别嘌呤醇对伴高尿酸血症慢性心力衰竭急性发作患者血清NO、MDA、SOD及肱动脉内皮依赖性舒张功能的影响

目的通过观察试验组和对照组用药前后慢性心力衰竭急性发作患者血浆一氧化氮（NO）丙二醛（MDA）超氧化物歧化酶（SOD）及肱动脉内皮依赖性舒张功能（EDD）的变化来探讨别嘌呤醇对伴高尿酸血症慢性心力衰竭急性发作患者内皮功能及氧自由基的影响。方法78例慢性心力衰竭急性发作患者被随机分为别嘌呤醇组（常规治疗＋别嘌呤醇，38例）和对照组（常规治疗，40例），分析NO、MDA、SOD在1周治疗前后浓度的变化及EDD的变化。结果别嘌呤醇治疗7d后，与对照组相比，试验组血SOD浓度明显升高（P〈0．05），血MDA显著下降（P〈0．05），而试验组NO及肱动脉EDD有上升趋势；但差异无统计学意义。结论别嘌呤醇能显著增加慢性心力衰竭急性发作患者血SOD，降低血MDA，因而减轻此类患者氧化应激的程度，进而可能对该类患者内皮舒张功能产生积极影响。     

慢性心力衰竭合并轻度肾功能不全30例临床分析

目的分析肾功能不全对慢性心力衰竭住院患者治疗的影响。方法随机选取本院2005年1月至2009年1月慢性心力衰竭住院病例100例,根据血清肌酐水平分为A组（肾功能正常组）和B组（轻度功能不全组）二组,比较二组的临床特点及治疗情况。结果A组与B组比较,性别比、年龄≥65岁、以及心功能IIII级以上例数和左室射血分数（LVEF）差异无统计学意义（P〉0．05）。人院平均年龄、住院平均天数和住院病死率两组比较差异有统计学意义（P〈0．01）。结论慢性心力衰竭合并轻度肾功能不全患者年龄大,住院时间长,住院病死率高,肾功能不全是增加慢性心力衰竭患者住院病死率的独立危险因素。     

老年急性失代偿性心力衰竭合并肾功能不全60例治疗体会

目的：探讨利尿剂或血液净化疗法治疗老年急性失代偿性心力衰竭合并肾功能不全的疗效及预后。方法：60例年龄≥60岁的急性心衰合并急性肾损伤患者,在常规利尿剂应用无效基础上,40例用利尿剂加量治疗,20例用血液净化治疗。观察利尿剂或血液净化治疗前后肾功能、血气分析、尿量及血浆B型脑利钠肽（BNP）浓度变化;90d内死亡、再住院率及肾功能变化。结果：利尿剂加量组或血液净化组在治疗前后血肌酐、尿素氮、血pH、碳酸氢根、24h尿量及血浆BNP水平均有改善（P〈0.05）;两组治疗48h后血液净化组较利尿剂加量组血肌酐、尿素氮及BNP浓度明显下降（P〈0.01）,SaO2、24h尿量明显上升（P〈0.01）。随访90d后,利尿剂加量组22例（55.0%）肾功能恢复,90d再住院15例（37.5%）,死亡7例（17.5%）;血液净化组12例（60.0%）肾功能恢复,90d再住院5例（25.0%）,死亡3例（15.0%）。结论：血液净化疗法改善老年急性失代偿性心力衰竭合并肾功能不全的疗效及预后优于单纯利尿剂治疗。     

慢性肾功能不全患者不同病期血浆白细胞介素-8的含量及其临床意义

目的：了解慢性肾功能不全患者不同病期血浆白细胞介素８（ＩＬ８）的含量及其临床意义。方法：用双抗夹心酶联免疫吸附法分别测定慢性肾功能不全患者不同病期血浆ＩＬ８含量，并与正常对照组比较。结果：慢性肾功能不全代偿期及氮质血症期患者血浆ＩＬ８略低于正常对照组，但差异无显著性（Ｐ均＞０．０５）。肾功能衰竭期患者血浆ＩＬ８含量显著低于正常对照组（Ｐ＜０．０１）。在慢性肾功能不全病程中，血浆ＩＬ８含量与血肌酐、尿素氮呈显著负相关（ｒ＝－０．５８，Ｐ＜０．０１；ｒ＝－０．５１，Ｐ＜０．０１）。结论：慢性肾功能不全患者肾功能衰竭期机体全身免疫功能低下，急性炎症反应减弱。     

慢性心力衰竭急性发作院内死亡相关危险因素的研究

目的 对因慢性心力衰竭急性发作而入院患者的院内死亡率及与其相关的危险因素进行分析,旨在找出有价值的预警指标指导临床实践.方法 对434例慢性心力衰竭急性发作患者进行回顾性分析,检测其入院时的各项指标,包括性别、年龄及入院后的第一次临床检查和实验室检查指标.结果 慢性心力衰竭急性发作的院内死亡率为11.9%;发现6个与院内死亡率相关的危险因素:冠心病史(OR值1.845,95%置信区间1.016～3.351)、高钠血症(OR值3.631,95%置信区间1.571～8.391)、低钠血症(OR值2.310,95%置信区间1.133～4.713)、高钾血症(OR值3.188,95%置信区间1.542～6.590)、血尿素氮升高(OR值3.450,95%置信区间1.699～7.005)和血肌酐升高( OR值2.334,95%置信区间1.256～4.339).结论 既往冠心病史、合并肾功能不全、异常血钠、高钾血症提示慢性心力衰竭患者预后不良.     

大黄牡蛎汤高位保留灌肠治疗早期慢性肾功能不全的疗效观察及护理

目的：探讨大黄牡蛎汤高位保留灌肠治疗早期慢性肾功能不全的疗效。方法：对31例早期慢性肾功能不全患者给予大黄牡蛎汤高位保留灌肠1次／d，15d为1个疗程。治疗前、后查肾功能。结果：治疗后的血肌酐和尿素氮降低，肌酐清除率上升，治疗前、后相比有显著性差异（P〈0．01）。结论：大黄牡蛎汤高位保留灌肠治疗早期慢性肾功能不全疗效肯定，有推广应用价值。     

大黄牡蛎汤高位保留灌肠治疗早期慢性肾功能不全的疗效观察及护理

目的：探讨大黄牡蛎汤高位保留灌肠治疗早期慢性肾功能不全的疗效。方法：对31例早期慢性肾功能不全患者给予大黄牡蛎汤高位保留灌肠1次／d，15d为1个疗程。治疗前、后查肾功能。结果：治疗后的血肌酐和尿素氮降低，肌酐清除率上升，治疗前、后相比有显著性差异（P〈0．01）。结论：大黄牡蛎汤高位保留灌肠治疗早期慢性肾功能不全疗效肯定，有推广应用价值。     

老年肺心病患者急性加重期肾功能损害早期诊断指标探讨

老年慢性肺源性心脏病患者急性加重期，常由于并发呼吸衰竭、心力衰竭、感染等诱因而发生肾功能损害，如何对早期肾功能损害作出诊断，从而早期治疗，是临床非常关注的问题。本文采用放射免疫及生化方法检测了老年肺心急性加重期患者的血、尿β2-微球蛋白（β2-MG）、血尿素氮（BUN）、肌酐（Cr）、尿微量白蛋白含量，以探讨其在早期诊断肾功能损害中的临床意义。     

慢性肾功能不全患者冠脉介入前水化治疗的护理

目的探讨慢性肾功能不全合并冠心病患者在行冠脉介入检查及治疗前水化治疗的护理要点。方法术前全面评估患者情况、做好水化治疗的护理,密切监测介入后的病情变化。结果105例患者经水化治疗后,血肌酐(Scr)为71.4～184μmol/L,无1例发生肾功能不全加重或出现急性肾功能衰竭,好转出院。结论做好慢性肾功能不全患者冠脉介入前水化沿疗的护理,是避免患者肾功能不全加重或出现急性肾功能衰竭的有效措施。     

心肾综合征临床诊断与监测的生物标记物

心肾综合征（CRS）是指心脏或肾脏功能不全时相互影响、相互加重而导致的心肾功能急剧恶化的临床综合征.Ronco等[1-2]将CRS分为5个亚型：Ⅰ型：急性CRS,即急性失代偿性心功能不全导致的急性肾损伤（AKI）;Ⅱ型：慢性CRS,是慢性心力衰竭导致的肾功能不全的过程;Ⅲ型：急性肾心综合征,指急性缺血性肾功能障碍导致的急性心脏功能受损;Ⅳ型：慢性肾心综合征,即慢性肾功能不全造成的冠状动脉疾病和心力衰竭等心脏损害情况;Ⅴ型：继发性CRS,指在心肾功能不全中出现的全身系统事件的情况.在美国,30％住院的急性心力衰竭（HF）患者有慢性肾功能衰竭史（血清肌酐水平＞2 mg/dl）[3].Smith等[4]进行了文献荟萃,分析了16个中心共80098例HF患者与肾功能损害和病死率的关联,发现63％的心力衰竭患者合并有轻度肾功能不全,其中20％有中度或重度肾功能不全,而肾小球滤过率（GFR）每下降10 ml/min,死亡率增加7％.我国一项临床调查中发现,66例肾性高血压发生急性左心心力衰竭发生率为264例次,抢救成功252例次,成功率95.4％[5].提示CRS是一种临床常见综合征.早期诊断、及时治疗将有利于改善患者心、肾功能,提高患者生存率.因此,有关CRS临床早期诊断与病情监测的生物标记物的研究近年来受到了广泛重视,现简介如下.     

Psychovegetative disturbances in patients with chronic non-calculous cholecystitis combined with chronic opisthorchosis

A complex clinico-instrumental, laboratory and psychological examination of 122 patients with chronic non-calculous cholecystitis (CNCC), 63 of who had chronic opisthorchosis (CO), was conducted. The controls were 33 healthy individuals. Patients with CNCC and CO had hypomotoric dyskinesia, Oddi's sphincter dysfunction, higher levels of personal anxiety and depression more often than others.     

Living with chronic hepatitis

Chronic hepatitis (CH) may be defined as persistence of an inflammatory reaction in the liver for greater than 4 months. Different immune mechanisms of liver damage are operative in children with the three common types of CH. In autoimmune CH the cytotoxic effect is mostly confined to the non-T cell lymphocyte fraction. Autoimmune CH is steroid responsive and has a generally favorable prognosis. In hepatitis B virus (HBV) hepatitis both T and non-T lymphocytes are responsible for the cytotoxic reaction. Steroid or interferon treatment is controversial and the prognosis is less favorable. Hepatitis delta virus (HDV) hepatitis only occurs in children with HBV hepatitis as either a co-infection or superinfection. As a co-infection the HBV is usually eliminated and CH does not ensue. Superinfection with HDV, however, frequently leads to rapidly progressive liver damage and a more serious prognosis. Non-A, non-B (NANB) hepatitis is a diagnosis of exclusion. In NANB hepatitis, the cytotoxic effect is predominantly T cell. NANB hepatitis generally runs a mild course, and no treatment is usually recommended.     

Coping with chronic pain

Many models of pain give coping an important role in understanding adaptation to chronic pain. Among these, Lazarus and Folkman's cognitive-phenomenological model of stress and coping provides a theoretical framework to conceptualise stress phenomena and coping strategies related to chronic pain. Chronic pain often necessitates new coping skills. An understanding of the concept of coping and how the patients cope is therefore crucial for the success of rehabilitation. The current study examined how coping, as measured by the Ways of Coping Checklist, was related to medical variables, depression measured by the Short Zung depression rating scale, and Rosenberg's self-esteem scale. The study sample consisted of 88 people who were recruited for a multidisciplinary pain management programme. Data were collected as part of a routine pre-treatment evaluation. Results indicated that the most predominant stressors were related to family life and social activities. We also recognised on the one hand, appraising pain as a challenge was predictive of problem-focused coping, while on the other hand, appraising pain as a threat, experiencing depression, and reduced self-esteem were predictive of emotion-focused coping. Clinical implications of these results in nursing are discussed.     

Nutrition in chronic heart failure with coexisting chronic kidney disease

BACKGROUND AND RESEARCH OBJECTIVES: Patients with heart failure (HF) may be predisposed to malnutrition. Little is known about the nutritional status of patients with HF, particularly patients who have coexisting major medical conditions such as chronic kidney disease. The purposes of this study were to (1) describe the nutritional status of 211 patients with chronic HF, (2) examine relationships between nutrition variables and health-related quality of life, and (3) evaluate the nutritional status of the subset of HF patients with coexisting chronic kidney disease. SUBJECTS AND METHODS: The sample included 211 patients with chronic HF recruited for a larger study about health-related quality of life. Clinical data were retrieved retrospectively from the computerized medical records system at the study site. RESULTS AND CONCLUSIONS: Mean body mass index of the 122 patients for which height was available was 31.4, and no differences in body mass index were noted among patients with varying New York Heart Association class functional status. Evaluation of the mean laboratory values indicated that patients had abnormal elevations of serum glucose, hemoglobin A1C, creatinine, and low-density lipoprotein cholesterol. Higher hemoglobin A1C levels were significantly correlated with poorer health-related quality-of-life scores, although the magnitude of the correlations was modest. Estimated glomerular filtration rate indicated that 54 (27%) of the HF patients likely had coexisting chronic kidney disease, and these patients had significantly lower serum albumin and worsening anemia. The results indicate the need for future prospective studies that incorporate evaluation of nutritional status and the ways in which coexisting chronic kidney disease influences outcomes.     

Depression and chronic fatigue in the patient with chronic pain

Chronic benign pain is commonly associated with chronic fatigue and depression. Depression and chronic fatigue syndrome are also associated with each other and often include pain. Psychologic factors are prominent in these conditions, and they may share neurobiologic factors as well. Management requires separately addressing each component of patients' distress and usually includes physical rehabilitation, education, administration of nonhabituating medications and often counseling. Depression may be a favorable prognostic sign, as it suggests a treatable condition and provides incentive for recovery.     

Coping with the chronic complainer

"Somatoform disorders" are characterized by symptoms suggesting a physical illness for which there are no demonstrable organic findings and which seems linked to psychologic factors. Often viewed mainly as chronic complainers, patients with these disorders require thorough evaluation. The physician's goal is to help the patient to function. This is accomplished by reassuring the patient that he will receive care, offering regular appointments, avoiding unnecessary tests and counseling the family.