尿毒症患者长期血液透析的血脂变化

尿毒症患者常存在血脂代谢紊乱 ,而脂质代谢紊乱与高血压和动脉硬化有明显相关。为此 ,我们观察尿毒症患者长期血液透析的血脂变化 ,报道如下。1　对象和方法1·1　对象　选 1999年 2月～ 2 0 0 1年 2月在我院行血液透析 1年以上尿毒症患者共 42例 ,慢性肾小球肾炎2 0例 ,慢性肾盂肾炎 7例 ,糖尿病肾病 4例 ,梗阻性肾病 3例 ,高血压肾病 3例 ,系统性红斑狼疮性肾病 3例 ,先天性多囊肾 2例。其中男性 2 2例 ,女性 2 0例 ,年龄 2 0～ 78岁 ,平均 (4 3 6± 11 6 )岁。全部患者在观察中均未使用过影响血脂的药物。正常组为 40例健康体检者 ,男 2…     

血液透析治疗肾综合征出血热急性肾功能衰竭1011例报告

我院自 1982年开展血液透析 (ＨＤ)以来 ,对 14 18例肾综合征出血热 (ＨＦＲＳ)急性肾功能衰竭 (ＡＲＦ)患者进行了ＨＤ ,共计 4 184次。为探讨肾综合征出血热(ＨＦＲＳ)急性肾功能衰竭 (ＡＲＦ)血液透析 (ＨＤ)治疗的指征、时机、方法及与预后的关系 ,对 1991年 5月至2 0 0 1年 5月间资料完整的 10 11例 32 14次ＨＤ资料进行回顾性分析 ,报告如下。1　资料与方法1·1　研究对象　 10 11例ＨＦＲＳ患者为我院住院患者 ,经间接免疫荧光法检测血清抗 -ＨＶ -ＩｇＭ均为阳性 ,按 1986年南京全国ＨＦＲＳ临床专题会议制定的诊断和分型标准 ,分重…     

经皮球囊扩张术在维持血透患者内瘘血管腔狭窄或阻塞的应用研究

我们自 1998年开始采用经皮球囊扩张术(ＰＴＡ)对 14例慢性肾衰尿毒症血液透析内瘘狭窄和阻塞病者进行治疗 ,获得满意效果 ,报告如下。1　资料和方法1 1　一般资料　 14例终末期尿毒症患者经造影证实有动静脉内瘘狭窄或阻塞。其中男性 8例 ,女性6例。年龄 2 3～ 73岁 ,平均年龄 59 2岁。原发病是糖尿病肾病 5例 ,高血压肾病 3例 ,慢性肾炎 2例 ,其他 4例。透析年限 3～ 144个月 ,平均 32 5个月。内瘘狭窄或阻塞至ＰＴＡ时间 5～ 2 0ｄ ,平均8.7ｄ。全部病例的内瘘为桡动脉与头静脉间的端侧吻合术式。1 2　治疗方法　在带Ｃ型臂和ＤＳＡ的Ｘ…     

老年肾衰病人血液透析长期存活的临床分析(附24例)

随着老年人口的迅速增长,老年肾衰患者及行血液透析的人数也逐渐增多,本文对我院自1991-0 2～2 0 0 3 -12 2 4例老年尿毒症病人血液透析长期存活(5年以上)临床分析如下。1　资料和方法1·1　对象选择　本组2 4例尿毒症患者均为老年病人,其中男性13例,女性11例,年龄60～78(平均66 8)岁。病因:慢性肾小球肾炎:17例,高血压肾小动脉硬化4例,慢性间质性肾炎1例,乙肝相关性肾炎1例,糖尿病肾病1例。开始血液透析时血肌酐浓度(92 2 6±3 2 2 6) μmol/L ,血尿素氮浓度(3 1 5±6 6)mmol/L ,内生肌酐清除率1 2～13 5ml/min ,均并发多器官损害1·2…     

血液透析患者高血压的机制与治疗体会

1血液透析患者高血压的特点据统计尿毒症血液透析患者86%合并有高血压,而且尿毒症血液透析患者的血压变化与原发性高血压完全不同。透析后血压逐渐下降,直至次日清晨然后逐渐升高,至第二日夜间也不降低,正常人夜间收缩压降低50%,舒张压降低20%,透析病人这种变化节律消失。2透析病人高血压的发病机制     

血液透析除水治疗高血压977例报告

血液透析的远期并发症中 ,高血压常见且危害大 ,是血液透析患者的常见死亡原因之一。 80 %的血透病人在开始血透治疗前即有高血压 ,其中原发病为肾小球肾炎、原发血管病变或糖尿病肾病的病人高血压发病率可达 90 %～ 10 0 % ,接受血液透析治疗后 ,6 5 %的非糖尿病病人的血压不能有效控制。1　资料与方法我科 1980年至 2 0 0 0年间收治终末期肾病血液透析病人 10 2 7例 ,其中男性 5 74例 ,女性 4 5 3例 ,年龄 7～ 2 0岁 19例 ,2 1～ 4 0岁 4 92例 ,4 1～ 6 0岁 4 75例 ,6 1岁以上 4 1例。原发病中慢性肾炎 897例 ,糖尿病 6 9例 ,其他疾病 6 1…     

妊娠高血压综合征型肾病综合征25例临床分析

本文对我院 2 0 0 0年 1月～ 2 0 0 0年 12月发生的 2 5例妊娠高血压综合征 (下称妊高征 )型肾病综合征进行回顾分析 ,探讨其临床特点与不良妊娠结局的关系 ,以提高对该病的认识和重视。1　资料与方法1 1　资料来源　在我院产科住院分娩产妇合并为重度妊高征 132人 ,其中有 2 5例为肾病综合征作为肾病组 ,10 7例未发生肾病综合征仅为单纯重度妊高征作为对照组。肾病组年龄为 ( 2 5.4 3± 2 .34 )岁 ;对照组年龄为 ( 2 5.90± 2 .4 0 )岁。所有病例既往均无慢性高血压及心肝肾等疾病。1 2　诊断标准　按妇产科学第 4版诊断标准诊断妊高征 ,肾…     

综合治疗老年尿毒症并上消化道出血29例

上消化道出血是尿毒症患者的一个重要并发症 ,严重者可直接导致死亡 ,是内科危重急症之一。及时的诊断和给予适当的治疗常可挽救患者的生命。 1997年 1月～ 2 0 0 0年 12月我们共收治老年尿毒症并上消化道出血 2 9例 ,全部采用综合治疗 ,效果较好 ,现报告如下。1　资料与方法1·1　一般资料　 2 9例均为老年慢性透析患者 (≥ 6 0岁 ) ,腹膜透析 (ＰＤ) 12例 ,血液透析 (ＨＤ) 17例 ,透析时间为 3月～ 6年 ,其中男性 2 0例 ,女性 9例 ,年龄 6 0～76岁 ,平均 6 6 5岁 ;既往有胃十二指肠溃疡病史 8例 ,3例因腰腿痛曾短期服非甾体类药 ,均无慢…     

尿毒症肺水肿33例临床分析

尿毒症肺水肿是尿毒症常见并发症 ,是肾功能衰竭常见的致死原因。我们从 1995年～ 2 0 0 1年共收治78例尿毒症患者 ,其中有 33例出现尿毒症肺水肿 ,现分析报告如下。1　临床资料1·1　一般资料　本组 33例均为住院的尿毒症患者 ,其呼吸道症状及胸片异常均能除外其它肺部疾病引起。其中 ,男 2 0例 ,女 12例 ,年龄 2 4～ 6 5岁 ,平均 38.2岁。原发病诊断中慢性肾炎 18例 ,慢性肾盂肾炎 6例 ,糖尿病肾病 3例 ,多囊肾 2例 ,高血压性肾病 2例 ,狼疮性肾炎和膀胱癌各 1例。尿毒症病程 1.1～ 5年 ,平均 1.8年。1·2　临床表现　咳嗽、咳痰 2 2例 (6…     

尿毒症血液透析患者合并结核感染临床分析

目的 分析尿毒症血液透析患者合并结核感染的临床特征,提高诊治经验.方法 对15例合并结核感染尿毒症血液透析患者的临床资料进行回顾性分析.结果 尿毒症透析患者363例,并发结核感染15例(4.13％),15例患者中肺结核3例,结核性胸膜炎4例(单侧3例,双侧1例),结核性心包炎1例,颈部淋巴结核3例,腰椎结核1例,结核部位不明确3例.经抗结核治疗,13例治愈,2例死亡.结论 尿毒症血液透析患者结核感染发生率明显升高,以肺外结核为主,症状不典型,实验室检查阳性率低,合理的抗结核治疗有效.     

有性才会有健康

性是基本的人权。根据我国著名的性学家史成礼教授的研究,性有“三大功能”:生育功能、享乐功能和健康功能。     

Communicating with people with dementia

It can be very difficult to communicate with people with dementia. Each case requires its own unique handling. Not every scenario is covered, as many times your own judgment is what will work, best according to the circumstances. These can change from dawn to evening and from day to day. Never assume things will be the way they were the last time you communicated. Be on your guard. Be adaptable. The article will help get you started to think of your own ways to communicate.     

经方汗证治验

临床上汗证病情复杂,分自汗、盗汗、黄汗和但头汗出,治疗汗证方药诸多,有益气固表、养阴清热和清热除湿等方法,疗效不一。受恩师刘健主任教导和《伤寒论》《金匮要略》病脉证并治启发,以脉证并治、方证对应思想,浅谈桂枝加附子汤、黄芪芍药苦酒汤、柴胡桂枝干姜汤和三物黄芩汤治疗汗证的经验,为经方治疗汗证提供新思路。     

Working with patients with physical disabilities

Medical practices need to make a number of adaptations to ensure that their facilities and staff are accessible to patients and other office visitors with physical disabilities. This article describes 10 specific strategies for preparing your medical practice for patients with disabilities, both inside and outside your office. It describes minimum standards for office doorways, sidewalk inclines, ramps, reception areas, and other adaptations medical offices need to make. The article also describes specific do and don't advice for communicating with patients with physical disabilities. It suggests strategies for preparing written materials for disabled patients, for communicating verbally, and for providing healthcare education. Finally, it suggests an appropriate role for medical practice staff in the delivery of healthcare services to patients with physical disabilities.     

Coping with Children with ADHD: Coping Styles of Mothers with Children with ADHD or Challenging Behaviours

Parents of children with Attention Deficit Hyperactivity Disorder (ADHD) can experience significant levels of stress in their parenting roles, however, little is known about the specific coping strategies used by these parents. This pilot study Investigated the coping strategies used by mothers of children with ADHD. A 34 item questionnaire was developed to identify maternal coping strategies. A cohort of 38 mothers of children with ADHD and a control group of 30 mothers of children without ADHD or any other disability/illness completed the questionnaire. Factor analysis of responses produced three factors: Aggressive/Confrontive Coping, Rational Coping, and Indirect Coping. These factors are similar to coping dimensions proposed by Folkman and Lazarus. Comparisons between the two groups of mothers revealed that mothers of children with ADHD used significantly more Indirect Coping.     

Problems with measuring satisfaction with social care

The measurement of customer satisfaction has become widespread in both healthcare and social care services, and is informative for performance monitoring and service development. Satisfaction with social care services is routinely measured with a single question on overall satisfaction with care, comprising part of the Adult Social Care Survey. The measurement of satisfaction has been problematised, and existing satisfaction measures are known to be under‐theorised. In this article, the process of making an evaluation of satisfaction with social care services is first informed by a literature review of the theoretical background, and second examined through qualitative interviews conducted in 2012–2013 with 82 service users and family carers in Hampshire, Portsmouth and Southampton. Participants in this study were from white British and South Asian backgrounds, and the influence of ethnicity in the process of satisfaction evaluation is discussed. The findings show that the majority of participants selected a positive satisfaction rating even though both positive and negative experiences with services were described in their narratives. It is recommended that surveys provide opportunity for service users and family carers to elaborate on their satisfaction ratings. This addition will provide more scope for services to review their strengths and weaknesses.     

Ending clinical relationships with people with schizophrenia

The potential for the social worker-client relationship to contribute to therapeutic outcomes is not always apparent with clients who have schizophrenia. Their cognitive impairments often make it difficult for these clients to regulate interpersonal boundaries and for social workers to connect with them. Clinical practice is enhanced, however, by recognizing that severely impaired clients have the capacity and desire for relationships with service providers and others. The manner in which the clinical relationship ends is important for maintaining clinical gains and determining whether the client will risk investing in future relationships. The purpose of this article has been to sensitize social workers to the delicate nature of managing the endings of those relationships.