连续性肾脏替代疗法治疗急性肾功能衰竭的临床观察

目的观察连续性肾脏替代疗法（CRRT）治疗重症急性肾功能衰竭（ARF）的疗效和对预后的影响。方法对2003年以来16例ARF（伴发多器官功能障碍综合征,MODS）患者进行CRRT的临床资料回顾性分析。结果11例患者经CRRT治疗24 h后,生命指征平稳,BUN、Scr下降（P〈0.05）,二氧化碳结合力（CO2CP）正常,85-264h后进入多尿期;5例患者死于严重创伤或MODS。治疗过程中无低体温和低血压等并发症。结论CRRT治疗重症ARF患者,血液动力学稳定,溶质清除率高,有利于营养支持及清除炎性细胞因子,从而改善重症ARF患者的预后。     

腹膜透析在颅内出血患者肾损伤中的应用

目的分析腹膜透析（PD）在颅内出血患者肾损伤中的应用价值。方法回顾性分析本院收治的颅内出血急性肾损伤（AKI）患者腹膜透析8例。结果8例AKI患者中，治愈4例（50．0％），继续腹膜透析2例（25．0％），自动出院1例（12．5％），死亡1例（12．5％）。PD后SCr、3UN和血清K^＋水平均较透析前显著下降（P〈0．05），CO2CP水平较透析前显著升高（尸〈0．05）。结论PD对颅内出血AKI具有良好的治疗效果，是AKI治疗的最佳选择。     

每日血液透析治疗40例急性肾衰竭的临床研究

目的观察每日血液透析治疗急性肾衰竭的疗效。方法对本院40例急性肾衰竭患者采用每日血液透析进行抢救治疗。结果所有患者DHD3—15次，开始自我感觉明显好转，胃纳改善，总体健康状况提高，失眠、焦虑等状态减轻。治疗后的MAP、BUN、Scr、K^＋均有显著降低，CO2-CP有显著升高，与治疗前比较差异有统计学意义（P〈0．05）。治疗期间发生低血压5例，均可耐受，随访6个月～1年，无一例转为慢性肾功能衰竭，无死亡病例。结论DHD能使血流动力学稳定，缓慢调节液体平衡，营养指标明显改善，控制血压好，增加中分子物质的清除，减少体内毒素水平的波动，患者的生活质量明显上升，是一种比较接近生理性透析方式，推荐对于有一定经济条件的患者可以应用DHD治疗。     

急性重症胰腺炎并肾功能衰竭的腹膜透析治疗

目的探讨腹膜透析（PD）在急性重症胰腺炎并急性肾功能衰竭中的应用。方法对13例急性重症胰腺炎并急性肾功能衰竭患者进行PD治疗回顾分析。结果死亡5例，存活8例，病死原因与高龄、APACHEⅡ积分高、衰竭器官及PD早晚有关。结论PD血流动力学稳定，早期PD治疗并加大透析剂量及增加透析次数，能改善急性重症胰腺炎并急性肾功能衰竭的预后。     

床边急诊腹膜透析治疗横纹肌溶解综合征并发急性肾功能衰竭的护理体会

目的探究床边急诊腹膜透析治疗横纹肌溶解综合征并发急性肾功能衰竭的护理价值。方法选取横纹肌溶解综合征并发急性肾功能衰竭患者30例,这30例患者均接受床边急诊腹膜透析治疗,同时对这30例患者实施综合护理,并对护理的结果进行分析。结果 5例患者经腹膜透析以及护理后,其肾功能衰竭患者的不良症状得以缓解,停止腹膜透析治疗后,患者的BUN水平仍保持在每升22 mmo L,Cr水平小于每升446μmo L。20例患者的血BUN以及Cr水平经治疗以及护理后4周-6周恢复至正常水平。4例RM-ARF患者接受切开减压术。1例患者接受截肢治疗。结论床边急诊腹膜透析治疗横纹肌溶解综合征并发急性肾功能衰竭患者接受有效的护理干预,利于患者腹膜透析治疗疗效的提高。     

连续性血液净化治疗重症心力衰竭合并肾衰竭疗效分析

目的：探讨连续性血液净化治疗重症心力衰竭合并肾衰竭疗效。方法：选择心功能不全合并肾功能不全患者80例。随机分为对照组及治疗组，均给予强心、利尿等治疗，治疗组另外给予连续血液净化治疗，比较两组患者治疗第三天的NT-proBNP、BUN及Cr水平以及平均住院日。结果：治疗前两组NT-proBNP，BUN和Scr水平未见明显差异，治疗3d后，治疗组患者血清NT-proBNP，BUN和Scr水平低于对照组（P＜0.05）。平均住院日治疗组（7.3±2.8）d，对照组（12.6±6.2）d，治疗组低于对照组（P＜0.05）。结论：连续性血液净化对于心功能不全合并肾功能不全是一种有效的、简单的、快速的治疗方法，可以明显缩短住院周期，减轻医疗费用节约医疗资源。     

CRRT治疗横纹肌溶解综合征合并急性肾衰竭

目的观察CRRT（连续性肾脏替代治疗）治疗重症横纹肌溶解综合征合并急性肾衰竭的临床疗效。方法对2010～2012年抢救的16例重症横纹肌溶解综合征合并急性肾衰竭（ARF）患者进行CRRT治疗的临床资料进行回顾性分析。观察肌红蛋白、肌酸磷酸激酶、乳酸脱氢酶、肌酐、尿素氮、电解质以及生命体征变化。结果 16例患者经CRRT治疗后,肌红蛋白、肌酸磷酸激酶、乳酸脱氢酶、肌酐、尿素氮均显著下降,差异有统计学意义（P〈0.05）。15例患者肾功能逐渐恢复正常,治愈出院,1例患者因病情延误死于多器官功能衰竭（MODS）。结论对于重症横纹肌溶解综合征合并急性肾衰竭应尽早进行CRRT治疗,从而改善患者的预后。     

心内直视术后腹膜透析的护理

目的 探讨腹膜透析（PD）对心内直视术后急性肾功能衰竭（ARF）的治疗与护理效果,及其对血流动力学的影响。方法对70例心内直视手术后ARF行PD治疗的患者的临床资料作回顾性分析。结果 单纯ARF的死亡率为10．5％,显著低于合并其它系统器官衰竭组的46．4％（P〈0．05）,PD第3～39天内肾功能恢复,其中1～2天内血钾[K^＋]恢复正常,第2～5天内碳酸氢根[HCO3^-]恢复正常,第4～6天内血尿素氮（BUN）下降49．2％,血肌酐（Cr）下降42．6％,其中18例术后低心排量合并ARF者透析前后血流动力学各参数无显著变化（P〉0．05）。结论 PD对心内直视手术后ARF有较好的治疗效果,且对血流动力学无明显影响。     

应用连续性血液净化治疗急性肾衰竭患者的临床疗效观察

目的探讨连续性血液净化治疗急性肾衰竭患者的临床疗效,为临床推广作出指导。方法选择我院门2011年2月至2013年2月收治的急性肾衰竭患者47例为研究对象,完全随机分为两组。对照组给予常规血液透析治疗,观察组则给予连续性血液净化治疗。对比观察两组患者的临床治疗效果。结果（1）两组患者治疗后血肌酐（Scr）、血尿素氮（BUN）指标均优于治疗前,且观察组较对照组更明显,差异具有统计学意义（P〈O．05）（2）观察组患者的死亡率为4．17％（1／24）,明艟低于对照组21．74％（5／23）,差异具有统计学意义（P〈0．05）。结论连续性血液净化治疗急性肾衰竭征患者的临床疗效显著,能够促进患者肾功能的恢复,同时还能最大限度地挽救患者生命,值得临床广泛推广．     

连续性肾脏替代治疗患者的护理

连续性肾脏替代（Continuousrenalreplacementtherapy，CRRT）的技术在不断提高与完善，临床应用范围日益扩大。从最初单一提高重症急性肾衰竭（Acuterenalfailure，ART）的疗效扩展到各种临床上常见危重患者的急救（严重创伤、感染、烧伤、急性胰腺炎、肝功能衰竭、全身性炎症反映综合征和多器官功能障碍综合征等）被视为是近年来急救医学中最重要的进展。我院自２０００－０１～２００１－０２对２５例重症急性肾衰竭患者施行CRRT治疗，现将护理体会报告如下。１临床资料２０００－０１～２００１－０２，共为２５例重症肾功能衰竭…     

Role of endothelin ET(A) and ET(B) receptor subtypes in the regulation of intrarenal blood flow and oxygen tension in rats

The aim of the present study was to investigate the role of endothelin ET(A) and ET(B) receptors in the regulation of intrarenal blood flow and oxygen tension in normotensive Sprague-Dawley rats. Thiobutabarbital anaesthetized rats were divided into four groups (n = 6-9 per group): (i) saline (4 mL/kg per h); (ii) BQ123; (iii) BQ788; and (iv) BQ123 + BQ788. After baseline measurements, the ET(A) receptor antagonist BQ-123 (30 nmol/kg per min, i.v.) and/or the ET(B) receptor antagonist BQ-788 (30 nmol/kg per min, i.v.), was administered for a period of 60 min. Total renal blood flow (RBF), cortical and outer medullary perfusion (laser-Doppler flowmetry) and Po(2) (Clark-type microelectrodes) were analysed throughout. At baseline, there were no significant differences between groups in mean arterial pressure (MAP), RBF, cortical and outer medullary perfusion and Po(2). Infusion of BQ-788 reduced RBF, cortical perfusion and outer medullary Po(2) (P < 0.05) and increased renal vascular resistance (P < 0.05) compared with saline-treated and BQ123 + BQ788-infused groups. BQ-123 and coinfusion of BQ-123 + BQ-788 increased outer medullary perfusion compared with the saline-treated group (P < 0.05) without significantly affecting outer medullary Po(2) and MAP. Neither selective nor combined ET(A) and ET(B) receptor antagonism significantly affected renal cortical Po(2). In conclusion, in normotensive rats, ET(B) receptor antagonism caused renal vasoconstriction and reduced RBF and cortical perfusion. Furthermore, ET(B) receptor antagonism decreased outer medullary Po(2). These effects were mediated by ET(A) receptor activation and are not due to a lack of ET(B) receptor activation per se. Finally, BQ-123 increased renal outer medullary perfusion, suggesting a tonic vasoconstrictor effect of ET(A) receptors in the medulla of normotensive rats.     

慢性肾损害肾血流动力学改变的观察

对９２例健康人及慢性肾损害肾功不全各期５１例患者，进行肾内各分级动脉血流测定。结果显示肾功代偿期肾血流各参数与正常对照组差异无显著性，而肾功不全氮质血症期和尿毒症期，与正常对照组及二组之间血流各参数均有显著性差异。而随着肾损害肾功不全的加重，Ｖｍａｘ，Ｖｍｉｎ、ＴＡＭＸ渐近下降，ＰＩ，ＲＩ、Ｓ／Ｄ逐渐增高，因此通过肾内血流的测定，观察血流动力学的改变，可反映肾损害的程度和肾功能状况。     

血管紧张素转化酶抑制剂与肾功能的临床评价

目的:探讨应用血管紧张素转化酶抑制剂(ACEI)治疗心血管疾病时引起急性肾衰竭和高钾血症的原因及其应对方法.方法:查阅近期国外相关文献,以及与笔者的临床经验相结合进行分析、评价.结果与结论:应用ACEI类药物对于高血压和慢性肾衰竭患者来说是一把"双刃剑".ACEI可以改善肾功能,也可能引起急性肾衰竭和高钾血症.只要肾脏灌注充分且体液丧失不严重,ACEI就可改善肾脏的血流动力学,从而进一步改善肾脏的盐分泌;而在体液显著丧失时,血管紧张素Ⅱ则可使肾小球滤过率(GFR)迅速下降,继发少尿或无尿性肾衰竭.一般来说,在急性肾衰竭缓解之后可重新安全的服用ACEI,尤其是诱发因素已纠正后.     

Lanthanum carbonate for the treatment of hyperphosphataemia in renal failure and dialysis patients

Hyperphosphataemia is a usual accompaniment of end stage renal disease and dialysis, in the absence of dietary phosphate restriction or supplemental phosphate binders. It is associated with renal osteodystrophy, metastatic calcification and increased mortality and morbidity. Despite dietary restriction and dialysis, most patients will require a phosphate-binding agent to treat this condition. However, phosphate control has not significantly improved over the last two decades, mainly because of the lack of an ideal oral phosphate-binding agent. Aluminium- and calcium-based agents are associated with major side effects, despite their undoubted efficacy. Although sevel-amer hydrochloride represents a step forward in the management of hyperphosphataemia, it is not an ideal phosphate binder due to its cost and tablet burden. Lanthanum carbonate is the most recent non-calcium, non-aluminium, phosphate-binding agent. It is effective and well-tolerated, and no n-egative effects on bone histology have been observed.     

人基因重组红细胞生成素对慢性肾功能衰竭未透析患者贫血的疗效和肾功能的影响

目的:观察人基因重组红细胞生成素(rHuEPO)对慢性肾功能衰竭未透析患者贫血的疗效和肾功能的影响.方法:39例患者rHuEPO起始剂量100IU/kg,每周3次sc,观察5～30mo.结果:rHuEPO治疗20wk后所有患者贫血明显纠正,平均Hct由(18±2)%上升至(32±3)%(P<0.001),生活质量显著提高.治疗早期Hct上升幅度尿毒症未透析组显著低于氮质血症组.尿毒症未透析组rHuEPO维持剂量显著高于氮质血症组.分别为(150±57.7)和(275.0±42.5)IU·kg~(-1)·wk~(-1)(P<0.01).以血Cr倒数为指标,治疗期间患者肾功能恶化速度与治疗前无显著差别.治疗期间50%患者BP升高.结论:rHuEPO能有效纠正慢性肾功能衰竭未透析患者贫血,不加速肾功能恶化.     

肾动态显像与静脉肾盂造影在肾功能评价中应用价值的比较

目的:探讨放射性核素99mTc-DTPA肾动态显像对IVP不显影患肾功能评价的临床意义。方法:对37例受检者(40只患肾)进行了肾动态显像,并与同期IVP检查对比分析。结果:37例受检者中核素显像显示有功能者91.2%,无功能者9.8%;IVP检查显示有功能者38.7%,无功能者61.3%。可见,核素显像显示有功能者明显高于IVP检查(P<0.01)。IVP不显影的患肾99mTc-DTPA动态显像主要表现为~级,即放射性摄取中度以上减少占81.5%GFR均值22.8 mL/min,肾实质不显影占18.5%。结论:99mTc-DTPA肾动态显像较IVP不显影患肾功能的评价可以获得直观的肾脏摄取-排泄曲线和GFR值,从而能够定量的评判分肾功能,为术式的选择提供重要依据。此法简便、无创、灵敏及可重复性的特点,是评价肾功能的理想方法。     

彩色多普勒超声诊断肾恶性循环肿瘤的价值(附20例分析)

目的:评价彩色多普勒超声诊断肾常见恶性肿瘤的价值。方法:分析20例手术病理证实为肾恶性肿瘤的超声表现。结果:肾恶性肿瘤的灰阶超声各异,彩色多普勒超声表现为抱球型和丰富血流型的肾脏肿瘤,术前均定性诊断正确(9/9)。对于星点型、少血流型的肾脏肿瘤,诊断符合率分别为75%(3/4),85.7%(6/7)。超声定性诊断与术后病理符合率为90%。结论:肾恶性肿瘤的回声多种多样,无特异性,彩色血流丰富和抱球型的肿瘤,多考虑恶性。超声诊断对血供丰富的肾肿瘤意义更大,可作为肾恶性肿瘤患者术前首选的检查方法。     

B超引导下单纯性肾囊肿穿刺注射乙醇与腹腔镜下肾囊肿去顶减压术临床疗效及社会效益比较

目的探讨腹腔镜肾囊肿去顶减压术与肾囊肿穿刺硬化治疗单纯性肾囊肿的治疗效果和经济价值。方法收集腹腔镜肾囊肿去顶减压术或者穿刺硬化治疗161例,分析患者年龄、性别、BMI、囊肿的情况;手术时间、出血量、并发症、住院时间、费用、肾功能、复发的情况。结果2组BMI、性别比、随访时间、囊肿大小以和位置方面差异均无统计学意义（P〉0．05）,但是穿刺组平均年龄高于腹腔镜组（P〈O．01）;腹腔镜组手术时间和住院时间均明显长于穿刺组（P〈0．01）,住院费用也明显高于穿刺组（P〈0．01）,2组并发症发生率间差异无统计学意义（P〉0．05）;2组术前术后血肌酐水平的改变差异均无统计学意义（P〉0．05）;腹腔镜组的复发率明显低于穿刺组（P〈0．05）,在穿刺组中,囊肿直径大于8cm的患者的复发率明显高于直径〈8cm患者（P〈0．05）。结论腹腔镜肾囊肿去顶减压术效果明确,复发率低,并发症少,穿刺硬化治疗创伤小恢复快,对于一些特殊的高危患者不能耐受手术的时候,可以选择这种治疗方式。     

Pharmacokinetics of atenolol in patients with renal impairment

Summary The pharmacokinetics of atenolol, a new cardioselective -adrenoceptor blocking agent, were determined following both acute and chronic dosing in 33 hypertensive patients with widely differing levels of renal impairment. In patients with normal renal function the atenolol half-life was calculated to be about six hours following single 100 mg oral doses. This value increased markedly in patients with renal insufficiency and the blood clearance of atenolol was found to have a significant correlation with the glomerular filtration rate. This demonstrated the importance of the kidneys in the elimination of the drug. After 8 weeks oral treatment with atenolol (100 mg twice daily) a significant decrease in blood pressure, heart rate and plasma renin activity was observed, but no correlation was established between the blood levels of atenolol and any of its pharmacodynamic effects. A positive correlation was found however between the anti-hypertensive action of atenolol and the pretreatment value of the plasma renin activity.     

Effect of renal function on risedronate pharmacokinetics after a single oral dose

AIMS: To determine the relationship between risedronate pharmacokinetics and renal function. METHODS: Risedronate was administered to adult men and women (n=21) with various degrees of renal function (creatinine clearance 15-126 ml min-1 ) as a single oral dose of 30 mg. Serum samples were obtained for 72 h after dosing, and urine samples were collected for 72 h after dosing and then periodically for 6 weeks. Risedronate concentrations were determined using an enzyme-linked immunosorbent assay (ELISA). Risedronate serum concentration-time and urinary excretion rate-time profiles were analysed simultaneously using nonlinear regression. RESULTS: Renal clearance and volume of distribution were linearly related to creatinine clearance (r2=0.854, P<0.001; and r2=0.317, P<0.01, respectively). Decreases in predicted renal clearance and volume of distribution of 82 and 69%, respectively, were observed when creatinine clearance decreased from 120 to 20 ml min-1. A 64% decrease in predicted oral clearance was observed when creatinine clearance decreased from 120 to 20 ml min-1 (P=0.064). Iohexol clearance, a predictor of renal function, produced similar results to those observed with creatinine clearance. Risedronate was well tolerated by the study population. CONCLUSIONS: Risedronate renal clearance was significantly related to a decrease in renal function. There was a consistent reduction in oral clearance with a decrease in creatinine clearance. However, based on the regression analysis, generally no dosage adjustment appears to be necessary for most patients with mild or moderate renal impairment (creatinine clearance >20 ml min-1 ).