肾移植术后糖尿病的诊治策略

目的探讨肾移植术后糖尿病的诊治策略。方法对1例肾移植术后糖尿病患者的血糖谱和降糖方案进行分析。结果肾移植术后糖尿病患者的血糖控制不同于一般的1型糖尿病或2型糖尿病。结论肾移植术后免疫抑制剂的使用造成了糖尿病的高发,针对使用的免疫抑制剂不同,应该使用不同的降糖策略。     

肾移植术后患者的护理体会

肾移植是将异体肾脏移植到患者的体内,使其恢复血液循环并发挥其应有的正常功能。现阶段,同种异体肾脏移植手术已在同内外广泛开展,与血液透析相比,具有提高病人生活质量、长期存活、医疗费用较低等优点。病人在进行肾移植手术后,护士的专业护理对于手术的成败及病人的康复起着极其重要的作用。现对我院2008年6月～2009年10月所实施的85例肾移植手术后病人的护理体会报告如下。     

肾移植术后输尿管梗阻

我院1979-2000年间共施行肾移植术354例次,并发输尿管梗阻10例。现将我院对肾移植术后并发输尿管梗阻的治疗体会报告如下:     

肾移植术后上消化道出血22例

上消化道出血是肾移植术后较严重的并发症之一。我院于 1991～ 2 0 0 0年共施行同种肾移植 711例次 ,发生上消化道出血 2 2例 (3 1% )。1　临床资料1 1　一般情况　 2 2例中 ,男 17例 ,女 5例 ;年龄 2 3～ 62岁。原发病均为慢性肾小球肾炎。术前胃镜检查 15例 ,均示胃粘膜贫血改变 ,其中诊断为慢性浅表性胃炎 12例 ,点状溃疡 3例。术后服用环孢素Ａ、泼尼松加硫唑嘌呤或骁悉三联免疫抑制剂。发生肾功能不良 ,早期行血液透析 9例 ,因排斥反应术后用甲泼尼龙冲击治疗 5例 ,肾移植术后出现外科并发症 7例 ,行 2次手术后发生上消化道出血。术后…     

肾移植术后护理与健康指导

目的总结肾移植术后护理体会及健康指导的作用。方法对4例行同种异体肾移植术病人进行健康教育及精心护理,促进患者术后早日康复。结果通过4例肾移植术后患者进行护理和健康指导,患者术后异常得到及时发现和处理,术后并发症减少,生活质量提高。结论通过积极仔细的术后护理和康复指导,患者术后并发症显著下降,生活质量明显提高,经随访移植器官功能良好,生活质量改善。     

肾移植术后感染的临床分析

目的　为肾移植术后预防并治疗感染提供参考。方法　对我院７ ａ ５３ 例尸体肾移植术后发生１４ 例次感染的临床资料进行分析。结果　感染率２６－４％ （１４／５３） ，病死率１４－２ ％ （２／１４） ，切肾率１４－２ ％ （２／１４） ，主要致病因素为细菌、真菌、病毒，主要感染部位为肺、泌尿道。结论　必须从受体选择、免疫抑制药以及抗生素合理使用等方面预防感染     

肾移植术后并发恶性肿瘤CT诊断二例

肾移植是慢性非肿瘤性肾病、尿毒症的一种可靠治疗手段。影响术后患者生存质量的最常见原因是排斥反应及术后并发症,但并发恶性肿瘤的危险性也不应忽视,现报告２例肾移植术后并发恶性肿瘤,并经手术病理证实,以引起同道注意。例１女,５３岁。因慢性肾盂肾炎、尿毒症作...     

膀胱癌术后肾移植1例

<正> 病人,男,64岁。因膀胱癌术后19年,发现肾功能异常6个月入院。1982年经病理确诊膀胱癌后,在外院行全膀胱切除回肠代膀胱术。术后恢复顺利,随访至今无肿瘤复发。2001年元旦初因回肠造瘘口流出肉眼血尿,无脓尿及米汤样尿液,当时查B超发现“右肾萎缩,右肾盂轻度扩张,左肾盂重度积水,左输尿管未显示”。进一步行“MRI”检查提示“左肾盏、肾盂及中、上段输尿管扩张,下段输尿     

肾移植术后急性肾小管坏死的临床护理

随着医院开展。肾移植外科技术的日益成熟，肾移植被更多的病人所接受，但术后也存在着一些并发症，其中以急性。肾小管坏死最为常见。从1998～2001年以来共行肾移植术共11例，其中术后发生急性。肾小管坏死的共有5例。下面就同种异体。肾移植术后发生的急性肾小管坏死这一并发症的病情观察，心理护理和预防感染等方面，摸索出了一些经验，共大家共同探讨。     

持续肾脏替代疗法在肝移植术后肾功能衰竭中的应用

目的探讨持续肾脏替代疗法对肝移植术后肾功能衰竭的治疗效果。方法将持续肾脏替代疗法应用于7例肝移植术后肾功能衰竭病人,平均治疗36.1h,置换液以前稀释方式输入,流量为2～4L/h,血流量150～250ml/min,采用普通肝素抗凝。结果7例病人中4例好转,2例死亡,1例因经济原因自动出院;所有患者治疗中血流动力学稳定,血BUN及血Cr下降明显,具有显著性差异(P<0.05),但血中胆红素下降不明显(P>005);治疗中未发现明显的副作用。结论持续肾脏替代疗法对肝移植术后肾功能衰竭有改善预后的作用,患者耐受性好,是抢救肝移植术后肾功能衰竭有效手段之一。     

Computed tomography of renal cell carcinoma in patients with terminal renal impairment

Purpose

An increased incidence of renal tumors has been observed in patients with end-stage-renal-disease (ESRD). The very strong association with acquired renal cystic disease (ACRD) and increased incidence of the renal tumors (conventional renal cell carcinoma (CRCC), papillary renal cell carcinoma (PRCC) or papillary renal cell adenoma (PRCA)) was reported. This study discusses the role of computed tomography (CT) in detecting renal tumors in patients with renal impairment: pre-dialysis, those receiving dialysis or with renal allograft transplants.

Materials and methods

Ten patients (nine male, one female) with renal cell tumors were enrolled into a retrospective study; two were new dialysis patients, three on long-term dialysis, and five were renal transplant recipients with history of dialysis. All patients underwent helical CT, a total of 11 procedures were performed. Sixteen-row detector system was used five times, and a 64-row detector system for the six examinations. All patients underwent nephrectomy of kidney with suspected tumor, 15 nephrectomies were performed, and 1 kidney was assessed during autopsy. CT findings were compared with macroscopic and microscopic assessments of the kidney specimen in 16 cases.

Results

Very advanced renal parenchyma atrophy with small cysts corresponding to ESRD was found in nine patients, chronic pyelonephritis in remained one. A spontaneously ruptured tumor was detected incidentally in one case, patient died 2 years later. In the present study, 6.25% (1/16) were multiple PRCA, 12.5% (2/16) were solitary PRCC, 12.5% tumors (2/16) were solitary conventional renal cell carcinomas (CRCC's), 12.5% tumors (2/16) were multiple conventional renal cell carcinomas (CRCC's), 25% (4/16) were CRCC's combined with multiple papillary renal cell carcinomas with adenomas (PRCC's and PRCA's), and 25% (4/16) of the tumors were multiple PRCC's combined with PRCA's without coexisting CRCC's. Bilateral renal tumors were found in our study in 60% (6/10) confirmed in six cases, one kidney left on follow-up due to the small tumors.

Conclusions

With the use of a multi-detector row system, it is possible to detect smaller foci suspected to originate in multiple tumors, especially when up to 3-mm thin multi-planar reconstructions are used. Two cases demonstrated the possibility the development of RCC in impaired kidneys may start before dialysis initiation.     

超声乳化人工晶状体置入术治疗肾移植术后白内障的疗效观察

 目的 观察超声乳化联合人工晶状体置入术治疗肾移植术后白内障的效果。方法 采用回顾性病例对照研究。肾移植术后白内障患者(观察组)23例30只眼,以及同期就诊的单纯年龄相关性白内障患者(对照组)26例33只眼,两组患者性别、年龄匹配,均行超声乳化联合人工晶状体植入手术。全部患者术前、术后进行眼科检查包括矫正视力、眼压测定、裂隙灯检查、间接检眼镜眼底检查及光学相干断层成像(OCT)。术前检测角膜内皮细胞计数。术后4周检查泪膜破裂时间(BUT),并行干眼主观症状评分。结果 肾移植术后患者行白内障手术者占2.3%,其中后囊下白内障(PSC)多见,发生率为65.2%。观察组患者术前眼压高于对照组(P=0.017),术后视力检查显示观察组患者治疗后1周、4周时的矫正视力与对照组无统计学差异(P＞0.05),两组手术并发症发生率无统计学差异(P＞0.05)。但观察组术后泪膜破裂时间(BUT)明显短于对照组(P=0.000),术后干眼主观症状的评分明显高于对照组(P= 0.002)。结论 肾移植术后白内障患者,行超声乳化及人工晶状体置入术治疗安全有效,术后视力恢复良好,但术后干眼症状较重。     

肾移植术后环孢素A肝毒性防治回顾性分析

目的 分析肾移植术后环孢素A（CsA）及普乐可复（FK506）等免疫抑制剂的肝毒性以及防治措施。方法分析346例肾移植患者术后90天内静脉血谷丙转氨酶（ALT）、谷草转氨酶（AST）、总胆红素（BILJ）、直接胆红素（BILD）含量,判定患者肝功能状况;以及相应的治疗措施及其效果,综合判定治疗措施的合理性。结果 CsA组肝功能异常发生率为26．90％,术后两周ALT、AST和BILD明显升高（P〈0．01）,BILT升高（P〈0．05）;FK506组肝功能异常发生率为7．14％,ALT、AST、BILT和BILD略升高（P〉0．05）;骁悉（肿）和布累迪宁（MRZ）组肝功能异常发生率无明显区别。18例转换FK506 1周后,ALT、AST、BILT和BILD均明显降低（P〈0．01）。结论 CsA肝毒性为肾移植术后常见并发症,FK506肝毒性明显低于CsA;密切检测CsA浓度以及依据CsA浓度下限用药是预防肝毒性的关键;对于严重肝功能障碍患者,转换FK506是有效的治疗途径。     

肾移植术后受者血清中肝肾功能指标动态监测的临床意义

 目的 探讨肾移植术后受者肝、肾功能各指标的动态变化及其临床意义。方法 应用日立7600生化全自动分析仪对受者术后1、3、5、7 d,1、2、3周血清中的肝肾功能指标进行动态监测,比较肾功能恢复稳定组(A组)与肾功能恢复不良组(B组)各指标的差异。结果 (1) B组术后1 d 尿素氮(BUN)水平高于A组(P＜0.05),A组在5 d后持续下降,B组在2周内下降,3周反弹时水平约为A组的两倍(P<0.01);(2)术后1 d B组肌酐(CR)水平约为A组1.5倍,A组呈递减趋势;B组水平出现反弹,3周时B组水平约为A组的3倍(P<0.01);(3)两组术后胱抑素C(CYSC) 水平在1 d时无统计学差异,A组呈下降趋势,B组在3 d后出现持续反弹,到3周时超过术后1 d的水平,约为A组的2.5倍(P<0.01);(4)两组转氨酶水平均在正常参考范围内,同组谷草转氨酶(AST)、谷丙转氨酶(ALT)变化极其相似,A组总胆汁酸(TBA)呈缓慢上升趋势,B组的改变无规律;(5)超敏C反应蛋白(HS-CRP)3周内两组水平无统计学差异(P>0.05)。结论 为正确评估受者肾功能,建议以CYSC替代BUN、CR,联合检测受者血清中TBA、CRP更能全面地反映肝功能的状态。     

Contrast enhanced MR angiography with parallel imaging in the early period after renal transplantation

Purpose

To evaluate renal allograft vessels in the early period after kidney transplantation with three‐dimensional (3D) contrast‐enhanced MR angiography (3D CE MRA) using a parallel imaging technique.

Materials and Methods

Sixty‐three consecutive patients were examined with 3D CE MRA and integrated SENSE technique (Sensitivity Encoding) 2 to 21 days after renal transplantation. MR angiography studies were analyzed for the presence of arterial stenosis. The degree of renal transplant artery stenosis was graded qualitatively as <50% = mild, 50–70% = moderate, 70–99% = severe, and occlusion. Four patients (6.3%) with moderate (n = 1) or severe (n = 3) arterial stenoses on CE MRA underwent selective intra‐arterial digital subtraction angiography. In two patients, selective intravenous digital subtraction angiography (DSA) was performed.

Results

Twenty‐seven (42.9%) of the 63 patients had normal CE MR angiograms, 29 (46%) showed mild, 3 patients (4.8%) moderate, and 4 patients (6.3%) severe stenoses of the donor artery. In three patients, the severe stenosis of the graft artery was confirmed by surgery or intra‐arterial DSA. One patient with suspicion of severe arterial stenosis on MRA had moderate vessel narrowing on DSA. Twelve months after kidney transplantation, serum creatinine levels were not significantly different in patients with mild and moderate stenoses from those without (P > 0.19) but significantly different from those with severe stenoses (P < 0.05).

Conclusion

The incidence of mild and moderate vessel narrowing at the arterial anastomosis is unexpectedly high in the early period after kidney transplantation and is most likely due to surgery‐related tissue edema. J. Magn. Reson. Imaging 2009;29:909–916. © 2009 Wiley‐Liss, Inc.     

Bilateral asymmetry in the gait deviation index in school-aged children with the trait of developmental coordination disorder

BackgroundAlthough previous studies have identified asymmetry in gait parameters in children with developmental coordination disorder (DCD), they have not investigated whether these findings coexist with asymmetry in gait quality, as represented by the gait deviation index (GDI).Research questionThis study sought to measure gait symmetry in children with traits of DCD (DCD trait) to elucidate the characteristic gait pattern.MethodsThis study included 172 (82 girls, 90 boys) participants with and without DCD trait (age: 6–12 years), as assessed using the Japanese version of the Developmental Coordination Disorder Questionnaire (DCDQ-J), which consists of three subscales. Three-dimensional gait analysis data were obtained during the gait trials. GDI, step length, and step time data were recorded for both the right and left legs, and symmetry ratios were calculated.ResultsParticipants in the DCD trait group (n = 30) had a significantly lower GDI score (p < 0.0001) and a higher GDI symmetry ratio (p = 0.004) than typically developing children. Furthermore, DCD trait was related to the GDI symmetry ratio (odds ratio, 1.2; p = 0.001; 95 % confidence interval, 1.062–1.289). The control during movement, which was a DCDQ-J subscale, was negatively correlated with the GDI symmetry ratio (r=-0.257, p<0.001).SignificanceThis study’s results lend support to the hypothesis that an increase in the GDI symmetry ratio is associated with the DCD trait. A quantitative assessment of gait performance is important to help identify gait asymmetry, including gait quality, in children with a DCD trait. Children with a DCD trait have a poor ability to control the interaction of lower leg movements, which may cause bilateral asymmetry in gait quality.     

The osseous and dental changes of patients with chronic renal failure by CBCT

Objectives:

The aim of the present study was to evaluate the osseous changes of the jaws of patients with chronic renal failure (CRF) by CBCT.

Methods:

On CBCT scans obtained from 15 patients with CRF and 15 control patients (7 males and 8 females), the mean was calculated for the antegonial index (AI), mental index (MI), panoramic mandibular index (PMI) and mandibular cortical index (MCI). The MI, AI and PMI, pulp chamber size, number of teeth with pulp calcification and lamina dura loss were compared using the paired t-test, and the MCI values were analysed using the χ² test.

Results:

There were no statistically significant differences in the PMI, MI and AI values in patients with CRF and the control group. With regard to MCI, the cortical margins of the mandible were more porous in patients with CRF than in the control group, and also soft-tissue calcifications, lamina dura loss and radiolucent defects were more common in patients with CRF. There were no statistically significant differences in pulp chamber size and pulp calcifications between patients with CRF and the control group.

Conclusions:

Radiographic changes in the jawbones of patients with CRF may be commonly seen. CBCT is a valuable diagnostic tool for the evaluation of osseous findings, pulp chamber, soft-tissue calcifications and MCIs and allows indices measurement in three dimensions without any superposition.     

右美托咪啶对活体亲属供肾者术后肾功能的影响

 目的 探讨右美托咪啶对活体亲属供肾者术后肾功能的影响。方法 选择2015-01至2017-12择期亲属供肾术者40例,随机分为右美托咪啶组和对照组,各20例。右美托咪啶组供肾者麻醉诱导前10~15 min静脉泵入右美托咪啶1 μg/kg,继以0.5 μg/(kg·h)维持,手术结束前30 min停药;对照组供肾者按右美托咪啶组静脉泵入等量的生理盐水。于麻醉诱导前(T₁)、术毕即刻(T₂)、术后24 h(T₃)、术后48 h(T₄)采血检测TNFα、IL-6和IL-10的浓度。监测术前、术后24 h及48 h血清尿素氮(BUN)及肌酐(Cr)浓度。结果 右美托咪啶组较对照组术后24 h和48 h血清BUN[24 h, (6.41±1.23) mmol/L vs (9.24±1.25) mmol/L; 48 h, (6.62±1.30) mmol/L vs (8.41±2.4) mmol/L]和Cr[24 h, (98.2±4.7) μmol/L vs (111.4±5.1) μmol/L; 48 h, (104.4±6.2) μmol/L vs (119.5±8.2) μmol/L]明显降低(P<0.05)。T₂-T₄时右美托咪啶组与对照组比较,血清TNF-α和IL-6浓度均明显降低,而IL-10的浓度明显增高(P<0.05)。结论 一定剂量的右美托咪啶对活体亲属供肾者手术后早期具有肾功能保护作用。     

心血管疾病住院患者饮食生糖负荷和糖类、脂肪及蛋白质摄入量的研究

目的研究成年心血管疾病住院患者饮食生糖负荷情况及与代谢性疾病发病相关性,了解成年心血管疾病住院患者能量和糖类、脂肪及蛋白质生热营养素摄入情况。方法采用膳食回顾法估算118例成年心血管疾病住院患者的总能量及三大营养素的摄入量,根据食物血糖生成指数（glycemic index,GI）和糖类摄入量计算饮食生糖负荷（glycemic load,GL）。分析住院患者饮食GL的性别和年龄分布,分析不同饮食水平患者的膳食结构。结果成年心血管疾病住院患者每日膳食GL平均为256.7,老年患者平均为222.0,中、青年患者平均为278.6,中、青年患者高于老年患者。低膳食GL的患者膳食糖类供能比低,脂肪供能比高,谷薯类摄入低,脂肪摄入高,超重和肥胖发生率高。结论低膳食GL的患者粮谷类消费过低,脂肪消费过高,膳食结构不合理,以此作为患者的住院及家用饮食指导的依据,从而提供平衡、合理的膳食结构。