首页 | 本学科首页   官方微博 | 高级检索  
相似文献
 共查询到20条相似文献,搜索用时 15 毫秒
1.
Teicoplanin, a glycopeptide antibiotic against Gram-positive bacteria, is used during continuous venovenous hemodiafiltration (CVVHDF), though adsorption onto a hemofilter has been observed in an in-vitro study. We report a case of extensive augmentation of teicoplanin clearance by a polymethyl methacrylate (PMMA) hemofilter. A 74-year-old man (body weight 53 kg) was performed CVVHDF with the PMMA hemofilter. The effluent flow rate maintained at 600–650 mL/h. The measured teicoplanin clearance was 31.0 mL/min, and the clearance was reduced to 11.1 mL/min over the next 6.5 hours. In conclusion, we should closely monitor teicoplanin dosing during CVVHDF using a PMMA membrane hemofilter.  相似文献   

2.
Objective. To evaluate the Procalcitonin (PCT) clearance during continuous veno-venous hemodiafiltration (CVVHD).?Design. Case report?Setting. Surgical intensive care unit?Patient. 51-year-old man, who had undergone total thyroidectomy about ten years before owing to multiple endocrine neoplasia 2 (MEN 2), suffering from multiple organ dysfunction syndrome (MODS) with acute renal failure after severe trauma caused by a traffic accident.?Measurements and main result. The samplings of prefilter (afferent) and post-filter (efferent) blood and of ultradiafiltrate were 6 times performed during 24 h of CVVHD to calculate the PCT clearance of hemdiafiltration.?During the first half period of CVVHD the serum PCT concentration did not decrease, though PCT had been eliminated from serum. On the other hand during the latter half period of it the serum PCT value decreased (from 46.8 ng/ml to 29.4 ng/ml) and the amount of the eliminated PCT from serum was about 100 ng per minute and its clearance was 2.3 ∼ 3.4 ml/min.?Conclusion. The CVVHD could eliminate PCT from serum. First it was brought about by the adsorption by the filter menbrane and then by ultradiafiltration. Received: 25 February 1999/Final revision received: 31 May 1999/Accepted: 9 June 1999  相似文献   

3.
Tumor lysis syndrome, caused by massive tumor cell death, is an infrequent occurrence in solid tumors, and only a few cases of tumor lysis syndrome occurring in patients with lung cancer have been reported. We present a case of tumor lysis syndrome in a patient with mixed small cell and non-small cell lung cancer complicated by Listeria sepsis. Despite aggressive supportive measures with fluids, electrolytes, antibiotics, pressor agents, ventilation, and alkalinization of the urine, multiorgan failure developed, and the patient died on day 5 in the intensive care unit. Physicians should be aware of this infrequent but potentially fatal complication occurring in critically ill patients with bulky solid tumors so that early and aggressive therapeutic measures can be initiated and appropriate monitoring can be performed.  相似文献   

4.
赵琨  郑晓静  汪银 《护理研究》2009,23(36):3381-3382
急性肿瘤溶解综合征(acute tumor lysis syndrome,ATLS)是一组严重的代谢紊乱性疾病,是恶性肿瘤病人进行细胞毒性药物治疗时,由于肿瘤细胞大量溶解破坏,快速释放细胞内容物,使电解质紊乱而发生的一组症候群,主要表现为:高钾血症、高磷血症、高尿酸血症,低钙血症.  相似文献   

5.
连续性血液透析滤过在MODS患者治疗中的临床疗效   总被引:14,自引:0,他引:14  
目的观察连续性血液透析滤过在治疗MODS患者的临床疗效.及其容量平衡的情况。方法中南大学湘雅二医院20例MODS患者行床旁CBP治疗,采用Aquarius机器、AV600s透析膜行床旁连续性静脉-静脉血液透析滤过(CVVHDF)治疗,置换液流量2~4L/h,透析液流量4~6L/h,治疗时间6~10h/天,观察治疗前、后患者血清尿素氮(BUN)、肌酐(SCr)、尿酸(UA)及血清电解质钾、钠、氯、钙、磷及二氧化碳结合力的变化,比较设定治疗剂量与实际治疗剂量,设定净超滤量与实际净超滤量的差值。结果20例患者均很好地耐受治疗。治疗后BUN、SCr及Ua下降率分别为(42±13)%、(36±9)%及(52±11)%,血清钾、钠、氯、钙及二氧化碳水平无显著变化,血磷水平明显下降(P<0.01)。设定治疗量为(47.2±8.1)L,而实际治疗量为(45.8±6.7)L,误差率为2.9%(中位数,95%范围0.3%~8.3%)。设定净超滤量为(3112±1002)ml,实际净超滤量为(2921±927)ml,误差率为6.8%(中位数,95%范围2.9%~9.9%)。总的容量误差率为0.51%(中位数,95%范围0.21%~0.96%)。结论连续性血液透析滤过能有效用于MODS患者的救治,毒素清除能力强,能保持水、电解质及酸碱平衡,很好地保持容量平衡。  相似文献   

6.
Objective To assess the influence of continuous hemodiafiltration (CHDF) on cortisol and catecholamine kinetics in multiple organ dysfunction syndrome.Design Consecutive clinical study.Setting General intensive care unit of a university hospital.Patients Ten adult patients with multiple organ dysfunction syndrome requiring CHDF.Measurements and results A total of 40 samples were collected during CHDF for cortisol and catecholamine assays. The clearances for cortisol, epinephrine, norepinephrine and dopamine were 2.5±1.7 ml/min, 26.3±2.7 ml/min, 16.7±4.2 ml/min and 26.3±2.6 ml/min (Mean±SE), and their daily extractions were 1.8±0.2 mg/day, 11.4±4.8 g/day, 1.0±0.1 g and 2.3±0.3 g/day, respectively. There were no significant changes in blood cortisol and catecholamine levels during CHDF conducted for 48 h.Conclusions The cortisol and catecholamine losses during CHDF were small and unlikely to lead to hemodynamic disturbances.  相似文献   

7.
OBJECTIVE: To assess the effect of continuous hemodiafiltration (CHDF) on ketamine and midazolam kinetics in multiple organ dysfunction syndrome (MODS). DESIGN AND SETTING: Consecutive clinical study in a general intensive care unit of a university hospital. PATIENTS: Twelve adult patients with MODS requiring CHDF. MEASUREMENTS AND RESULTS: A total of 68 samples were collected during CHDF for ketamine, norketamine, and midazolam assays. The clearance values for ketamine and norketamine were 10.8 +/- 6.6 and 10.9 +/- 11.5 ml/min and their daily extractions were 21.4 +/- 7.1 and 10.2 +/- 11.5 mg/day, respectively. Midazolam was not eliminated through the filter during CHDF. There were no changes in Ramsay Sedation Score or Glasgow Coma Scale during CHDF. CONCLUSIONS: Small fractions of ketamine and norketamine were eliminated during CHDF in MODS. Midazolam was not eliminated during CHDF. CHDF did not affect the sedation using ketamine and midazolam even in MODS patients.  相似文献   

8.
Sir, A 74-year-old man presented to the emergency room after he hadnot urinated for over 24 h. He had noticed decreasing urineoutput over the last couple of days. A week prior, he was seenby his primary care physician for worsening cough and weightloss, and was diagnosed with stage IV squamous cell carcinomaof the lung. He was scheduled to start chemotherapy later inthe week of his presentation. He had a history of chronic obstructivelung disease, coronary  相似文献   

9.
Plasma exchange has gained widespread acceptance as an effective mode of blood purification in patients suffering from acute hepatic failure. However, it is still undetermined whether a single use of plasma exchange is capable of removing inflammatory cytokines completely or of preventing the development of citrate toxicity inherent with fresh frozen plasma. To clarify these issues we developed combined plasma exchange and continuous hemodiafiltration (CHDF) modality in which CHDF is performed in an opposite direction to plasma exchange. This study was designed to assess the effectiveness of combined modality therapy. Fifteen patients with acute hepatic failure were treated with plasma exchange (plasma exchange group) or plasma exchange and CHDF (plasma exchange + CHDF group), and various biochemical parameters were determined before and after treatment. Although citrate levels increased significantly after treatment compared with pretreatment levels in both the plasma exchange group and the plasma exchange + CHDF group, the percentage of the increase in citrate levels was significantly higher in the plasma exchange group than in the plasma exchange + CHDF group. Bilirubin levels were significantly lower after treatment in both the plasma exchange and plasma exchange + CHDF groups. There were no significant differences in tumor necrosis factor-alpha levels before and after treatment in the plasma exchange group, but they were significantly lower after treatment in the plasma exchange + CHDF group. Interleukin-6 (IL-6) levels increased significantly after treatment in the plasma exchange group, but there were no significant differences in the IL-6 levels before and after treatment in the plasma exchange + CHDF group. Interleukin-8 levels increased significantly after treatment in the plasma exchange group while decreasing significantly after treatment in the plasma exchange + CHDF group. These results indicate that combining plasma exchange and CHDF in a parallel circuit is an effective modality for suppressing the elevation of blood citrate levels and for removing inflammatory cytokines. This finding may have important implications for the development of an effective treatment for patients with acute hepatic failure.  相似文献   

10.
11.
急性肿瘤溶解综合征的预防及护理进展   总被引:1,自引:0,他引:1  
葛云云  龚孝淑 《护理研究》2004,18(15):1338-1339
急性肿瘤溶解综合征 (ATLS)是肿瘤治疗中易并发的急症 ,严重影响病人的生存。护理人员应积极预防 ,包括正确评估危险因素 ,加强监测 ,及时处理 ,降低病死率。  相似文献   

12.
OBJECTIVE: To describe the management of tumor lysis syndrome (TLS) with rasburicase in 2 patients who presented with cancer within the first month of life and compare and contrast both cases with respect to their underlying renal physiology, management, and eventual outcome. CASE SUMMARY: TLS developed in 2 neonates born at 38 weeks' gestational age; both were managed in part with rasburicase. One patient was a 21-day-old infant who received 2 days of induction chemotherapy for the treatment of congenital Stage IV-S neuroblastoma. With a single 0.2 mg/kg dose of rasburicase, the serum urate level normalized and the infant completed therapy without incident. The second patient was a 4-day-old neonate with congenital precursor-B cell acute lymphoblastic leukemia who presented with spontaneous TLS complicated by renal dysfunction. Despite several doses of intravenous rasburicase (2 doses of 0.1 mg/kg and 4 doses of 0.2 mg/kg), as well as aggressive supportive therapy, the infant died of complications arising from uncontrolled TLS. DISCUSSION: Neonates may be at particular risk for TLS given their immature renal function and its predisposition toward metabolic derangements. While rasburicase has the potential to provide a rapid reversal of TLS in this patient population, when TLS is complicated by pre-existing acute renal failure, additional interventions and alternative anti-tumor strategies may be necessary for a successful outcome. When managing TLS in infancy, clinicians must consider the relative degree of renal immaturity and its predisposition toward metabolic derangements. CONCLUSIONS: Rasburicase appears to be well tolerated and effective in lowering serum urate concentrations in the treatment of therapy-related TLS in neonates. However, in instances of spontaneous TLS complicated by the normally low glomerular filtration rate in the newborn infant, the use of rasburicase and other supportive care measures may still be inadequate, warranting further study.  相似文献   

13.
14.
15.
10例急性肿瘤溶解综合征患儿的抢救与护理   总被引:1,自引:0,他引:1  
总结10例急性肿瘤溶解综合征(ATLS)患儿的抢救和护理。10例ATLS患儿中除1例死于高钾血症,1例放弃治疗,其余坚持治疗的8例均救治成功。认为熟悉ATLS的临床特征和发生机制,密切监测血尿酸、肾功能、电解质及生命体征的动态变化是救治成功的关键,早期采取干预措施是患儿安全、顺利度过危险期,减少肿瘤治疗相关死亡的保证。  相似文献   

16.
目的 总结日间连续性静脉-静脉血液透析滤过(CVVHDF)在心脏术后的临床应用经验.方法 2002年6月~2008年3月对中国医科大学附属第一医院收治的12例患者在心脏手术后肾功能不全进行了日间CVVHDF,观察日间CVVHDF对患者的心率、中心静脉压、平均动脉压、动脉血氧分压、肾功能变化、升压药物剂量以及围术期和预后情况.结果 12例患者中8例在体外循环下行冠状动脉旁路移植手术(CABG),2例在非体外循环下行CABG,2例在体外循环下行瓣膜置换手术,术后均进行日问CVVHDF,每次透析持续8~12h,第一次透析6h后患者的心率、中心静脉压、肌酐和尿素氮及多巴胺用量较未透析时明显下降(P<0.05),而平均动脉压、动脉血氧分压较未透析时明显升高(P<0.05).围术期死亡2例,其余10例患者中有3例改为内科规律透析治疗,7例患者肾功能恢复到术前水平出院后尿量恢复未再透析治疗,术后随访(36.90±29.06)个月,生活质量明显提高.结论 日间CVVHDF是治疗心脏术后肾功能不全的有效方法.  相似文献   

17.
What is known and Objective: Tumour lysis syndrome (TLS) is an oncologic emergency with potentially devastating consequences classically associated with cytotoxic chemotherapy. In recent years, molecularly targeted drugs have assumed an increasingly important role in cancer therapeutics. The possibility of TLS is often overlooked in this setting. Rasburicase, a recombinant urate oxidase, is remarkably effective in treating hyperuricemia, thought to be central to the pathogenesis of renal injury in TLS. Our objective is to review the literature on TLS especially as it pertains to targeted therapies and summarize current knowledge and provide future directions regarding the role of rasburicase in the management of TLS. Methods: A MEDLINE search was conducted using PubMed and the keyphrase ‘tumor lysis syndrome’ to identify articles describing TLS with a broad range of novel anti‐cancer agents. Meeting abstracts were also reviewed. Additionally, the biomedical literature was searched using the keyword ‘rasburicase’. Results and Discussion: Tumour lysis syndrome has been described with nearly every class of ‘targeted therapy’. This is not surprising as any drug causing death of cancer cells by any mechanism may lead to TLS in the appropriate setting. Although there is a wealth of evidence suggesting that rasburicase is extremely effective in correcting hyperuricemia, prospective trials showing that it improves hard outcomes such as acute renal failure, need for dialysis and mortality are lacking. Furthermore, much lower doses and durations of therapy than approved appear to be effective in controlling hyperuricemia, potentially leading to enormous cost savings. What is new and Conclusion: Any effective cancer therapy can lead to TLS. Physicians should consider the risk of TLS on a case‐by‐case basis and determine appropriate prophylaxis. The role of rasburicase continues to evolve. Randomized controlled trials evaluating clinically relevant outcomes are needed.  相似文献   

18.
张汀  王艳  阿胜  陈孟华 《中国血液净化》2011,10(11):606-609
目的研究日间静静脉血液透析滤过(continuous venovenous hemodiafiltration,CVVHDF)在脓毒血症合并急性肾损伤(acute kidney injury,AKI)患者治疗中的应用和影响预后的因素.方法观察分析宁夏医科大学总医院肾脏内科采用日间静静脉血液透析滤过以置换流量35~40ml/(kg·h)、透析液流量1500~2000 ml/h为方案救治的16例脓毒血症合并急性肾损伤患者的资料,评估临床特点和影响预后的因素.结果7例(43.8%)患者度过疾病的急性期(存活组),APACHE Ⅱ评分为(25.4±6.7);9例(56.2%)患者在急性期死亡(死亡组),APACHE Ⅱ评分为(34.4±4.3).对2组患者的临床资料、生化指标、机械通气状况、脏器损伤的特点、疾病的严重程度等因素进行分析,发现2组患者应用CVVHDF治疗前的机械通气状况、脏器衰竭数量、血钠、尿量之间差异有统计学意义(P<0.05).同时,死亡组APACHE Ⅱ评分(急性生理学与慢性健康状况评分Ⅱ)高于存活组,代谢性酸中毒严重程度明显.结论日间CVVHDF可降低脓毒血症合并急性肾损伤患者的死亡率.脓毒血症患者的预后受患者是否存在机械通气、脏器衰竭数量、血钠水平、代谢性酸中毒程度及APACHE Ⅱ分值的影响.  相似文献   

19.
Tumour lysis syndrome (TLS) can be a life threatening complication of cancer therapy where cells undergo overwhelming lysis. The result is a pattern of metabolic abnormalities leading to acute renal failure and possible coagulopathy. Prophylactic pharmaceutical interventions can prevent this syndrome in almost all patients reducing possible admission to the intensive care unit. This article reviews the clinical efficacy, side effect profile, dosing and administration of rasburicase, an intravenous recombinant urate oxidase used in patients at risk of Tumour lysis syndrome due to a high tumour burden or where treatment is required. Rasburicase is an expensive but effective treatment option in the prevention and treatment of tumour lysis syndrome.  相似文献   

20.
It has been claimed humoral mediator network including pro-inflammatory cytokines plays a pivotal role in the pathophysiology of SAP. On the other hands, we have reported CHDF using polymethyl methacrylate (PMMA) membrane hemofilter could remove cytokines in blood of a patient continuously and effectively. Therefore, we applied CHDF to patients with SAP. CHDF was performed using a PMMA-hemofilter for removal of causative cytokines regardless of renal function 24 hours a day without interruption until IL-6 blood level became below 400 pg/ml. Selective digestive decontamination (SDD) was also given for prevention of bacterial translocation. Forty-two out of 45 patients (93%) receiving both CHDF and SDD survived. We conclude critical care with PMMA-CHDF and SDD is an effective treatment for SAP.  相似文献   

设为首页 | 免责声明 | 关于勤云 | 加入收藏

Copyright©北京勤云科技发展有限公司  京ICP备09084417号