急性肾功能衰竭血液透析治疗的临床观察

目的探讨急性肾功能衰竭血液透析治疗的疗效.方法给53例急性肾功能衰竭患者一周2～3次,每次2～4小时的血液透析治疗.结果治愈32例(占60.3%),转慢性透析4例(占7.6%),放弃治疗3例(占5.7%),死亡14例(占26.4%).结论急性肾功能衰竭患者早期血液透析治疗,有利于减少严重并发症,帮助肾功能恢复,提高抢救成功率,减少死亡率.     

短时无钾碳酸氢盐血透治疗急、慢性肾衰严重高钾血症38例临床分析

目的 探讨短时无钾碳酸氢盐血透治疗急、慢性肾衰严重高钾血症的疗效。方法 回顾性分析38例急、慢性肾衰严重高钾血症患者，先短时用无钾碳酸氢盐透析液透析，再根据电解质情况，按标准碳酸氢盐透析液透析后的疗效。结果 全部患者均顺利完成血透，血透结束后查电解质血钾均恢复正常。结论 急、慢性肾功能衰竭所致严重高钾血症患者，实施短时无钾碳酸氢盐血透是安全有效的。     

老年重症肾衰竭患者实施床边间歇性血液透析的预见性护理

目的 观察并探讨预见性护理干预在老年重症肾衰竭（SRF）患者实施床边间歇性血液透析（IHD）中的效果.方法 选择2012年3月-2014年1月在某院接受IHD的72例老年SRF患者,根据随机数字表法分为两组,各36例.干预组患者接受预见性护理干预（透析次数286次）,对照组患者接受常规护理（透析次数292次）.观察护理前后两组患者急性生理与慢性健康（APACHEⅢ）评分、24h尿量、脉搏血氧饱和度（SpO2）、中心静脉压（CVP）、血清肌酐（SCr）和血清氮末端-前体脑钠肽（NT-proBNP）水平,以及IHD过程中并发症发生情况.结果 两组患者透析前所监测指标相比,差异无统计学意义（P＞0.05）.护理后,干预组APACHEⅢ评分、CVP、SCr和NT-proBNP明显低于对照组,24 h尿量和SpO2明显高于对照组,差异有统计学意义（P＜0.05）;且观察组低血压、高血压、低血糖和心律失常发生率分别为6.3％,4.2％,4.9％和2.4％,对照组为16.4％,13.4％,10.6％和6.2％,两组相比差异具有统计学意义（x2值分别为14.700,15.070,6.588,4.823;P ＜0.05）.结论 预见性护理干预能明显改善SRF患者的状况,减少并发症的发生,值得在临床上进一步推广.     

Role of proteases in patients with acute renal failure and regular hemodialysis therapy

The potential role of proteases in patients with acute renal failure and regular hemodialysis therapy was investigated. Proteases released from blood cells, damaged kidney cortex and different strains of Pseudomonas aeruginosa in patients with septicemia may contribute to an accelerated protein catabolism. The imbalance of the protease-antiprotease system suggests the valve of active antiproteolytic agents in the treatment of these pathologic states. Our own observation of an in vitro suppression of enhanced proteolysis by the administration of alpha 2-macroglobulin seems to support the usefulness of such a procedure (W.H. H?rl, C. Gautert, I.O. Auer et al., Am. J. Nephrol., 2 (1982) 32-35). As long as alpha 2-macroglobulin is not available, the value of its treatment has to be confirmed by the administration of fresh frozen plasma containing alpha 2-macroglobulin. Also the search for other active antiproteolytic agents is required.     

短时高容量血液滤过与间歇性血液透析治疗重症胰腺炎的疗效比较

目的 比较短时高容量血液滤过(STHVH)治疗与间歇性血液透析(IHD)治疗伴急性肾功能衰竭(ARF)的重症胰腺炎(SAP)的疗效。方法 15例伴急性肾功能衰竭的重症胰腺炎患者,9例给予短时高容量血液滤过治疗,6例接受间歇性血液透析治疗。15例患者血液净化治疗前后均纪录各项急性生理学指标及28日存活率,同时检测血肌酐、尿素氮、电解质、淀粉酶浓度、动脉血pH值及血浆肿瘤坏死因子α(TNFα)、白介素1βp(IL-1β)、白介素8(IL-8)、白介素10(IL-10)的水平。结果 APACHEⅡ积分治疗前两组无差异(24.4±4.3 vs 23.2±3.1,P>0.05),治疗后血滤组积分呈下降趋势,至第7日(13.2±1.6)明显低于治疗前(24.4±4.3)和血液透析组(20.2±2.3),P<0.05。血滤组每日治疗前血肌酐、尿素氮、电解质、淀粉酶浓度、动脉血pH值与血液透析组比较无明显差异(P>0.05)。血滤组升压药剂量较血液透析组明显减少(P<0.05),且28天存活率血滤组与血液透析组比较(66.7％vs 33.3％,P<0.05)有显著性意义。血滤组治疗后血浆促炎症因子TNFα、IL-1β、IL-8的水平较治疗前和血液透析组明显降低(P<0.05),抗炎症因子IL-10水平较治疗前和血液透析组升高(P<0.05)。结论 短时高容量血液滤过改善伴急性肾功能衰竭的重症胰腺炎患者预后优于间歇性血液透析。     

Rhabdomyolysis associated with acute renal failure in patients with severe acute respiratory syndrome

An outbreak of severe acute respiratory syndrome (SARS) occurred in Taiwan in 2003. SARS complicated with rhabdomyolysis has rarely been reported. This study reported three cases of rhabdomyolysis developing during the clinical course of SARS. Thirty probable SARS patients were admitted to the isolation wards at Linkou Chang Gung Memorial Hospital between 4 April and 4 June 2003. Thirty patients, including four men and 26 women aged from 12 to 87 years (mean age 40). Eleven (36.7%) patients had respiratory failure and required mechanical ventilation with paralytic therapy; three (10%) patients had rhabdomyolysis complicated with acute renal failure and one received haemodialysis; four (13.3%) patients died. Three cases with rhabdomyolysis all received sedative and paralytic therapy for mechanical ventilation. Haemodialysis was performed on one patient. Two patients died from multiple organ failure, and one patient fully recovered from rhabdomyolysis with acute renal failure. SARS is a serious respiratory illness, and its aetiology is a novel coronavirus. Rhabdomyolysis resulting from SARS virus infection was strongly suspected. Immobilisation under paralytic therapy and steroids may also be important in developing rhabdomyolysis.     

慢性肾衰血液透析患者并发急性左心衰58例分析

目的探讨慢性肾衰血液透析患者并发急性左心衰的原因及防治措施。方法对58例慢性肾衰并发急性左心衰患者的临床资料进行回顾性分析。结果 58例急性左心衰患者经过序贯超滤透析临床症状均改善。结论高血压、容量负荷过重和贫血是诱发急性左心衰的主要原因,序贯超滤透析是治疗慢性肾衰血液透析患者合并急性左心衰的有效措施之一。     

间歇性血液透析治疗急性肾功能衰竭的护理

目的 探讨间歇性血液透析治疗急性肾功能的观察护理要点。方法 对60例不同病因所致的急性肾功能衰竭患者采用间歇性血液透析治疗,针对不同病因和特点,治疗中采取相应护理,保证透析顺利进行。结果 60例中治愈38例,死亡13例,9例放弃治疗。结论 间歇性血液透析在急性肾功能衰竭的治疗中仍起着很大的作用,透析中密切观察病情变化并作好相应护理,使每次血液透析治疗顺利有效地进行,可为治疗成功提供保障。     

Risk factors and outcome of acute renal failure in patients with severe acute pancreatitis

Objective

Acute renal failure (ARF) is one of the most common causes of death in patients with severe acute pancreatitis (SAP). Here, we aimed to investigate the risk factors of ARF in patients with SAP, assess the prognosis of patients with SAP and ARF, and seek potential measures to prevent ARF.

Method

A cross-sectional study was performed to analyze the data from patients with SAP. Both univariate and multivariate logistic regression analyses were performed, including 15 indices such as age, history of renal disease, Acute Physiology and Chronic Health Evaluation II scores, hypoxemia, abdominal compartment syndrome (ACS), and others. Univariate analysis was also used to compare the prognosis between the groups of patients with SAP with and without ARF.

Results

There was a significant difference in age, history of renal disease, Acute Physiology and Chronic Health Evaluation II scores, hypoxemia, and ACS between the groups with and without ARF. Patients with SAP and ARF had significantly longer average length of stay and intensive care unit length of stay and higher infection rate of the pancreas and mortality rate.

Conclusion

The significant risk factors for ARF in patients with SAP include history of renal disease, hypoxemia, and ACS. Measures that can prevent ARF include homeostasis maintenance, adequate perfusion of the kidneys, adequate oxygenation, and abdominal decompression to avoid ACS.     

艾滋病合并急性肾衰竭病人血液透析治疗后的护理管理

[目的]探讨人类免疫缺陷病毒（HIV）阳性合并急性肾衰竭病人血液透析后的护理管理,以减少并发症,预防感染,延长病人生命.[方法]为24例HIV阳性合并急性肾衰竭实施血液透析病人准备单人单间病室,每周透析2次或3次,每次3h～4h,规范消毒隔离工作,实行责任包干,加强心理护理、抗病毒治疗宣教,出院后定期随访.[结果]24例病人经积极有效的治疗和护理,肾功能恢复正常19例,死亡3例,自动出院2例.[结论] HIV阳性合并急性肾衰竭病人血液透析后进行有效的护理管理,可缩短抗病毒治疗时间,提高抗病毒治疗依从性,减少并发症,提高HIV病人的生存率.     

连续性肾脏替代治疗与间歇性血液透析治疗重症急性肾功能衰竭的比较

目的比较连续性肾脏替代治疗(CRRT)与间歇性血液透析治疗(IHD)对重症急性肾功能衰竭的治疗效果.方法收集我科自2001年12月至2002年12月重症急性肾功能衰竭患者52例.每次治疗前、后采血测肾功能、离子,透析前、透析后及透析中每隔2小时测量血压、心率,记录肾功能恢复时间,并记录治疗结束后APACHE-Ⅱ评分.结果 CRRT组与IHD组透析中低血压的发生次数、心律失常发生次数分别为(1.93±0.35)、(3.88±1.23),P<0.05;(1.39±2.37)、(3.75±3.39),P<0.01;24小时尿量达到600毫升的时间分别为(15.44±5.29)天、(22.93±8.44)天,P<0.05.治疗后两组APACHE-Ⅱ评分分别为(14.20±5.56)、(17.30±4.37),P<0.05.结论重症急性肾功能衰竭用CRRT治疗在血流动力学稳定性、溶质清除率及预后方面优于IHD.     

Appropriate antibiotic dosing in severe sepsis and acute renal failure: factors to consider

Severe sepsis and septic shock cause considerable morbidity and mortality. Early appropriate empiric broad-spectrum antibiotics and advanced resuscitation therapy are the cornerstones of treatment for these conditions. In prescribing an antibiotic regimen in septic patients with acute renal failure treated with continuous renal replacement therapy, several factors should be considered: pharmacokinetics, weight, residual renal function, hepatic function, mode of renal replacement therapy (membrane and surface area, sieving coefficient, effluent and dialysate rate, and blood flow rate), severity of illness, microorganism, minimum inhibitory concentration, and others. Studies that determine the serum antibiotic concentrations are very useful in establishing the correct dosage in critical patients.     

Pharmacologic treatment of acute renal failure in sepsis

The pathophysiology of acute renal failure in sepsis is complex and includes intrarenal vasoconstriction, infiltration of inflammatory cells in the renal parenchyma, intraglomerular thrombosis, and obstruction of tubuli with necrotic cells and debris. Attempts to interfere pharmacologically with these dysfunctional pathways, including inhibition of inflammatory mediators, improvement of renal hemodynamics by amplifying vasodilator mechanisms and blocking vasoconstrictor mechanisms, and administration of growth factors to accelerate renal recovery, have yielded disappointing results in clinical trials. Interruption of leukocyte recruitment is a potential promising approach in the treatment of septic acute renal failure, but no data in humans are presently available. Activated protein C and steroid replacement therapy have been shown to reduce mortality in patients with sepsis and are now accepted adjunctive treatment options for sepsis in general.     

Factors predictive of acute renal failure and need for hemodialysis among ED patients with rhabdomyolysis

OBJECTIVE: We assessed the primary causes of rhabdomyolysis, the factors associated with the development of acute renal failure (ARF), and the need for hemodialysis (HD) among a series of patients presenting to an urban emergency department with rhabdomyolysis. METHODS: A chart review between January 1992 and December 1995 was conducted of patients aged 18 years or older with a diagnosis of rhabdomyolysis and an initial serum creatine phosphokinase greater than 1000 U/L. Patients were excluded if they had evidence of myocardial ischemia, cerebrovascular insufficiency, or the development of rhabdomyolysis after hospitalization. Demographic information, presumed causative factors, past medical history, medication usage, and laboratory data were collected. RESULTS: Ninety-seven patients (93 men, 4 women) were enrolled, with a mean age of 35.7 years. The most common causes of rhabdomyolysis were cocaine (30), exercise (29), and immobilization (18). Seventeen of 97 (17.5%) patients developed ARF; 8 patients (8.25%) needed HD. Several clinical and laboratory factors were statistically associated with development of ARF and need for HD. The only variable that was predictive of both ARF and need for HD in separate multivariate regression models was the initial creatinine (Cr). Initial blood urea nitrogen also was predictive of the need for HD. No patient developed ARF with an initial Cr less than 1.7 mg/dL. CONCLUSION: Acute renal failure and need for HD are common complications of rhabdomyolysis. Except for initial serum Cr and blood urea nitrogen, clinical and laboratory factors were not reliable predictors for the development of ARF or need for HD.     

Hemodynamic tolerance of hemodialysis in septic patients with acute renal failure: comparison between recirculating and single-pass bicarbonate hemodialysis

Septic patients with acute renal failure (ARF) are especially intolerant to acetate hemodialysis (HD). Hemodynamic tolerance in septic patients is improved by using bicarbonate dialysis and high Na concentration dialysate. The potential improvement of hemodynamic tolerance with recirculating v single-pass bicarbonate HD (BiHD) has not been evaluated in such patients. We then compared the hemodynamic tolerance in a randomized cross-over study, using a pulmonary artery catheter and biologic changes during the two types of HD in eight severe septic patients with ARF. Patients were dialysed for four hours with a 1 m²1 cuprophan dialyzer, alternatively using single-pass and recirculating system. No absorbent cartridge was used in recirculating BiHD. Intravascular volume expansion (IVE) was used as needed to maintain a systolic arterial pressure of at least 80 mm Hg. Similar doses of catecholamines (dopamine essentially) and equal ultrafiltration rate (mean, 1.55 ± 0.61 for four hours) were used during the two types of dialysis in each patient. No hemodynamic parameter was significantly different between the two procedures, but IVE was lower (370 ± 550 mL v 740 ± 590 mL; P < .05) and weight loss higher (1.06 ± 0.88 kg v 0.68 ± 0.99 kg; P < .05) in recirculating BiHD than in single-pass BiHD. No biologic differences were found between recirculating and single-pass BiHD except for a lower decrease of blood urea (Δ, 10.5 ± 3.4 μmol/L v 12.8 ± 4.9 mmol/L; P <.05) and creatinine (Δ, 107 ± 40 μmol/L v 153 ± 69 μmol/L; P < .05) in recirculating BiHD. Recirculating BiHD was better tolerated than single-pass BiHD, requiring less IVE. This lesser IVE during recirculating BiHD with similar decrease in pulmonary wedge pressure suggests a venoconstrictor effect. This venoconstrictor effect is likely due to a lower loss of catecholamines (dopamine) in the dialysate. Recirculating BiHD is better tolerated than single pass, providing higher weight loss. This procedure is particularly interesting in patients with cardiovascular instability, especially after septic shock.