血液透析并发腹痛25例临床分析

血液透析并发腹痛２５例临床分析湘雅医院血液净化中心邓翠林，左晓霞，谭翠英，文斌关键词血液透析；尿毒症；并发症我国现已广泛应用血液透析（ＨＤ）治疗急性肾功能衰竭（ＡＲＦ）及慢性肾功能衰竭（ＣＲＦ）。由于透析设备不断改进，医疗技术日益提高，对ＣＲＦ患者采...     

血液透析治疗尿毒症的心血管并发症30例体会

血液透析治疗尿毒症的心血管并发症３０例体会郑敏秀北京市小庄医院（１０００２６）血液透析治疗慢性肾功能衰竭已广泛应用于临床，随着透析技术的不断改进，其治疗效果在不断提高。而在治疗过程中对其并发症的处理尤为重要。减少并发症的发生及提高并发症的治疗效果则是...     

老年血液透析患者的临床特点

目的探讨老年慢性肾功能衰竭尿毒症患者血液透析的临床特点。方法选择慢性肾功能衰竭尿毒症期行血液透析患者62例,根据年龄分为老年组（年龄≥60岁,32例）和非老年组（年龄〈60岁,30例）,比较两组患者的营养指标、炎症指标以及重要透析并发症发生率。结果老年组5年存活率明显低于非老年组（P〈0.05）,透析中并发症的发生率明显高于非老年组（P〈0.05）,老年血液透析主要死亡原因是心血管并发症（占54.5%）。结论老年血透患者生存率低、并发症发生率高,应进一步加强老年血透的管理。     

尿毒清冲剂减少腹膜透析次数30例小结

尿毒清冲剂减少腹膜透析次数３０例小结刘宏富，周彦天津市天和医院肾内科（３０００５０）关键词尿毒清冲剂；腹膜透析对于慢性肾功能衰竭终末期尿毒症的治疗，多采用维持性透析疗法──血液透析和腹膜透析。连续性不卧床腹膜透析（ＣＡＰＤ）问世至今，已有８６０００余...     

慢性肾功能衰竭中药灌肠的护理体会

慢性肾功能衰竭中药灌肠的护理体会丁慧马鞍山钢铁总公司医院（２４３０００）关键词慢性肾功能衰竭，中药．灌肠目前，慢性肾功能衰竭（ＣＲＦ）的主要治疗手段为透析疗法，包括血液透析（ＨＤ）和腹膜透析（ＰＤ）。但透析疗法价格昂贵，需要特殊设备，部分患者无力承担...     

血液透析患者静脉插管以及内瘘护理的几点体会

血液透析患者静脉插管以及内瘘护理的几点体会山西医学院第一附属医院肾内科王瑞栋，吴文慧我科自９５年，起共为４１名患者作血液透析治疗，包括急诊、长期住院及门诊透析患者。其作血液透析的指征分别是：慢性肾功能不全尿毒症（２７人）；急性肾功能衰竭（８人）；急性...     

血液透析治疗尿毒症心包炎46例观察

血液透析治疗尿毒症心包炎４６例观察哈尔滨市第一医院透析科王怀功，徐锐之，李秀兰，吕德滨尿毒症心包炎是慢性肾功能衰竭晚期常见的并发症。对透析患者和医生都是一个难点。随着血液净化技术和肾移植的广泛开展及不断改进，其治疗效果逐渐提高。我院从１９８７年５月至...     

腹膜透析联合血液透析对慢性肾功能衰竭的疗效观察

目的：探讨血液透析联合腹膜透析与腹膜透析治疗慢性肾功能衰竭患者的临床疗效。方法：选取我院2006年10月~2010年10月收治的慢性肾功能衰竭患者80例,其中32例行腹膜透析联合血液透析治疗（联合组）,48例仅进行腹膜透析（腹透组）,观察两组疗效。结果：两组治疗后肾功能均得到改善,联合组肌酐、尿素氮均低于腹透组,差异均有统计学意义（均P〈0.05）;治疗后联合组血红蛋白及白蛋白水平高于腹透组,甲状旁腺素水平低于腹透组,差异均有统计学意义（均P〈0.05）;联合组治疗中并发症少于腹透组,差异有统计学意义（P〈0.05）。结论：腹膜透析联合血液透析治疗慢性肾功能衰竭,可明显改善肾功能,减少并发症,改善患者生活质量,值得应用。     

慢性尿毒症血液透析病人的护理

尿毒症是肾功能逐渐减退的最后阶段，是慢性肾功能衰竭的晚期。而治疗的方法只有肾脏移植和各种透析两种，由于肾脏移植费用昂贵而且供体问题难以解决，所以现阶段尿毒症患者多采用透析来延长生命。血液透析和腹膜透析是目前挽救尿毒症患者生命的主要手段，做好患者透析中各种护理，是使患者顺利完成透析治疗的重要环节，现介绍一下血液透析的护理体会。     

无肝素透析治疗尿毒症并发颅内出血16例分析

颅内出血是维持性血液透析的慢性肾功能衰竭患者的严重并发症之一,病死率较高.其治疗方法主要是透析治疗.我院1999年以来对维持性血液透析的尿毒症并发颅内出血的16例患者采用无肝索透析,明显提高了救治的存活率.现将结果分析报告如下.     

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.