认知行为干预在减少维持性血液透析患者急诊透析中的作用

目的 探讨认知行为干预(CBT)对减少维持性血液透析(MHD)患者急诊透析发生率的影响.方法 收集2004年1月-2005年12月在行MHD的230例患者为对照组.2006年开始对患者实施CBT,将2006年1月-2007年12月行MHD的230例患者为实验组,对两组发生急诊透析的原因、两组患者非常规透析时间来医院急诊透析的发生率、两组患者对健康教育内容掌握程度、透析间期体重控制情况进行比较分析.结果 实验组急诊透析的发生率0.08%,对照组为0.16%;实验组对健康教育内容掌握程度100%,对照组为43.3%;实验组体重控制率99%,对照组为45%;两组比较差异均有统计学意义(P<0.05).结论 CBT可减少MHD患者急诊血透诱因,从而降低急诊血透发生率,从而减轻患者的经济负担,提高患者生活质量.     

不同肝素抗凝对血液透析患者脂质代谢的影响

体外循环抗凝是保证尿毒症血液透析患者顺利透析的重要手段。常规应用的普通肝素钠是有不同相对分子质量组成的混合物,抗凝作用强、相对经济,但半衰期短、出血危险性大,给临床工作带来一     

Erythropoietin requirement in patients with type 2 diabetes mellitus on maintenance hemodialysis therapy

Diabetes is known to be a risk factor for the severity of anemia in non-dialyzed patients with renal failure. The aim of this study was to evaluate differences in hemoglobin (Hb) response to erythropoietin (EPO) in diabetic and nondiabetic patients on chronic hemodialysis (CHD). Sixty-four patients on CHD were included in the study: 24 type 2 diabetics (mean age, 59+/-11 years; 10 men, 14 women) and 40 nondiabetics (age, 53+/-14 years; 21 men, 19 women). All patients received a fixed dose of 50 mg ferric saccharate and EPO per week, dosed individually to achieve a target Hb level of 12 g/dl. Hb levels, ferritin, transferrin saturation (TSAT), EPO requirement (IU/kg/week), folic acid, vitamin B12 and C-reactive protein (CRP) were measured every two months. Additionally, the incidence of infectious diseases during the observation period of six months was evaluated, and a univariate correlation analysis of CRP and EPO requirements was performed in both groups. Patients with and without diabetes were divided into two groups each: those with normal CRP and those with elevated CRP. The EPO requirements of these groups were compared. Under identical iron substitution the mean Hb level increased more, but not significantly, in non-diabetic patients than in diabetic patients. After 6 months the mean Hb levels were 12.1+/-1.2 versus 11.5+/-1.2 g/dl (NS), although the actual EPO requirement was higher in diabetic than in non-diabetic subjects (244+/-122 versus 183+/-118 IU/kg/week; p<0.05). CRP after 6 months was significantly higher in diabetic than in non-diabetic patients (2.6+/-2.2 versus 1.5+/-1.3 mg/dl; p<0.05), as was the incidence of infectious disease (n/patient/month) (0.24 versus 0.08; p<0.05). The correlation coefficient between CRP and EPO requirements was statistically significant in both diabetic (r=0.547 p<0.01) and non-diabetic subjects (r=0.577; p<0.001). All other laboratory indices were similar in both groups. In the diabetic patients with normal CRP (n=6) the Hb levels achieved after six months were similar to those of non-diabetic patients (n=10) with normal CRP (11.9+/-1.1 versus 12.1+/-1.2%), and the required EPO was comparable. We conclude that the Hb response to EPO is reduced in diabetic patients on CHD. This elevated EPO requirement may be explained by a greater prevalence of infectious diseases, characterized by a significantly higher CRP level, in these patients. Other causes for the elevated EPO requirement could be excluded.     

Electroconvulsive therapy in a patient on chronic hemodialysis.

ECT is an effective treatment for patients with the diagnosis of major depression unresponsive to an antidepressant drug regimen, refusal of oral intake, hypokinesia, and suicidal ideation with the need for urgent intervention. A.B. benefited from ECT with an improvement of mood and appetite. Unfortunately, he experienced cognitive deficits, which prevented him from returning to his career as a high school physics teacher, and to this day he continues to live in an extended care facility.     

Analgesic dilemma in chronic hemodialysis patients

Analgesic drug abuse led to end-stage renal disease in 31% of 122 patients in a cross-sectional investigation at our center. Addiction to analgesics and tranquilizers remained a serious problem in these patients even after they were placed on chronic hemodialysis. There is strong evidence that drug addiction leading to end-stage renal disease and chronic hemodialysis correlates with a special type of personality typified by the 60-year-old depressive woman suffering from chronic headache.     

Mezlocillin disposition in chronic hemodialysis patients

The pharmacokinetics of a single 1-g intravenous dose of mezlocillin were examined in six functionally anephric patients undergoing hemodialysis. Hemodialysis clearance calculated by plasma extraction ratios across the dialyzer membrane and by dialysis fluid agree well, averaging 26 and 32 ml/min. Dialyzer extraction ratios averaged 0.16 +/- 0.07, and 23.3 +/- 9.6% of the dose was measured in the dialysate. Plasma clearances (104 +/- 45 ml/min) and steady-state volumes of distribution (0.22 +/- 0.07 liter/kg) of mezlocillin showed good agreement with literature values. The nonrenal clearance (4.25 +/- 2.30 liters/h per 1.73 m2) of mezlocillin was appreciable. Drug loss by hemodialysis is small and should have little effect on therapeutic dosage needs.     

Prevalence of hepatitis G in patients on chronic hemodialysis

Hepatitis G virus (HGV) is a newly described RNA virus from the family of flaviviridae. It is closely related to the hepatitis C Virus (HCV) but is more common than HCV among healthy blood donors. The pathogenicity of HGV in immunosuppressed patients such as those undergoing hemodialysis is unclear. We measured the incidence of HGV in 105 patients undergoing hemodialysis in a chronic outpatient hemodialysis facility. HGV-RNA was detected using a RT-PCR method with primers directed against the 5' non-coding region and the NS5a gene of HGV. Nine (8.6%) patients were HGV RNA positive, eleven (10.5%) were anti-HCV positive, three (2.9%) were positive for hepatitis B surface antigen. Four patients were positive for both HGV and HCV; three of them had normal liver enzymes while one showed elevated ALT levels but no other signs of exacerbation of preexisting hepatitis. The prevalence of HGV among dialysis patients is comparable to that of HCV. The transmission route for HCV is nosocomial transmission during dialysis, whereas HGV shows both ways of transmission: blood transfusion mediated by a high prevalence of HGV among healthy blood donors and nosocomial transmission. HGV appears to play a minor role in acute hepatitis, even in immunosuppressed patients.     

The effect of vitamin E therapy on plasma and erythrocyte lipid peroxidation in chronic hemodialysis patients

The effect of vitamin E therapy on plasma and erythrocyte (RBC) lipid peroxidation was investigated in patients undergoing chronic hemodialysis. Before vitamin E therapy, both plasma and RBC lipid peroxidation values of chronic hemodialysis patients were significantly higher than those of healthy controls. Treatment with vitamin E (300 mg/day) for 1 month resulted in a significant decrease of lipid peroxidation. Vitamin E therapy may be a promising approach to prevent peroxidation of membrane lipids in chronic renal failure.     

Bicarbonate hemodialysis in the therapy of chronic kidney failure

A method of random sampling was applied to 10 CRI patients to analyze the results of 24 hemodialyses with acetate solution for dialysis (35 mmol/l) and 34 hemodialyses with bicarbonate solution for dialysis (35 mmol/l). Significant reduction of complications like headache, nausea, vomiting, tachycardia, dyspnea, extrasystole was observed in bicarbonate dialysis. The concentration of mean molecular uremic toxins was decreased from 5.75 +/- 0.84 mmol/l in acetate dialysis up to 2.63 +/- 0.21 mmol/l in bicarbonate dialysis. The content of intracellular potassium returned to normal. The concentration of serum cholesterol was decreased from 5.6 +/- 0.4 up to 4.8 +/- 0.2 mmol/l. These data indicated a favorable effect of bicarbonate dialysis on intracellular metabolism. Preliminary data did not confirm the normalizing effect of bicarbonate dialysis on the development of uremic osteopathy.     

维持性血液透析患者C反应蛋白的变化及洛伐他汀的干预研究

目的探讨维持性血液透析患者C反应蛋白变化,以及洛伐他汀对其的影响。方法维持性血液透析患者20例,洛伐他汀剂量20 mg/d口服,观察12周;观察指标包括血总胆固醇、甘油三酯、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HLD-C)、血C反应蛋白、白蛋白。结果维持性血液透析组治疗前C反应蛋白水平升高,使用洛伐他汀12周后血总胆固醇、甘油三酯、LDL-C均明显降低,而HDL-C上升,C反应蛋白从治疗前(10.83±3.0)mg/L降至(7.78±2.16)mg/L(P<0.05)。血白蛋白经洛伐他汀12周治疗后上升,从治疗前(32.47±4.65)g/L上升至(34.47±6.78)g/L(P<0.05),白蛋白上升与血C反应蛋白下降呈负相关(r=-0.305,P<0.05)。结论维持性血液透析患者存在微炎症状态,洛伐他汀对维持性血液透析患者除降脂外,还具有抗炎作用,能明显降低血C反应蛋白水平。     

Myocardial remodeling in chronic renal failure patients on hemodialysis

Pathologic myocardial changes in is one of the main causes of death in patients with terminal chronic renal failure (CRF). The authors studied structural and functional condition of the myocardium and the effect of various CRF factors on cardiovascular complications. The study demonstrates positive correlation between systolic arterial pressure (AP) and left ventricular (LV) remodeling, as well as between the degree of anemia and LV remodeling in patients with CRF on program hemodialysis. Concentric LV hypertrophy (LVH) was revealed in 24 (65%) patients, eccentric LVH--in 7 (19%) patients. The results show that eccentric LVH with reduced ejection fraction in CRF patients on hemodialysis is associated with high systolic and pulse pressure.     

125例维持性血液透析治疗患者退出原因分析

目的探讨维持性血液透析患者退出透析原因及影响生存率和生存质量的相关因素。方法对2002年1月～2007年1月在青岛大学医学院附属青岛市立医院血液净化中心进行维持性血液透析的235例患者进行回顾性分析。结果共125例患者退出治疗,退出率53.19%,其中以死亡、肾移植和因经济原因退出为主,分别占38.40%、21.60%、20.80%。死亡原因以脑血管病为主（31.25%）,其原发病高血压肾病占80.0%;其次为心血管病占25.00%,原发病以糖尿病肾病为主占75.0%。组间比较死亡组平均年龄较大,因全身衰竭和恶性肿瘤死亡者更明显（P〈0.01）。因心血管病、严重感染和全身衰竭死亡者平均透析龄较短（P〈0.05和0.001）。结论维持性血液透析患者退出治疗的主要原因是死亡和经济条件制约,脑血管病是死亡的主要原因,并发症的发生与原发疾病有关,高血压、糖尿病、高龄是影响死亡率的重要因素,老年患者发生全身衰竭和恶性肿瘤的危险性增加,合理选择透析方式和处方能有效延长患者寿命,提高生存质量。     

帮厨疗法对慢性精神分裂症病人疗效的影响

[目的]探讨帮厨疗法对慢性精神分裂症病人的辅助治疗作用。[方法]将135例慢性精神分裂症病人随机分成研究组(66例)与对照组(69例),两组均予以利培酮维持治疗,研究组在此基础上辅以3个月的帮厨疗法。在治疗前后分别采用阴性症状评定量表(SANS)、住院精神病病人康复疗效评定量表(IPROS)和精神病病人护理观察量表(NORS)评定治疗效果。[结果]研究组病人治疗后SANS、IPROS及NORS评分低于对照组,差异有统计学意义(P<0.01)。[结论]帮厨疗法有助于改善慢性精神分裂症病人的精神症状,提高其生活质量,促进病人早日重返社会。     

心理干预对维持性血液透析患者心理健康状况的影响

目的 探讨心理干预对维持性血液透析患者心理健康状况的影响.方法 将64例维持性血液透析患者随机分为两组,每组32例,两组患者在常规治疗的同时均予以常规护理,研究组在此基础上联合心理干预,观察8周.于心理干预前后采用症状自评量表和抑郁自评量表评定干预效果. 结果心理干预前,两组患者症状自评量表各项因子分〉2分者共35例,不同心理问题检出率为57.38%;干预后两组症状自评量表多项因子分均显著低于干预前（P〈0.01）,但研究组躯体化、强迫、抑郁、焦虑、敌对、精神病性因子分均显著低于对照组（P〈0.05或0.01）.干预后研究组抑郁自评量表总分显著低于干预前（P〈0.01）,对照组则均无显著变化（P〉0.05）. 结论 维持性血液透析患者存在诸多的心理问题,心理干预可显著改善患者的心理健康状况,减轻或缓解病痛,提高生活质量.     

L-肉碱对维持性血液透析患者慢性左心功能不全的疗效观察

目的观察L-肉碱(LC)对伴有左心室收缩功能减退的维持性血液透析(HD)患者的疗效.方法入选患者随机分为贝那普利组(A组)和贝那普利组 LC组(B组),疗程6个月,观察两组治疗前后心脏结构和功能的变化.结果两组治疗前后心脏左心室收缩功能、舒张功能、左心室重量指数都显著性改善,但仅左心室收缩功能在B组比A组显著性提高.结论对伴有左心室收缩功能减退的HD患者补充LC可以提高其左心室收缩功能,而对舒张功能,左心室重量指数无显著性改善.     

Potassium flux of erythrocytes in chronic hemodialysis patients

BACKGROUND: In chronic hemodialysis patients, hyperkalemia is frequently observed. In these patients, erythrocytes were examined to know whether they participate in the regulation of K(+) or not. METHODS: Erythrocyte K(+) release (DeltaKr) was induced by the incubation of erythrocyte suspension at 4 degrees C for 24 h and the K(+) influx followed at 37 degrees C for 3 h. K(+) flux of erythrocytes or DeltaKi/DeltaKr ratio, which was reflected by Na(+)/K(+)-exchanging ATPase, was measured in chronic hemodialysis patients. K(+) concentration was measured by ion-selective electrode method. RESULTS: Non-diabetic hemodialysis patients classified into three groups according to their serum levels were compared for various factors. Among them, the DeltaKi/DeltaKr ratios in medium- and high-serum K(+) groups were significantly lower than those in the low serum K(+) group. The effect of hemodialysis on erythrocyte K(+) flux was examined. After hemodialysis, the mean DeltaKi/DeltaKr ratio increased significantly compared with that before the treatment. Erythrocyte K(+) concentrations converted into a narrower range after hemodialysis. CONCLUSION: The reduced K(+) flux in erythrocyte may play a part in the development of hyperkalemia in non-diabetic chronic hemodialysis patients.     

Adequacy of glycemic control in hemodialysis patients with diabetes

OBJECTIVE: We sought to measure the prevalence of inadequate glycemic control in prevalent hemodialysis patients with diabetes and to examine independent predictors of inadequate glycemic control in these patients. RESEARCH DESIGN AND METHODS: This is a cross-sectional study of prevalent hemodialysis patients with diabetes in southeastern Ontario (n = 100). Data were collected by chart review and interview. The outcome variable was inadequate glycemic control defined as HbA1c (A1C) >0.07. Other measured variables were diabetes type, diabetes duration, diabetes physician, blood glucose monitoring, diabetes medications, BMI, time on dialysis, and other demographic, clinical, and laboratory variables. RESULTS: Fifty-four patients had A1C >0.07. In bivariate analysis, these patients had a longer diabetes duration (23.6 vs. 14.7 years, P < 0.001), higher proportion with insulin use (81.5 vs. 58.7%, P = 0.012), higher proportion with microvascular complications (66.7 vs. 43.5%, P = 0.017), and lower erythropoietin (EPO) dose (7.0 vs. 11.9 x 10(3) units/week, P < 0.01) than patients with adequate glycemic control. There was no difference between the two groups in terms of macrovascular complications (59.3 vs. 65.2%, P = 0.54). In multiple logistic regression controlling for age and diabetes type, the diabetes duration (odds ratio 1.09 [95% CI 1.04-1.15], P < 0.001), EPO dose (0.90 [0.85-0.97], P < 0.01), and blood glucose monitoring (10.06 [1.03-98.74], P = 0.05) were the only significant independent predictors of A1C >0.07. CONCLUSIONS: A high proportion of hemodialysis patients with diabetes had inadequate glycemic control, particularly those with longstanding disease. Patients with inadequate glycemic control had a significantly higher burden of microvascular complications.