Total body potassium depletion and severe myopathy due to chronic liquorice ingestion.

A 33-year-old patient with hypokalaemia associated with severe myopathy following liquorice ingestion is described. Potassium depletion was confirmed by total body potassium measurements and myopathy was established by electromyography and enzyme studies. The potential hazard of chronic liquorice consumption even as a sweet is illustrated by this case.     

Intravascular haemolysis and acute renal failure following potassium dichromate poisoning.

An 18-year-old girl developed acute renal failure 24 hr after ingestion of potassium dichromate. Laboratory data revealed associated intravascular haemolysis. Renal histology showed features suggestive of acute tubular necrosis. She went into diuretic phase after 11 days of oliguria and subsequently regained normal renal function. Both direct toxic damage by dichromate and intravascular haemolysis may have contributed to the development of acute tubular necrosis and acute renal failure.     

连续性肾替代疗法治疗老年慢性肾功能不全合并多器官功能障碍的效果分析

目的分析连续性肾替代疗法治疗老年慢性肾功能不全合并多器官功能障碍的效果。方法回顾性分析本院2019年3月至2020年3月收治的93例老年慢性肾功能不全合并多器官功能障碍患者的临床资料,根据治疗方法的不同分为A组(n=45)与B组(n=48),A组采用间断性血液透析治疗,B组采用连续性肾替代疗法治疗。比较两组血流动力学[心率(HR)、平均动脉压(MAP)及心脏指数(CI)]、肾功能[血肌酐(SCr)、尿素氮(BUN)]水平。结果治疗后,两组HR水平均低于治疗前,MAP、CI水平均高于治疗前,且B组HR水平低于A组,MAP、CI水平均高于A组,差异有统计学意义(P<0.05);治疗后,两组SCr、BUN水平均低于治疗前,且B组低于A组,差异有统计学意义(P<0.05)。结论连续性肾替代疗法治疗老年慢性肾功能不全合并多器官功能障碍效果显著,可有效稳定机体血流动力学,改善肾功能,缓解病情。     

Type IV renal tubular acidosis and spironolactone therapy in the elderly.

Spironolactone therapy is a well-known cause of hyperkalaemia, but in susceptible patient, it may also be associated with metabolic acidosis. We report a case of severe renal tubular acidosis (Type IV) with life-threatening hyperkalaemia caused by spironolactone, and discuss the mechanisms by which this may occur.     

彩色多普勒超声监测移植肾急性肾小管坏死血流动力学变化的研究

目的探讨彩色多普勒超声对移植肾急性肾小管坏死(ATN)肾动脉血流动力学变化规律及临床意义。方法应用彩色多普勒血流显像(CDFI)及彩色多普勒能量显像(CDEI)对69例肾移植手术患者进行监测,观察移植肾形态、大小、内部回声及血流分布情况,比较移植肾功能正常组、ATN组形态学及血流参数。结果与移植肾正常组比较,移植肾ATN组皮质变薄,锥体增高(P<0.01);移植肾ATN组皮质部血流减少(P<0.05),各级肾动脉阻力指数明显增高(P<0.05)。结论彩色多普勒超声在肾移植手术后ATN的诊治中具有重要的临床参考价值。     

连续性肾脏替代治疗多器官功能障碍综合征的急救

目的 探讨应用连续性肾脏替代治疗(CRRT)对多器官功能障碍综合征(MODS)合并重症急性肾衰竭(ARF)患者的临床疗效和影响预后的因素. 方法 回顾性分析36例MODS患者行CRRT的临床资料,根据存活时间是否超过15 d分为存活组和死亡组,分别对器官衰竭数目及类型、APACHEⅡ评分、从出现肾功能不全至开始行CRRT的时间、行CRRT总时间及临床指标进行比较. 结果 存活组与死亡组年龄、性别、原发病类型比较无统计学差异,而在器官衰竭数目及类型、APACHEⅡ评分、从出现肾功能不全至行CRRT时间、治疗总时间及并发症发生率方面,两组均有统计学差异. 结论 CRRT为MODS的急救手段之一,早期根据病情选择合适的治疗模式和剂量应用CRRT可提高MODS抢救成功率.     

生物人工肾小管治疗急性尿毒症伴重症感染致多器官衰竭猪的研究

目的观察人肾近曲小管细胞构建的生物人工肾小管辅助装置(RAD)对急性尿毒症伴重症腹腔感染致多器官障碍综合征(MODS)/多器官衰竭(MOF)猪的疗效。方法原代培养人肾近曲小管细胞并构建RAD,将急性肾功能衰竭(ARF)伴MODS/MOF猪模型随机分为3组:①RAD组(A组,n=5):将RAD与血滤器连接,行连续静-静脉血液滤过(CVVH)治疗24h;②假RAD组(B组,n=5):将RAD换为无细胞的假RAD,余同A组;③未治疗组(C组,n=6)。观察生命体征、肝和肾功能、电解质、血气分析、血清肿瘤坏死因子(TNF)-α和生存时间。结果A组治疗至24h时,平均动脉血压(MAP)为(88.13±7.62)mm Hg(1mm Hg=0.133kPa),显著高于同时间点的B组[(63.50±11.82)mm Hg]和C组[(53.50±2.52)mm Hg,P值均<0.01]。A、B两组血尿素氮(BUN)、血肌酐(Cr)、血钾(K+)、动脉血氧分压(PaO2)、碳酸氢根(HCO3-)值均较C组明显改善,但两组间无明显差异(P>0.05)。A组治疗至24h时,血清TNF-α为(394.42±35.62)pg/ml,明显低于B组[(531.76±30.23)pg/ml]和C组[(552.89±27.81)pg/ml,P<0.05],B、C两组治疗前、后无明显变化(P>0.05)。A组生存时间为(118.73±8.48)h,明显长于B组的(81.20±11.76)h和C组的(74.96±23.00)h(P<0.01),分别延长46.20%、58.39%。结论应用人肾近曲小管细胞构建的RAD治疗MODS/MOF猪,能显著改善低血压,降低血TNF-α,延长生存时间。     

体位管理对CRRT治疗非计划下机的影响及护理对策

目的:探讨体位管理对连续性血液净化(CRRT)治疗过程中非计划性下机的影响,并分析其护理对策。方法:回顾性分析接受心脏手术患者术后肾脏衰竭等并发症而行CRRT 60例,对同一位患者行CRRT期间使用2组滤器,使用第1组滤器CRRT期间给予常规护理,即非体位管理,使用第2组滤器CRRT期间给予体位管理。结果:体位管理组CRRT非计划性下机的时间长于非体位管理(P<0.05)。结论:体位管理可延长心脏手术术后CRRT管路使用时间。     

肝肾联合移植术后移植肾功能延迟恢复的原因分析及综合治疗

目的探讨肝肾联合移植(LKT)术后移植肾功能延迟恢复(DGF)的原因及以持续肾脏替代治疗(CRRT)为基础的综合疗法治疗LKT术后DGF的疗效。方法2001年2月—2005年12月施行LKT的22例患者中,2例术后出现DGF,在日间无肝素连续静脉-静脉血液滤过治疗基础上,进行抗排斥、抗感染和营养支持等治疗。对患者围术期情况及随访结果进行分析。结果本组行LKT的22例患者手术成功率为100%,目前存活17例,受体健康状况及移植物功能良好。仅2例因DGF需CRRT治疗,CRRT治疗过程中无并发症发生,受体健康状况及移植物功能良好,随访至今无乙型病毒性肝炎复发。结论以CRRT为基础的综合疗法能有效治疗LKT术后DGF。     

连续性血液透析治疗老年终末期心功能不全103例临床研究

目的:观察连续性肾脏替代治疗(CRRT)对老年终末期心功能不全患者的疗效。方法:201例老年终末期心功能不全患者分血液透析组和对照组,脉搏指示连续心输出量监测(PiCCO)心输出量(CO)、心指数(CI)、血管外肺水(EVLWI)、心率(HR)评估血流动力学,测定血浆脑型利钠肽(BNP)评估心功能,记录机械通气参数及呼吸机支持力度,测定动脉血气,评估肺功能情况。结果:与对照组相比,血液透析组血流动力学CO(3.47±0.14vs 4.59±0.37)、CI(3.45±0.24vs 4.68±0.75)、EVLWI(7.89±0.74vs 5.67±0.21),BNP(13283.98±173.91vs 4584.26±94.71),呼吸机支持力度明显下降,动脉血气氧分压(85.32±14.35vs 101.43±5.87)提高,肺泡-动脉氧分压差(15.38±3.61vs 7.53±3.54)下降,心肺功能改善。结论:缓慢、连续性血液透析可有效治疗老年终末期心功能不全,与缓慢脱水减轻心脏负担、改善肺功能等有关。     

Electroconvulsive therapy and serum potassium.

In 54 patients presenting for electroconvulsive therapy, the concentration of serum potassium was measured before and after the induced convulsion modified with a standard anaesthetic technique of methohexitone and suxamethonium. It was found that there was a statistically significant rise in serum potassium, but that the duration of convulsion had no significant effect on that rise in serum potassium. In a further 11 patients, methohexitone alone was administered without ECT, and it was found that serum potassium fell. Methohexitone, suxamethonium and ECT in combination cause a rise in serum potassium which is not clinically important unless pre-induction level is abnormally high, and prolonged convulsion does not exaggerate this rise.     

肾小管和内皮素与肾间质纤维化的关系

目的：研究肾小管和内皮素与肾间质纤维化的关系。方法：应用肾小管上皮细胞及肾成纤维细胞的体外培养,通过逆转录多聚酶链反应,免疫组织化学染色,放射免疫测定及双重免疫组织化学染色技术,并测定３ＨＴｄＲ掺入率,观察肾小管损伤时产生的内皮素１（ｅｎｄｏｔｈｅｌｉｎ１ＥＴ１）与肾成纤维细胞增殖的关系。结果：肾小管上皮细胞既有ＥＴ１ｍＲＮＡ的表达,又有ＥＴ的两种受体（ＥＴＡＲｍＲＮＡ和ＥＴＢＲｍＲＮＡ）的表达,还有ＥＴ１的蛋白合成及分泌。且肾小管损伤及再生过程中,ＥＴ１表达增加。对体外培养的大鼠肾成纤维细胞加入ＥＴ１,３ＨＴｄＲ掺入率较对照组明显增高。并证明肾成纤维细胞有ＥＴＲｍＲＮＡ的表达。结论：损伤及再生的肾小管上皮细胞较正常时合成和分泌更多的ＥＴ１,ＥＴ１通过ＥＴＲ的作用,促使肾成纤维细胞的增殖,从而促进肾间质纤维化     

Blood cyclosporin concentrations and renal allograft dysfunction

Forty nine renal allograft recipients taking oral cyclosporin suffered 76 episodes of renal dysfunction within six months of transplantation. These episodes were diagnosed as graft rejection or cyclosporin induced nephrotoxicity on the basis of histological findings in allograft biopsy specimens and the response to treatment. Mean predose blood cyclosporin concentrations measured by radioimmunoassay during the week before the onset of renal dysfunction were significantly higher when the cause was cyclosporin toxicity rather than graft rejection (392 v 741 nmol/l (471 v 891 ng/ml). During this period there was a significant association between both the frequency of measurements above 666 nmol/l (800 ng/ml) and the diagnosis of toxicity and the frequency of measurements below 333 nmol/l (400 ng/ml) and the diagnosis of allograft rejection. Cyclosporin measurements made at the time of biopsy and reference to the highest or lowest concentrations measured during the week preceding biopsy were of less value in distinguishing between the two groups. Despite lacking specificity for the parent compound, the radioimmunoassay used produced results which were of clinical value in optimising cyclosporin treatment.