维持性血液透析患者皮肤瘙痒相关因素分析

目的:分析维持性血液透析(maintenance hemodialysis,MHD)患者皮肤瘙痒发生的相关因素。方法:利用Dirk R Kuypers的方法对本透析中心158例MHD患者的皮肤瘙痒情况进行评分,了解皮肤瘙痒的发生率、严重程度和临床特征,再进一步分析相关临床指标(性别、年龄、透析年限、皮肤干燥患病率、血液透析滤过(HDF)频率、透析前血肌酐、钙、磷、钙磷乘积、血红蛋白、甲状旁腺激素)与患者皮肤瘙痒发生的相关性。结果:本透析中心MHD患者皮肤瘙痒的发生率高达62.66%。其中轻度瘙痒占25.25%,中度瘙痒53.53%,重度瘙痒21.21%。患者发生皮肤瘙痒的常见部位是背部、下肢、胸部、头颈。其中背部尤其严重。皮肤瘙痒组与无皮肤瘙痒组相比,年龄、透析年限和皮肤干燥患病率、HDF频率、血磷、钙磷乘积、i PTH差异有统计学意义(P<0.05)。中重度瘙痒组的年龄、透析年限、皮肤干燥患病率、钙磷乘积、i PTH均高于轻度瘙痒组,差异有统计学意义(P<0.05)。结论:MHD患者皮肤瘙痒程度可能与皮肤干燥程度、钙磷乘积相关。     

血液透析病人皮肤瘙痒症状分析与治疗

目的对慢性肾功能不全血液透析患者皮肤瘙痒症状病因作初步探讨,并应用血液吸附技术进行治疗,观察其疗效。方法收集我院2000年5月~2005年5月在我院进行维持性血液透析6个月以上尿毒症患者60例,对其中28例有皮肤瘙痒症状者作临床分析,并随机分组。观察组14例病人血液透析(HD)同时行血液吸附;对照组14例行常规血液透析。结果瘙痒组患者年龄大于无瘙痒组患者(P<0.05),其皮肤干燥程度较重。瘙痒组患者血肌酐(Scr)、尿素氮(BUN)水平显著高于无瘙痒组(P<0.01),瘙痒与性别无关。血液吸附治疗后患者血磷水平显著下降(P<0.01),HD治疗前后血磷水平无明显变化(P>0.05)。结论血液透析病人皮肤瘙痒与患者年龄、皮肤干燥程度、透析时间长短、血浆白蛋白、血磷水平密切相关。常规血液透析间断串联血液吸附器治疗瘙痒症状疗效较佳,临床值得推广。     

维持性血液透析患者顽固性瘙痒的原因分析及护理对策

[目的]分析维持性血液透析患者顽固性皮肤瘙痒的原因,探讨相关护理对策以改善症状,提高透析疗效及生活质量。[方法]评估维持性血液透析患者皮肤瘙痒程度,针对不同原因提出对应的护理对策。[结果]96例患者中有46例发生皮肤瘙痒(占47.9%),皮肤瘙痒症原因复杂,可能与皮肤干燥、电解质代谢障碍、营养不良、甲状旁腺功能亢进、氮质代谢产物潴留、过敏反应等有关。[结论]通过采取不同的透析方式,加强心理护理、饮食护理、用药护理、皮肤护理等护理对策,瘙痒症状可有效改善。     

血液透析人群丙型肝炎病毒感染的多中心临床研究

目的:了解维持性血液透析(MHD)人群抗丙型肝炎病毒(HCV)抗体和HCV-RNA的阳性率,探讨其丙型肝炎病毒(HCV)感染的发生率?危险因素?血清转氨酶水平的变化?方法:选择苏北3个血透中心维持性血液透析患者303例,采集患者病史?输血史?透析器复用史等临床资料,同时采集静脉血检测丙氨酸转氨酶(ALT)?天门冬氨酸转氨酶(AST)?抗HCV抗体及HCV-RNA?结果:303例血液透析患者中,抗HCV阳性39例(12.9%),其中HCV-RNA阳性33例(84.6%)?抗HCV(+)组和抗HCV(-)组间性别?年龄无显著差异(P > 0.05),而抗HCV(+)组患者血液透析时间显著长于抗HCV(-)组[(4.18 ± 3.80)年 vs (2.75 ± 3.64)年,P = 0.023],输血发生率?透析器复用率也高于抗HCV(-)组(59.0% vs 38.3%,P = 0.014;28.2% vs 3.4%,P < 0.001)?尽管抗HCV(+)组患者转氨酶平均水平明显高于抗HCV(-)组患者,转氨酶异常的患者也较未感染者显著增加,但大部分患者(76.9%和79.5%)的转氨酶水平仍在正常范围内?结论:血液透析患者HCV感染的发生率明显高于普通人群;透析时间?输血史及透析器复用是血液透析患者HCV感染的危险因素;血透患者HCV感染的监测主要检测抗HCV抗体,必要时应进一步监测HCV-RNA;转氨酶水平不宜作为判断血透患者HCV感染的敏感指标?     

58例慢性肾功能衰竭合并皮肤瘙痒患者分析

目的调查分析慢性肾功能衰竭患者皮肤瘙痒的部位、程度、治疗情况及皮肤瘙痒对其生活质量的影响程度。方法对某院血液净化中心58例慢性肾功能衰竭患者的皮肤瘙痒部位及治疗情况进行调查,以视觉模拟评分法评估瘙痒程度,并对其进行皮肤病生活质量(DLQI)评分。结果 58例慢性肾功能衰竭患者中轻度、中度、重度瘙痒分别为21例(34.2%)、23例(39.7%)、14例(24.1%);合并皮肤感染5例。患者DLQI评分平均7.72±1.61,皮肤瘙痒对生活质量影响最显著的是症状与感受(50%),其次为工作和学习(40.67%)。58例患者中有38例患者接受血液灌流和(或)血液透析滤过治疗后症状缓解。18例患者接受皮肤科专科治疗,其中12例给予单纯局部对症治疗,瘙痒缓解不明显;6例给予口服及外用药物治疗,治疗效果较单用外用药物为好。结论规律血液灌流和(或)血液透析滤过治疗能有效地缓解慢性肾功能衰竭患者皮肤瘙痒,提高患者生活质量。     

输血前、术前、产前、血透前及腔镜检查前进行感染性疾病检测的意义

目的:输血前、术前、产前、血透前及腔镜检查前进行感染性疾病检测。分析传染原因,避免和预防医院感染和医疗纠纷的发生。方法:采用酶联免疫吸附试验对9001例输血前、术前、产前、血透前及腔镜前患者进行乙型肝炎病毒表面抗原(HBsAg)、梅毒螺旋抗体(抗-TP)、丙型肝炎病毒抗体(抗-HCV)、人类免疫缺陷病毒抗原抗体(HIV-Ag/Ab)四项指标的检测。结果:对9001例患者进行检测,阳性患者为714例(7.93%)。其中HBsAg阳性457例(5.08%),梅毒螺旋体抗体阳性165例(1.83%),丙肝抗体阳性86例(0.96%),艾滋病抗原抗体初筛试验阳性6例(0.07%)。结论:通过对输血前、术前、产前、血透前及腔镜检查前进行感染性指标检测,可明确患者健康状况,可以减少医院感染,杜绝医源性经血传播疾病而引起的医疗纠纷,保护医患双方的利益。     

维持性血液透析患者尿毒症性皮肤瘙痒临床综合分析

目的：探讨尿毒症性皮肤瘙痒（UP）在维持性血液透析患者中的发生状况、发病机制及与预后的关系.方法：通过可视模拟评分法（VAS）调查我院238例维持性血液透析患者UP的发生状况,收集患者稳定的血压、红细胞压积、血钙、血磷、甲状旁腺激素（iPTH）、Kt/V、C反应蛋白（CRP）等临床指标,应用多元逐步回归分析了解UP积分与各临床指标的关系,通过3a的随访了解UP与患者预后的关系.结果：238例患者中有132例合并UP,其中轻度瘙痒53例（22.2%）,中度瘙痒59例（24.8%）,重度瘙痒20例（8.4%）.31例为局限性皮肤瘙痒（23.5%）,101例为广泛性皮肤瘙痒（76.5%）.多元回归分析显示UP积分与血清iPTH、钙磷乘积和红细胞压积显著相关（P分别〈0.01,0.01和0.05）,而与年龄、性别、透析时间、血压、血清尿素氮、肌酐、血尿酸、血白蛋白、转铁蛋白、血钙、血磷、Kt/V和CRP水平无关.Kaplan-meier分析显示,UP与患者预后无关.结论：维持性血透患者UP的严重程度与稳定的血清iPTH水平、血钙磷乘积和红细胞压积显著相关,而与年龄、性别、透析时间等其它临床指标无关,UP不能作为判断预后的标志.     

脐疗联合不同血液净化方式对血液透析患者皮肤瘙痒的影响

目的观察脐疗联合不同血液净化方式对血液透析患者皮肤瘙痒的影响。方法将120例血液透析患者随机分为治疗组和对照组,各60例;2组又分别随机分为血液透析组(HD)、血液透析+血液透析滤过组(HD+HDF)、血液透析+血液灌流组(HD+HF),各20例。治疗组在对应对照组治疗方法的基础上采用贴脐疗法治疗。采用视觉模拟评分(VAS)法和行为评分(BRS)法比较各组患者治疗前、后皮肤瘙痒程度评分、情绪评分、皮肤干燥程度评分以及相关实验室指标[甲状旁腺素(PTH)、血清尿素氮(BUN)、血红蛋白(HGB)、血清肌酐(Scr)、血细胞压积(HCT)、钙磷乘积、钙、磷]的变化。结果 2组HD组、HD+HDF组、HD+HP组治疗前、后各项指标比较,差异均有统计意义(P<0.05);2组HD组治疗后各项指标比较,差异均无统计意义(P>0.05);2组HD+HDF组治疗后各项指标比较,瘙痒程度评分、情绪评分、皮肤干燥程度评分比较,差异有统计意义(P<0.05),其他实验室指标比较差异无统计意义(P>0.05);2组HD+HP组治疗后各项指标比较,瘙痒程度评分、情绪评分、皮肤干燥程度评分比较,差异有高度统计意义(P<0.01),其他实验室指标比较差异无统计意义(P>0.05)。结论脐疗通过穴位、经络、药物、物理刺激及长疗程、小剂量的药效累积作用,可显著改善血液透析患者的皮肤瘙痒、情绪、皮肤干燥等临床症状。     

维持性血液透析的终末期肾功能衰竭患者皮肤瘙痒的影响因素

目的研究钙磷代谢、炎症、贫血与瘙痒发生频率和程度的关系。方法对2003年1月在我院行维持性血液透析的终末期肾功能衰竭患者进行调查分析,询问患者近2周皮肤瘙痒发生的频率(分为“无”、“偶尔”、“每天”3个级别)和程度(分为“中等”和“严重”2个级别),同时测定患者周中透析前钙磷代谢、炎症、贫血和红细胞形态等相关实验室检测指标。将患者根据瘙痒发生的频率和程度进行分组。结果从未发生瘙痒者占26.2%,偶尔发生瘙痒者占34.1%,每天发生瘙痒者占39.7%。发生瘙痒者中,50.8%呈中度瘙痒,23.0%呈重度瘙痒。无论按瘙痒发生的频率还是程度分组,各组间年龄、透析龄、每周透析次数比、平均血红蛋白量、红细胞比容及反映红细胞形态的各指标、中位数C反应蛋白、中位数铁蛋白、平均总蛋白水平、透析前肌酐、尿素氮、全段甲状旁腺激素的差异均无显著性(P>0.05)。在不同频率的组间平均白蛋白水平的差异有显著性(P<0.05),但在不同程度的组间的差异无显著性,logistic回归分析显示瘙痒发生与否与血浆白蛋白水平不相关。平均血钙水平越高,瘙痒发生频率越高,但差异无显著性(P>0.05);平均血磷水平和钙磷乘积越高,瘙痒发生频率越高,程度越重,差异均有显著性(P值均<0.05)。logistic回归分析显示,瘙痒发生与否与血钙和血磷水平均呈正相关(P<0.05)。结论钙、磷代谢异常在终末期肾功能衰竭皮肤瘙痒的发生中占重要地位,应进一步致力于改善终末期肾功能衰竭患者钙、磷代谢紊乱的状况。     

血液透析患者丙型和戊型肝炎病毒感染状况分析

目的 探讨血液透析患者丙型肝炎病毒(HCV)和戊型肝炎病毒(HEV)感染状况,并分析两者阳性相关程度.方法 应用酶联免疫法(ELISA)分别对105例血液透析患者和80例健康对照组进行了血清抗-HCV、抗HEV-IgG的检测.结果 血液透析患者抗-HCV、抗HEV-IgG感染率分别是35.2%和20%,抗-HCV和抗HEV-IgG重叠感染率为7.6%,明显高于健康对照组.输血组HCV、HEV感染率明显高于非输血组,而输血量多者又高于输血量少者.结论 血液透析患者比健康对照组有更高的丙、戊肝感染率及重叠感染率,且阳性程度与输血量的多少有关.     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.