连续性肾脏替代治疗在重症急性肾功能衰竭中的应用及护理

[目的]研究连续性肾脏替代治疗（CRRT）与血液透析（HD）在重症急性肾功能衰竭中的疗效。[方法]收集大连医科大学第一临床学院重症ARF患者52例，分别采用CRRT和HD治疗方法。记录低血压（LBP）发生的次数及出现心律失常（ARY）的次数，BUN及Scr水平。[结果]发现治疗后两组BUN、Scr比较无显著性差异，治疗后CRRT组低血压发生次数、心律失常发生次数均明显少于HD组，但发生体外循环凝血的机率略高于HD组。说明CRRT血流动力学明显比HD稳定，与传统HD相比CRRT连续、缓慢、等渗地清除溶质和水分，更符合生理情况，成为重症监护病房（ICU）、肾内科不可缺少的治疗手段。     

血NGAL水平在ICU急性肾损伤患者早期CRRT中的作用研究

目的 探讨血中性粒细胞明胶酶相关脂质运载蛋白（NGAL）水平在ICU急性肾损伤（AKI）患者早期连续性肾脏替代治疗（CRRT）中的作用。方法 选取2019年1至12月在浙江省台州医院ICU诊断为AKI并接受CRRT的112例患者为研究对象。在诊断AKI时检测患者血NGAL水平，同时收集患者一般临床资料、实验室指标等。根据患者入ICU诊断AKI后24 h内是否行CRRT分为早期CRRT组59例和延迟CRRT组53例，采用Kaplan-Meier法评价早期CRRT对AKI患者28 d生存预后的影响。根据血NGAL水平，将患者分为NGAL高表达组（≥228.79 ng/mL）及NGAL低表达组（<228.79 ng/mL），采用Kaplan-Meier法评价不同血NGAL水平组内早期CRRT与延迟CRRT患者28 d生存预后。结果 早期CRRT组患者28 d全因死亡率低于延迟CRRT组，生存时间长于延迟CRRT组，差异均有统计学意义（均P<0.01）。NGAL低表达组内早期CRRT与延迟CRRT患者28 d全因死亡率及生存时间比较差异均无统计学意义（均P>0.05）。NGA...     

CRRT在老年急性胰腺炎治疗中的临床研究

目的：探讨高置换率和低置换率连续性肾脏替代治疗（CRRT）对急性胰腺炎（AP）呼吸循环及外周血TNF-α水平的影响。方法：回顾性分析2002年12月-2008年11月64例急性胰腺炎患者，并按每位患者接受CRRT置管率的不同分为两组。A组32例，CRRT置换率为2L／小时；B组32例，CRRT置换率为4L／小时。记录CRRT治疗前、后6、12、24小时的实测呼吸频率、心率和无创动脉血压等。于上述相应时点抽取动脉血，做动脉血气分析，并留取血样，使用ELISA法测定血清TNF-α水平。结果：CRRT后，两组患者的氧合指数和呼吸，均有明显的改善（与治疗前比较，P〈0．01），血压、心率也趋于稳定（P〈0，05或〈0．01）。其中B组患者的变化和血TN-α水平的改变更为显著（与A组比较，P〈0．05或〈O．01），在CRRT后，两组患者的外周血TNF—d水平均有明显降低（P〈0．01）。结论：高置换率CRRT比低置换率CRRT，能更有效地清除AP患者体内的炎症因子，因而更有利于其呼吸循环功能的改善。     

连续性肾脏替代治疗与普通血液透析治疗慢性肾病合并心力衰竭临床作用的异同

目的：探讨连续性肾脏替代治疗（CRRT）与普通血液透析治疗慢性肾病（CKD）合并心力衰竭临床作用的异同。方法：选取2019年4月—2020年9月广州市番禺区何贤纪念医院收治的53例CKD合并心力衰竭患者，按照随机数表法将分为两组，对照组26例给予普通血液透析治疗，观察组27例给予CRRT治疗，观察两组患者心功能和肾功能。结果：治疗后，观察组6分钟步行距离（6 MWD）长于对照组，左室射血分数（LVEF）高于对照组，左心室舒张末期内径（LVEDD）、左心室收缩末期内径（LVESD）低于对照组；尿素氮（BUN）、血肌酐（sCr）、半胱氨酸蛋白酶抑制剂C(Cys-C)低于对照组，差异有统计学意义（t=3.278、3.251、4.907、21.271、3.754、4.847、2.938,P<0.05）。结论：CRRT治疗CKD合并心力衰竭，可更好地调节该类患者心功能以及肾功能。     

血浆置换联合连续性肾脏替代疗法治疗劳力性热射病效果的影响因素

目的 探讨血浆置换（PE）联合连续性肾脏替代疗法（CRRT）治疗劳力性热射病（EHS）效果的影响因素。方法 收集2017年6月至2021年12月中国医科大学附属盛京医院、武警辽宁省总队医院与北部战区总医院急诊医学科采用PE联合CRRT治疗的62例EHS患者的临床资料。根据患者治疗前后急性生理与慢性健康状况评分（APACHEⅡ）下降幅度，将患者分为改善≥40%组（n=34）和改善<40%组（n=28）。采用t检验或χ2检验比较2组患者年龄、体质量指数（BMI）、发病2 h内体温控制水平、发病至PE联合CRRT治疗的间隔时间、置换血浆量、治疗前动脉血乳酸（Lac）水平、肌红蛋白（Mb）、肌酸激酶（CK）、血清尿素氮（BUN）、肌酐（Scr）、丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）、血小板（PLT）、活化部分凝血活酶时间（APTT）、纤维蛋白原（Fib）指标的差异。将单因素分析有统计学意义（P <0.05）的指标进行多因素logistic回归分析。结果 62例EHS患者应用PE联合CRRT治疗前后APACHEⅡ评分分别为（23.5±2.8）分、（10.6±1.3）分，2...     

乌司他丁联合连续性肾脏替代疗法治疗重症烧伤患者的效果及对炎症因子、28 d全因死亡率的影响

  目的  探讨乌司他丁联合连续性肾脏替代疗法（CRRT）治疗重症烧伤对炎症因子、28 d全因死亡率的影响。  方法  选取昆明医科大学第二附属医院2017年1月至2019年8月收治的重症烧伤患者86例,按随机数表法分为CRRT组与乌司他丁联合CRRT组,每组43例。CRRT组:常规治疗+CRRT,乌司他丁联合CRRT组:在CRRT组基础上联合乌司他丁,连续7 d。比较两组治疗前、治疗7 d后的危重评分（APACHEⅡ评分、SOFA评分、Marshall评分）、血清炎症因子（TNF-α、IL-6、IL-8）、抗生素和血管活性药物的使用时间、机械通气时间及28 d全因死亡率。绘制Kaplan-Meier生存曲线分析两组患者的28 d生存情况。  结果  治疗前,两组患者的APACHEⅡ评分、SOFA评分、Marshall评分的差异无统计学意义（P > 0.05）。两组患者治疗7 d后的各项评分均明显低于治疗前（P < 0.05）。乌司他丁联合CRRT组患者治疗7 d后的APACHEⅡ评分、SOFA评分、Marshall评分显著低于CRRT组（P < 0.05）。治疗前,两组患者血清TNF-α、IL-6、IL-8的差异无统计学意义（P > 0.05）。治疗7 d后,两组患者血清TNF-α、IL-6、IL-8均低于治疗前（P < 0.05）。乌司他丁联合CRRT组患者治疗7 d后的血清TNF-α、IL-6、IL-8显著低于CRRT组（P < 0.05）。乌司他丁联合CRRT组和CRRT组的28 d全因死亡率的比较差异有统计学意义（23.26% vs 44.19%,P < 0.05）。  结论  乌司他丁联合CRRT治疗重度烧伤患者可降低APACHEⅡ、SOFA及Marshall评分、血清TNF-α、IL-6、IL-8水平及28 d全因死亡率,缩短治疗时间,有效性和安全性较高。     

血液净化技术在急性肾衰竭并发MODS中的应用

①目的 探讨急性肾衰竭并发多脏器功能障碍（MODS）病人血液净化治疗模式的选择及疗效。②方法 应用间歇式血液透析（IHD）治疗急性肾衰竭并MODS病人22例，连续性肾脏替代（CRRT）治疗急性肾衰竭并MODS病人30例，比较其疗效。③结果 IHD组7例存活，15例死亡；CRRT组16例存活，14例死亡。两组病人治疗前的尿素氮（BUN）、肌酐（Cr）、HCO3^-、K^＋、pH值水平比较，差异均无统计学意义（t=1．05～1．83，P〉0．05）。CRRT组治疗后不同时间点的BUN、Cr、HCO3^-、K^＋与pH水平均低于IHD组，差异有统计学意义（t=2．72～13．80，P〈0．05）。CRRT组严重低血压、心绞痛、严重心律失常、心力衰竭的发生率低于IHD组，差异有统计学意义（χ^2=2．21～8．32，P〈0．05）。④结论 对于急性肾衰竭并MODS病人更宜行CRRT治疗。     

连续性肾脏替代治疗在危重病治疗中的应用

目的：探讨连续性肾脏替代治疗（CRRT）在抢救危重病患中的作用。方法：观察7例多脏器功能障碍（MODS）病人CRRT治疗前后心率、平均血压、血尿素氮、血肌酐、血钾、血钠氧合指数及动脉血pH的变化。结果：CRRT前后MBP改变无显性意义，但治疗后升压药减量；其余指标在治疗后均趋向正常，与治疗前相比菜显性意义。结论：CRRT血流动力学稳定，溶质清除率高，有利于患肾功能及呼吸功能的改善，在抢救危重病人中能起到一定的作用。     

连续性肾脏替代疗法在危重症病人应用中的护理

目的:观察连续性肾脏替代疗法（CRRT）在危重症病人应用中的疗效。方法:2015年11月至2016年11月行床边CRRT的30例病人（观察组）,在既往常规护理的基础上,通过强化专业人员CRRT知识培训、机器报警的预防及处理,并发症的预见性护理、血管通路的护理等综合护理的干预,与对照组（2014年10至2015年10应用CRRT治疗30例）机器报警意外提前下机例数进行比较,观察综合护理的干预效果。结果:治疗后,与对照组比较,观察组尿素氮、肌酐、钾和钠水平、血PCO₂、AB水平均有下降（P<0.01）,氯水平、血pH值、PO₂和SaO₂水平均有上升（P<0.05）;观察组意外提前下机率,13.33%低于对照组的40.00%（P<0.05）,抢救成功率73.33%,高于对照组的43.33%（P<0.05）。结论:在危重病人CRRT过程中,采取积极有效的护理干预能保证CRRT的安全顺利进行,从而达到满意的治疗效果。     

多脏器功能障碍综合征患者应用CRRT治疗的临床研究

目的：观察连续性肾脏替代治疗（CRRT）对多器官功能障碍综合征的疗效。方法：选择由各种病因导致的多器官功能障碍综合征患者52例,全部给予CRRT治疗,并检测CRRT前后的肾功能、电解质及动脉血气,利用美国BioZD无创心脏动力学系统监测血流动力学改变。结果：治疗前患者肾功能BUN、Scr和血清钾、血糖高,CRRT治疗后BUN、Scr和血清钾明显降低,血糖趋于稳定,与治疗前相比,差异有统计学意义（P〈0．05）。血清钠、血清钙趋于稳定。CRRT治疗过程中,患者pH值渐趋正常,与治疗前相比,差异有统计学意义（P〈0．05）。治疗前PaO2／FiO2低,CRRT治疗后与治疗前比较差异有统计学意义（P〈0．05）。治疗前后患者CI、SVR、TFC、CVP均有明显改善（P〈0．05）。结论：应用CRRT治疗MODS患者可有效改善肾功能,调节酸碱失衡、电解质紊乱,有效改善急性呼吸衰竭,患者血流动力学趋于稳定,有利于改善患者的预后。     

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.