inflammatory cytokines, reduce systemic inflammatory response syndrome, and improve the survival of ASOPP patients. Compared with CBP, OL‐HDF is an economical and effective method to treat ASOPP with less technical difficulty and more suitability for rural areas and primary hospitals.