危重患者连续静脉-静脉血液滤过治疗中滤液蛋白丢失

目的 探讨危重患者连续静脉-静脉血液滤过治疗(CVVH)中滤液蛋白丢失及其主要影响因素.方法 对2008年9月至2009年9月收治的18例脓毒症或重症急性胰腺炎合并急性肾功能衰竭患者的临床资料进行分析.其中男性12例,女性6例,平均年龄45岁(39～62岁),均行24 h CVVH.置换液流速4000 mL/h,跨膜压(TMP)、血流量和超滤率分别为(173±48)mm Hg(1 mmHg=0.133 kPa)、(277±89)ml/h、(179±4)ml/min.采集滤前和滤后血液,连续收集24 h滤液,测定血浆和滤液总蛋白浓度,计算滤液蛋白丢失量并进行统计学分析.结果 滤液蛋白平均浓度(231±67)mg/L,滤液蛋白丢失量(22±6)g/d.CVVH治疗前后血浆蛋白水平差异无统计学意义[(56±6)g/L比(55±10)g/L,P＞0.05].滤液蛋白浓度和m浆蛋白平均浓度之间存在较弱相关性(r=0.481,P＜0.05),和TMP之间存在显著相关性(r=0.564,P＜0.01),多元逐步回归分析表明TMP和血浆蛋白浓度是影响滤液蛋白丢失的主要因素.结论 CVVH除了肾脏替代治疗作用外,也会引起血浆蛋白质经滤器丢失,其中,TMP和血浆蛋白浓度是影响滤液蛋白丢失的主要因素.在对接受CVVH治疗的危重患者制定营养方案时,必须考虑经滤器额外丢失的蛋白质.     

连续性静脉-静脉血液滤过对多器官功能障碍综合征患者血浆细胞因子水平的影响

目的观察连续性静脉．静脉血液滤过（CVVH）对多器官功能障碍综合征（MODS）患者血浆细胞因子TNF-α、IL-1、IL-6、IL-8水平的影响。方法选择MODS患者22例,行CVVH治疗,取治疗前后动脉血做血气分析,取静脉血和滤出液检测有关细胞因子水平。在开始行CVVH前及CVVH治疗后1h．4h、8h分别测量心率和平均动脉压。结果22例患者CVVH治疗后血浆TNF-α、IL-1水平明显下降（P〈0．05）。超滤液中未检出TNF-α,但有较高浓度的IL-1、IL-6和IL-8。与CVVH前比较,患者心率显著下降（P〈0．05）,平均动脉压和氧合指数明显升高（P〈0．05）。CVVH治疗后患者的APACHEⅡ评分显著下降,其下降与置换液速度呈正相关。死亡患者置换液速度与存活患者置换液速度有显著差异（P〈0．05）。能够被CVVH有效清除的细胞因子与置换液速度呈正相关（P〈0．05）。结论CVVH可清除MODS患者血浆中部分细胞因子,并可改善患者血流动力学及氧合功能。加大置换液速度能更好地清除外周血细胞因子,并改善预后。     

持续缓慢低效血液透析和连续静脉静脉血液滤过的对照研究

目的比较单次持续缓慢低效血液透析(SLED)和连续静脉静脉血液滤过(CVVH) 对重症急、慢性肾衰竭(ARF、CRF)患者的疗效及其血流动力学变化。方法14例重症ARF、CRF患者随机接受SLED、CVVH治疗各10 h。测定治疗前后血电解质、肾功能、白介素6(IL-6)、β2微球蛋白(β2-MG)水平,治疗后1 h BUN、置换液和透出液尿素氮水平。计算溶质清除指数(SRI)、IL-6下降率、β2-MG下降率、血磷下降率。记录超滤量和治疗中血压等临床指标变化。结果14例患者均无失衡反应及严重低血压发生,无电解质紊乱,无血液净化相关性死亡。CVVH组:平均超滤量(3.30±1.95)L,SRI为(39.97±15.29)%,IL-6的下降率为(-22.81±85.30)%; β2-MG下降率为(35.01±24.83)%,血磷下降率为(24.40±23.20)%。SLED组:平均超滤量(5.40±2.96)L,明显高于CVVH组(P<0.05);一过性低血压发生率5/14,与CVVH组无显著性差异(P>0.05);SRI为(72.27±9.71)%,比CVVH组明显升高(P<0.01);IL-6下降率为(-32.86±63.68)%,与CVVH组比较无显著性差异(P>0.05);β2-MG下降率为(39.97±15.29)%,与CVVH 组比较无显著性差异(P>0.05);血磷下降率为(49.23±18.61)%,明显高于CVVH组(P<0.01)。结论SLED血流动力学稳定,对低分子毒素的清除较CVVH组高。SLED是治疗重症ARF、CRF的一种有效     

连续性肾脏替代治疗对心脏外科术后患者血磷水平的影响

目的观察连续性肾脏替代治疗(CRRT)对心脏外科术后患者血磷水平的影响。方法回顾性分析2013年2月至2014年1月在中国医科大学附属第一医院心脏外科术后行CRRT治疗30例患者的临床资料,其中男14例、女16例,年龄37~79(57.0±10.8)岁。16例应用连续性静脉-静脉血液滤过(CVVH)模式,14例应用连续性静脉-静脉血液透析滤过(CVVHDF)模式。在治疗开始前、治疗后24 h、48 h、补充磷剂后24 h 4个时间点抽取静脉血测定血磷水平。结果 CRRT治疗后24 h和48 h血磷水平较治疗前显著下降[(0.6±0.4)mmol/L vs.(0.4±0.2)mmol/L vs.(1.1±0.3)mmol/L,P0.01]。24 h后66.7%的患者存在低磷血症,予以补磷治疗后,血磷水平有所上升[(0.6±0.3)mmol/L,P0.01]。CVVH模式和CVVHDF模式下血磷水平差异无统计学意义(P0.05)。结论 CRRT治疗能导致低磷血症,且CRRT治疗时间越长,血磷浓度越低。适当的补磷治疗是必要的,同时应动态监测血磷水平,依据其变化行个体化治疗。     

连续性静脉-静脉血液滤过治疗终末期肾病伴难治性心力衰竭的临床体会

目的：观察应用连续性静脉-静脉血液滤过（CVVH）治疗终末期肾病（ESRD）伴难治性心力衰竭患者的临床疗效。方法：对我院2006年--2008年期间进行CVVH治疗的27例ESRD伴难治性心力衰竭患者的资料进行分析,观察患者在CVVH治疗前后血生化（尿素氮、肌酐、钠、钾）、动脉血气分析、呼吸、心率、血压及临床症状体征变化,记录APACHEⅡ评分。结果：24例患者心功能明显改善,有效率89．9％。CVVH治疗后血压平稳,心率、呼吸有稳定下降,未出现透析失衡表现,APACHEⅡ评分明显降低;尿素氮、肌酐水平显著下降,酸中毒纠正;糖尿病组与非糖尿病组治疗前APACHEⅡ评分相似,但尿素氮、肌酐水平明显低于非糖尿病组。结论：CVVH能平稳清除水分、溶质及部分细胞因子,改善心功能,稳定血流动力学,是ESRD伴难治性心力衰竭患者安全有效的治疗方法。     

连续性静脉-静脉血液滤过对尿毒症脑病的疗效观察

目的:探讨连续性静脉-静脉血液滤过(CVVH)对慢性肾衰竭(CRF)合并尿毒症脑病(UE)患者的血液动力学、电解质、溶质清除方面的影响,并评价其治疗效果。方法:30例次CRF并发UE的患者,接受CVVH治疗。观察治疗前和治疗中、治疗后患者的心率、平均动脉压(MAP)以及意识情况和患者的APACHEⅡ评分、Glasgow评分;测定治疗前、后的肾功能、电解质及血浆渗透压。结果:(1)CVVH治疗前后MAP、心率及渗透压变化无统计学差异(P>0.05);(2)CVVH治疗后意识明显改善,尿毒症症状明显缓解;(3)CVVH治疗后患者APACHEⅡ评分较治疗前有明显降低的趋势,Glasgow评分明显好转(P<0.05);(4)CVVH治疗后BUN、Scr清除好,电解质、酸碱紊乱得以纠正(P<0.05)。结论:CVVH具有稳定的血流动力学,缓慢、持续、稳定清除尿毒症毒素和纠正电解质和酸碱失衡,对心血管系统和血脑屏障的干扰小,病人的耐受性好,有助于尿毒症脑病的治疗。     

连续性静-静脉血液滤过治疗多器官功能障碍综合征伴高血钾患者的护理

目的 探讨无钾置换液用于连续性静一静脉血液滤过(CVVH)治疗多器官功能障碍综合征(MODS)伴高血钾的护理要点.方法 对10例MODS伴高血钾患者采用无钾置换液行CVVH治疗,治疗期间加强血管通路的护理、液体平衡的管理、监测生命体征等护理.结果 患者接受CVVH治疗5～6次,平均治疗时间6～12 h.10例均在首次治疗2 h后血清钾浓度下降,6 h后血清钾降至(4.76±0.41)mmol/L;且心律失常消失,恢复正常窦性心律.治疗后9例预后良好,1例死亡.结论 应用无钾置换液行CV-VH治疗MODS伴高血钾患者疗效较好,治疗中密切观察病情变化并做好相应护理,可保障治疗顺利有效地进行.     

连续性静脉-静脉血液滤过对内毒素休克羊血液动力学和炎性介质的影响

目的观察连续性静脉.静脉血液滤过(CVVH)对内毒素休克血液动力学和炎性介质的影响。方法 雄性绵羊12只,随机分为两组。对照组(A组,n=6),内毒素以1 mg·kg-1静脉泵注,30min内完成,同时静脉输注林格液15 ml·kg-1·h-1,持续6 h;血滤组(B组,n=6),于开始泵注内毒素后1 h给予CVVH治疗5 h,其余处理同A组。所有动物均给予气管插管、镇静、肌松、控制呼吸,行有创血液动力学监测;两组分别于内毒素泵注前(T0)、开始泵注后30、60、90、120、210、360 min(T1～T6)采静脉血及超滤液4ml,测定血浆及超滤液中内毒素、TNF-α、IL-6、IL-10的浓度。结果 血滤组CVVH治疗后(T1-T6)平均动脉压及体循环阻力指数明显上升、心率显著性下降。TNF-α于泵注内毒素后(T1-T6)两组均显著性增高,血滤组于CVVH治疗60 min(T4)时较治疗前(T2)虽无明显改变,但明显低于同时点对照组(P<0.01),CVVH治疗150～300 min(T5-T6)时TNF-α浓度较对照组及治疗前(T2)均显著性降低(P<0.05);IL-10虽呈增高趋势,但较治疗前和对照组无显著性变化;而两组IL-6水平则无明显差异。超滤液中可检测到TNF-α、IL-6、IL-10。结论 血滤治疗有利于纠正促炎细胞因子过度释放和抗炎细胞因子失衡,改善内毒素休克血液动力学。     

低剂量雷米普利对2型糖尿病肾病患者尿蛋白的影响

目的:观察雷米普利(ramipril)对不同时期2型糖尿病肾病患者尿蛋白及肾功能的影响.方法:选择2型糖尿病肾病患者90例,年龄42岁～76岁.分为治疗组54例,对照组36例.两组患者均根据尿蛋白和肾功能的不同再分为早期肾病组、临床期肾功能正常组和临床期肾功能不全组.治疗组给予口服雷米普利(2.5 mg/d),连续应用12周.对照组不予上述治疗.结果:与对照组比较,治疗组患者尿总蛋白和尿白蛋白明显降低,其中2型糖尿病早期肾病组尿总蛋白由治疗前的(0.34±0.11)g/24 h下降到(0.24±0.09)g/24 h(P＜0.01),尿白蛋白由(199±50)g/24 h下降到(148±35)g/24 h(P＜0.01);临床期肾功能正常组尿总蛋白由治疗前的(2.15±1.01)g/24 h下降到(1.66±0.86)g/24 h(P＜0.01);临床期肾功能不全组尿总蛋白由治疗前的(1.93±0.91)g/24 h下降到(1.68±0.81)g/24 h(P＜0.05).结论:应用雷米普利对不同时期的2型糖尿病肾病患者均有减少尿蛋白的作用,且早期应用效果尤佳.     

血浆置换联合连续性血液滤过治疗急性呼吸窘迫综合征的临床观察

目的 研究血浆置换(plasma exclrange,PE)联合连续性静脉-静脉血液滤过(continuous venous-venous hemofiltIlation,CVVH)治疗急性呼吸窘迫综合征(acute respitatory distresssyndrome ARDS)的疗效.方法 20例急性呼吸窘迫综合征患者除经内科常规治疗外,行PE联合CVVH,连续测定心率、平均动脉压(MAP)、中心静脉压(CVP),血pH、动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2),氧合指数(PaO2/FiO2)、肺动态顺应性(Cdyn)、气道阻力(Raw),同时抽取静脉血测定C反应蛋白(C-reactive protein,CRP)的浓度.并进行ICU监护的结果记录以APAcHE Ⅱ评分及SIRS评分判断患者病情的变化.结果 治疗过程中患者血流动力学稳定,血浆置换前后及CVVH治疗前与治疗后相比心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)、血PH、动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)、氧合指数(PaO2/FiO2)、肺动态顺应性(Cdyn)明显升高,气道阻力(Raw)明显下降(P＜0.05),血浆置换后C反应蛋白浓度明显下降(P＜0.05),CVVH治疗前与治疗后相比APACHE Ⅱ评分及SIRS评分差异显著(P＜0.05).结论 PE联合CVVH治疗可显著改善急性呼吸窘迫综合征患者的临床症状,有效改善急性呼吸窘迫综合征的预后.     

Prevention of tumor lysis syndrome using continuous veno-venous hemofiltration

Tumor lysis syndrome (TLS) and renal failure remain significant causes of morbidity and mortality in children with newly diagnosed Burkitt's lymphoma and high white blood cell count acute lymphocytic leukemia (ALL) despite conventional management with aggressive hydration, alkalinization, allopurinol, and the slow introduction of chemotherapy. A subgroup of patients at very high risk for TLS and renal failure can be identified based on the level of serum lactate dehydrogenase (LDH) and urine output. We evaluated the prospective use of continous veno-venous hemofiltration (CVVH), in addition to conventional management to prevent renal failure from tumor lysis, in three children with advanced abdominal Burkitt's lymphoma and in two children with high white blood cell count T-cel ALL who were at very high risk based on LDH and urine output. In this cohort of very highrisk patients, the LDH ratio (value at diagnosis/upper limit of normal) ranged from 0.88 to 10.3 and urine output from 0.13 to 4.7 ml/kg per hour. CVVH was begun at a mean time of 10.5 h before chemotherapy was initiated. Full-dose induction chemotherapy was begun within 24 h of diagnosis. After beginning CVVH, the uric acid levels decreased 46% prior to beginning chemotherapy and decreased to a mean of 4.2 mg/dl 24 h after chemotherapy was initiated. Four of the five patients had either no change or a drop in the serum creatinine. In patient one, blood urea nitrogen peaked at 58 mg/dl, and the creatinine at 4.7 mg/dl 6 days after beginning chemotherapy with a subsequent return to normal. Asymptomatic hypokalemia developed in all patients. After beginning chemotherapy, CVVH was continued for a mean of 85 h (range 70–91 h). No patient had complications secondary to CVVH. In summary, CVVH prevented renal failure secondary to TLS in 80% of these very high-risk patients. In the fifth patient, CVVH allowed full-dose chemotherapy to continue. The prospective use of CVVH could potentially decrease the morbidity and mortality associated with induction chemotherapy in very high-risk patients with a large tumor burden.     

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??Effect of continuous veno-venous hemofiltration on the plasma levels of endotoxin and cytokine in patients with severe intra-abdominal infection YANG Fan, ZHAO Yun-zhao, CHEN Yu, et al. Research Institute of General Surgery, Clinical School of Medical College, Nanjing University; Nanjing General Hospital of Nanjing Military Command, PLA, Nanjing 210002 China
Corresponding author ??ZHAO Yun-zhao, E-mail??yzzhaomd@gmail.com
Abstract Objective To investigate the clearance effect of continuous veno-venous hemofiltration??CVVH??on plasma endotoxin and cytokine in patients with severe intra-abdominal infection, and evaluate its clear ability and influence factors on endotoxin and cytokine in patients with severe intra-abdominal infection. Methods Twenty-one patients with severe intra-abdominal infection in ICU were enrolled for the CVVH treatment carried out between September 2010 and September 2011 in Nanjing General Hospital of Nanjing Military Command to observe the plasma changes of endotoxin, TNF-α, IL-10 during the treatment in 72h. The patients were divided into two groups: the filters were replaced every 24h group (n=10) and the control group (n=11). Results Plasma endotoxin and TNF-αdecreased significantly at 24h after CVVH treatment (P??0.05). Yet, the level of IL-10 began to decrease at 48h after CVVH treatment. The plasma endotoxin maintained on low level at 48h and 72h after CVVH treatment in the observation group compared with the control group(P??0.05). Conclusion Plasma endotoxin and cytokines (TNF-α, IL-10) can be removed effectively with CVVH in patients with severe intra-abdominal infection. CVVH has a positive effect on accelerate the removal of the plasma endotoxin and maintain a low level when replace the filter every 24 hours.     

连续性静脉-静脉血液滤过在腹部肿瘤术后急性肾功能衰竭中的应用

目的 探讨连续性静脉-静脉血液滤过在腹部肿瘤手术后急性肾功能衰竭中应用的临床意义.方法 对31例腹部肿瘤术后急性肾功能衰竭患者采用连续性静脉-静脉血液滤过治疗,比较治疗前、后电解质、血肌酐、尿素氮以及动脉血气分析的变化.结果 31例患者中30例存活,1例死亡.存活患者经连续性静脉-静脉血液滤过后血尿素氨和肌酐均逐渐下降直至恢复正常;经连续性静脉.静脉血液滤过后4～5 h血钾可降至正常范围;酸中毒得到纠正、动脉血氧分压明显升高,尿量分别于连续性静脉-静脉血液滤过后5～20 d恢复正常,所有患者经连续性静脉-静脉血液滤过后水肿得到明显改善.结论 连续性静脉-静脉血液滤过是治疗腹部肿瘤术后急性肾功能衰竭的一种有教、方便而安全的方法.     

连续性静脉-静脉血液滤过在腹部肿瘤术后急性肾功能衰竭中的应用

目的 探讨连续性静脉-静脉血液滤过在腹部肿瘤手术后急性肾功能衰竭中应用的临床意义.方法 对31例腹部肿瘤术后急性肾功能衰竭患者采用连续性静脉-静脉血液滤过治疗,比较治疗前、后电解质、血肌酐、尿素氮以及动脉血气分析的变化.结果 31例患者中30例存活,1例死亡.存活患者经连续性静脉-静脉血液滤过后血尿素氨和肌酐均逐渐下降直至恢复正常;经连续性静脉.静脉血液滤过后4～5 h血钾可降至正常范围;酸中毒得到纠正、动脉血氧分压明显升高,尿量分别于连续性静脉-静脉血液滤过后5～20 d恢复正常,所有患者经连续性静脉-静脉血液滤过后水肿得到明显改善.结论 连续性静脉-静脉血液滤过是治疗腹部肿瘤术后急性肾功能衰竭的一种有教、方便而安全的方法.     

不同剂量血液滤过对内毒素休克猪生存时间和细胞因子水平的影响

目的 探讨不同剂量连续性血液滤过（CVVH）对细胞因子的清除作用以及对血浆细胞因子水平的影响。 方法 采用静脉注射内毒素（E.coli O111: B4,15.7 μg/kg）的方法诱导内毒素休克猪模型。将内毒素休克猪按随机数字表法分为对照组(n=6)、 CVVH组 (n=6,前稀释法,等于后稀释法的45 ml·kg-1·h-1）和高容量血液滤过（HVHF）组 (n=6,前稀释法,等于后稀释法的70 ml·kg-1·h-1）。于造模前（基线）、成模时（T0）,成模后1 h（T1）、6 h（T6）、12 h（T12）、24 h（T24）分别测定血浆肿瘤坏死因子α（TNF-α）、白细胞介素（IL）6、IL-10和IL-18水平。 结果 对照组动物平均生存时间为（15.4±5.2） h;CVVH 组为(21.4±7.1) h;HVHF组为（22.4±6.7） h,CVVH组和HVHF组的生存时间显著高于对照组（均P < 0.05）。3组动物的心率（HR）、平均动脉压（MAP）、中心静脉压（CVP）和心排出量（CO）之间差异无统计学意义（P > 0.05）。内毒素休克猪成模后出现BUN和Scr的进行性升高,两治疗组的BUN和Scr水平显著低于对照组（P < 0.05）,但两者之间差异无统计学意义（P > 0.05）。对照组TNF-α和IL-6水平在T1时达高峰,IL-10水平在T0时最高,随后不断下降。IL-18水平在成模后上升,后无明显变化。CVVH组血浆IL-10（T6、T12、T24）水平低于对照组（P < 0.05）。HVHF组TNF-α（T6）和IL-10（T6、T12、T24）水平低于对照组和CVVH组（P < 0.05）,3组的IL-6和IL-18水平差异无统计学意义,IL-6（T6、T12）水平和动物生存时间呈负相关（P < 0.05）。 结论 CVVH和HVHF治疗均能显著延长内毒素休克猪的生存时间。CVVH能有效清除IL-10;HVHF治疗能清除TNF-α和IL-10;但CVVH和HVHF对IL-6和IL-18水平无明显影响;CVVH和HVHF均能有效清除BUN和Scr。IL-6水平是预测内毒素休克预后的独立指标。     

The nutritional/metabolic and hormonal effects of 8 weeks of continuous ambulatory peritoneal dialysis with a 1% amino acid solution

Circulating intermediary metabolites, hormones and plasma amino acids (AA) were measured at intervals over 24 hours in seven non-diabetic patients with chronic renal failure treated by continuous ambulatory peritoneal dialysis (CAPD), before and after an 8-week period during which a 1% amino acid dialysis solution replaced two of the four dextrose exchanges. Mean 24-hour concentrations of plasma total and essential amino acid were higher following the AA dialysate (total pre: 2893 +/- 185; total post: 3357 +/- 244; p less than 0.05; essential pre: 751 +/- 47; essential post: 1064 +/- 57 mumol/l; p less than 0.001). Mean 24-hour concentrations of the branched chain amino acids leucine, isoleucine and valine were higher following the AA dialysate (valine pre: 201 +/- 18; valine post: 321 +/- 19; p less than 0.001; leucine pre: 102 +/- 6; leucine post: 127 +/- 9; p less than 0.01; isoleucine pre: 67 +/- 5; isoleucine post: 85 +/- 7 mumol/l; p less than 0.05). Serum albumin increased with use of the AA dialysate (pre: 36 +/- 1; 2 weeks, 40 +/- 1; 4 weeks, 40 +/- 1; 6 weeks, 41 +/- 1; 8 weeks, 38 +/- 2 g/l). 24-hour profiles and mean 24-hour concentrations of blood glucose, serum insulin, serum triglyceride, plasma non-esterified fatty acids (NEFA), plasma 3-hydroxybutyrate and plasma alanine were unchanged after the AA period. Plasma bicarbonate decreased with use of the amino acid solution (pre: 21 +/- 1; 2 weeks, 18 +/- 1; 4 weeks, 18 +/- 1; 6 weeks, 16 +/- 1; 8 weeks, 16 +/- 1 mmol/l). Use of a 1% amino acid solution over an 8-week period in CAPD patients improves the plasma amino acid profile but results in a metabolic acidosis. The other endocrine and metabolic abnormalities of uremia remain unchanged.     

Amino Acid Metabolism in Acute Renal Failure: Influence of Intravenous Essential L-Amino Acid Hyperalimentation Therapy

A solution of 8 essential I-amino acids and hypertonic dextrose was administered to 5 patients in acute postoperative renal failure in a program of hyperalimentation designed to decrease the patient's catabolic state and to accrue certain metabolic benefits. A sixth patient receiving intravenous glucose alone served as a control. The pretreatment plasma concentrations of amino acids in all 6 patients did not differ significantly from normal; following intravenous essential amino acids at a dose of approximately 12.6 gm/24 hours, no significant elevations out of the normal range of these substances occurred. Since urinary excretion rates did not dramatically increase, urinary loss was excluded as a possible cause for the failure of increase of plasma concentrations. The results suggest that the administration of an intravenous solution of 1-amino acids and hypertonic dextrose is associated with rapid clearance from the blood of these substances and, with a failure of increased urinary excretion, indirect evidence of amino acid utilization for protein synthesis has been obtained. Histidine supplementation in patients with acute renal failure is probably unnecessary based on the lack of significant decreases in histidine concentrations in these patients.     

连续性静脉-静脉血液滤过在腹部肿瘤术后急性肾功能衰竭中的应用

目的 探讨连续性静脉-静脉血液滤过在腹部肿瘤手术后急性肾功能衰竭中应用的临床意义.方法 对31例腹部肿瘤术后急性肾功能衰竭患者采用连续性静脉-静脉血液滤过治疗,比较治疗前、后电解质、血肌酐、尿素氮以及动脉血气分析的变化.结果 31例患者中30例存活,1例死亡.存活患者经连续性静脉-静脉血液滤过后血尿素氨和肌酐均逐渐下降直至恢复正常;经连续性静脉.静脉血液滤过后4～5 h血钾可降至正常范围;酸中毒得到纠正、动脉血氧分压明显升高,尿量分别于连续性静脉-静脉血液滤过后5～20 d恢复正常,所有患者经连续性静脉-静脉血液滤过后水肿得到明显改善.结论 连续性静脉-静脉血液滤过是治疗腹部肿瘤术后急性肾功能衰竭的一种有教、方便而安全的方法.     

Blood-brain barrier derangement in sepsis: Cause of septic encephalopathy?

Patients with sepsis often manifest disorientation, somnolence, asterixis and coma, symptoms also seen in portasystemic encephalopathy. Altered plasma concentrations of the neutral amino acids and increased blood-brain transport of these acids may play a role in portasystemic encephalopathy. Plasma amino acids and blood-brain barrier transport of neutral amino acids were investigated in a rat model of abdominal sepsis, cecal ligation and puncture. The blood-brain transport was studied by the technique of Oldendorf with carbon-14-amino acids 12 and 24 hours after the induction of sepsis. In similar groups of animals, isolation of brain capillaries was carried out by the technique of Hjelle and the capillaries were incubated with carbon-14-amino acids to study transport activity.Plasma and brain amino acids were deranged in a fashion similar to the derangements seen in portasystemic encephalopathy, with a decrease in plasma branched chain amino acids and an increase in most neutral amino acids in brain. The changes were most pronounced after 24 hours. The brain uptake of several neutral amino acids was increased in the septic rats, while the uptake of lysine, a basic amino acid, was normal. In the brain capillaries isolated from septic rats, tyrosine and leucine transport was also greater than in sham-operated animals.Elevated neutral amino acids may play a role in the encephalopathy encountered in septic patients similar to its role in patients with portasystemic encephalopathy, as similar mechanisms appear to be operating.