慢性肾功能不全患者血尿渗透压及血清肌酐与肾功能…

检测了７５例慢性肾功能不全患者血浆渗透压（Ｐｏｓｍ）、尿渗透压（Ｕｏｓｍ）、Ｕｏｓｍ／Ｐｏｓｍ比值和血肌酐（ＳＣｒ）变化，结果：７５例患者均有Ｐｏｓｍ和ＳＣｒ升高（Ｐ〈０．０５￣０．００１）、Ｕｏｓｍ和Ｕｏｓｍ／Ｐｏｓｍ下降（Ｐ均〈０．００１），肾功能代偿期、失代偿期和尿毒症期相比，差异显著（Ｐ均〈０．００１），尿毒症期患者的尿量多寡并不影响其上述指标的变化。     

慢性肾功能不全分期血清胆红素水平测定的临床价值

目的探讨血清胆红素在慢性肾功能不全临床分期中的应用价值。方法患者禁食12h后,空腹抽取静脉血采用KHC3法测定163例慢性肾功能不全患者(根据肾功能受损程度,临床分为慢性肾功能不全代偿期、慢性肾功能不全失代偿期、肾功能衰竭期、尿毒症期)和120例健康人血清中的总胆红素(TBIL)、直接胆红素(DBIL),并进行比较分析。结果慢性肾功能不全代偿期、慢性肾功能不全失代偿期、肾功能衰竭期、尿毒症期患者的TBIL、DBIL均低于健康对照组,差异有高度统计学意义(P<0.01)。结论监测血清胆红素水平对于慢性肾功能不全的诊治具有重要的临床价值。     

16例肾功能不全患者造影前后血清肌酐的变化

肾功能不全患者使用造影剂后常引起急性肾功能损害 ,即造影剂肾病 (CAN ) ,其发生率可高达94 % [1] 。但是 ,国内对CAN报道甚少 ,作者等对 16例肾功能不全患者造影前后的血清肌酐值 (Scr)进行对比观察 ,结果报道如下。1　对象和方法1.1　病例选择　对本院 1999年 10月至 2 0 0 1年 10月之间的泌尿系结石并肾功能不全患者造影前后的Scr水平进行了统计 ,将其中资料齐全的 16例进行总结。 16例中 ,男 12例 ,女 4例 ,平均年龄 4 8± 2 0岁。1.2　造影方式　所有患者均采用静脉肾盂造影(IVP) ,所使用的造影剂为泛影葡胺 ,剂量为每人次4 0ml…     

儿科肾功能不全时抗菌药物的合理使用

肾脏是人体内药物代谢和药物排泄的鼋要器官，许多药物或其代谢产物经由肾脏排泄，由此可能导致肾脏损害的发生；原有肾脏疾病者尤其是肾功能不全者，药物的药代动力学与机体药效反应都将发生很大的变化，更易出现并加重已有的肾脏损害或导致其他脏器损害。临床工作中常常出现两种极端，一方面是忽视这种变化给机体带来的不利影响，仍按常规使用甚至滥用各种药物，从而导致药物性肾损害及其他药物不良反应发生率的增加；另一方面是由于惧怕并力求避免发生药物不良反应，往往不敢使用具有一定肾毒性的药物或不恰当地减低药物剂量，从而延误原发疾病治疗时机或者达不到应有治疗效果。因此，     

慢性肾功能不全患者血尿渗透压及血清肌酐与肾功能关系的探讨

检测了７５例慢性肾功能不全患者血浆渗透压（Ｐｏｓｍ）、尿渗透压（Ｕｏｓｍ）、Ｕｏｓｍ／Ｐｏｓｍ比值和血肌酐（ＳＣｒ）变化，结果：７５例患者均有Ｐｏｓｍ和ＳＣｒ，升高（Ｐ＜０．０５～０．００１）、Ｕｏｓｍ和Ｕｏｓｍ／Ｐｏｓｍ下降（Ｐ均＜０．００１），肾功能代偿期、失代偿期和尿毒症期相比，差异显著（Ｐ均＜０．００１），尿毒症期患者的尿量多寡并不影响其上述指标的变化。     

协同护理结合个体化护理模式在肾功能不全合并高血压患者中的应用

目的:探讨协同护理结合个体化护理模式在肾功能不全合并高血压患者中的应用效果。方法:选择2017年6月1日～2018年9月30日收治的45例慢性肾功能不全合并高血压患者作为对照组,采用常规护理;选择2018年10月1日～2019年12月31日收治的慢性肾功能不全的患者作为研究组,在常规护理基础上实施协同护理结合个体化护理模式。比较两组干预前后血压、内生肌酐清除率、自我护理能力[采用自我护理能力测定量表(ESCA)]、心理健康程度[采用症状自评量表(SCL-90)]及生活质量[采用健康调查简表(SF-36)],比较两组对护理工作满意度。结果:干预后,研究组血压低于对照组(P0.05)、内生血肌酐清除率高于对照组(P0.05),ESCA中自管概念、自我护理技能、健康知识掌握及自我责任感得分高于对照组(P0.01),SCL-90评分低于对照组(P0.01),SF-36评分高于对照组(P0.01);研究组对护理工作满意度高于对照组(P0.05)。结论:对肾功能不全合并高血压患者在常规护理基础上实施协同护理结合个体化护理模式,不仅有利于提高患者认知水平、自我护理能力,减缓肾功能恶化,还能促进患者心理健康,帮助患者回归社会,提升生活质量,提高患者满意度。     

C肽测定在肾功能不全患者中的诊断价值

以放射免疫法测定了９２例肾功能不全病人。６０例血肌酐正常肾脏病人及８０例健康人血，尿Ｃ肽（ＳＣ－Ｐ，ＵＣ－Ｐ）含量。结果发现肾功能不全病人组ＳＣ－Ｐ含量明显高于健康对照组（Ｐ＜０．０１），ＵＣ－Ｐ含量显著低于健康对照组（Ｐ＜０．０１）；血肌酐上升，ＳＣＰＰ亦上升，两者高度正关，ｒ＝０．８１７４，Ｐ＜０．０１。血肌酐正常肾脏病人组血β２微球蛋白（Ｓβ２－Ｍ）增高，ＳＣ－Ｐ亦增高，两者亦高度正相关，ｒ     

慢性肾功能不全60例个体化饮食护理

目的:探讨个体化饮食疗法在慢性肾功能不全患者中的应用效果。方法:对60例慢性肾功能不全患者实施个体化饮食疗法,比较治疗前后的上臂肌围(MAMC)、人血白蛋白(ALB)、血红蛋白(Hb)、肌酐(CREA)及尿素氮(BUN)等参数变化。结果:治疗6个月后患者MAMC、ALB和Hb水平明显上升,与治疗前比较差异有统计学意义(P<0.05);CREA及BUN与治疗前比较差异无统计学意义(P>0.05)。结论:个体化饮食疗法能改善慢性肾功能不全患者的营养状况。     

药物结晶致急性梗阻性肾功能不全1例

1病例资料患者，女，36岁。因双侧腰部疼痛，伴无尿20h余，于2012年8月收入新余市人民医院。入院前，患者在当地医院因肺部感染使用头孢曲松钠（剂量不详）和维生素C静脉滴注，共5d。人院体检：T36．8℃，P78次·min-1，R20次·min-1，BP126／75mmHg（1mmHg=0．133kPa）。     

充血性心力衰竭患者肾功能不全患病率及与心衰严重程度关系的研究

目的 回顾性观察充血性心力衰竭（CHF）患者肾功能不全发生率、探讨肌酐（Cr）水平的变化及与射血分数的相关性。方法 回顾性收集384例CHF患者的临床资料，根据患者血清肌酐水平分为肾功能正常组、肾功能不全代偿组和肾功能不全失代偿组。计算各组肾功能不全发生率，探讨Cr水平的变化并与左室射血分数（LVEF）进行相关性分析。结果 CHF患者肾功能不全的发生率为39．06％，并且随着心功能分级的升高肾功能不全患病率也在升高；随着心功能的恶化，血清Cr浓度在升高，且3组间有统计学差别（P〈0．05）；Cr与LVEF负相关（r=-0．37，P〈0．01）。结论 CHF患者中肾功能不全相当普遍，随着NYHA心功能分级的升高，肾功能在恶化。     

Dalteparin thromboprophylaxis for critically ill medical-surgical patients with renal insufficiency

PURPOSE: Thromboprophylaxis with low-molecular-weight heparin (LMWH) may be more effective than unfractionated heparin but also more likely to bioaccumulate and potentially cause bleeding in patients with renal insufficiency. The objectives of this study were to assess, among medical-surgical patients in the intensive care unit receiving dalteparin 5,000 IU daily for thromboprophylaxis, (1) the relationship between renal dysfunction and LMWH bioaccumulation as measured by trough anti-Xa levels, (2) the relationship between renal dysfunction and risk of bleeding as measured by a surrogate marker (peak anti-Xa levels), and (3) the relationship between anti-Xa levels, bleeding events, and thrombotic events. MATERIALS AND METHODS: In this prospective single-center cohort study, we enrolled patients 18 years or older, expected to stay 72 hours or longer, and with a creatinine clearance 30 mL/min or higher at intensive care unit admission. We administered 5,000 IU dalteparin subcutaneously each day. The main phase 1 objective was to detect bioaccumulation of dalteparin by measuring trough anti-Xa levels (22-23 hours post dalteparin). The main phase 2 objective was to examine the relationship between renal dysfunction and peak anti-Xa levels (4 hours post dalteparin). We recorded creatinine clearance daily and bleeding and thrombotic events, blinded to anti-Xa levels. RESULTS: We enrolled 19 patients aged 62.7 (13.2) years with an APACHE II score of 23.5 (9.4). We measured trough anti-Xa levels on 185 occasions in 19 patients; we measured peak anti-Xa levels on 113 occasions in 11 patients. We identified no bioaccumulation of LMWH in this study, as detected by trough anti-Xa levels. Most peak anti-Xa levels were in the conventional prophylactic range. CONCLUSIONS: When administered in prophylactic doses to critically ill patients with a wide range of calculated creatinine clearances, we found no evidence of bioaccumulation of dalteparin. If dalteparin does not bioaccumulate, it may be an attractive alternative agent for thromboprophylaxis.     

Cross-over assessment of serum bactericidal activity of moxifloxacin and levofloxacin versus penicillin-susceptible and penicillin-resistant Streptococcus pneumoniae in healthy volunteers

We compared the serum bactericidal activity (SBA) of moxifloxacin and levofloxacin against penicillin-susceptible and penicillin-resistant Streptococcus pneumoniae in 12 healthy volunteers. Each subject received 3 days of oral moxifloxacin 400 mg daily and levofloxacin 750 mg daily, respectively, with a 2- to 4-week washout period between regimens. Blood was drawn at 6 time points after the third dose of each antibiotic. Mean serum bactericidal titers (MSBTRs) for moxifloxacin were 4-fold higher than the mean titers for levofloxacin at each time point. For each drug, MSBTRs at each time point were the same or within one 2-fold dilution when analyzed according to the penicillin susceptibility of the strains or the sex of the subjects. The difference in SBA of the 2 drugs may have implications for the emergence of resistance and clinical outcome.     

Efficacy of sonography as a screening method in renal insufficiency

Ultrasonographic records of 239 patients with unexplained renal insufficiency were reviewed to determine the efficacy of renal ultrasonography as a screening examination. Ninety-five (40%) examinations were normal; 24 (10%) examinations showed no renal lesion, but some important incidental finding was discovered; 120 (50%) examinations showed a renal abnormality, including 24 (10%) that showed bilateral urinary tract obstruction. The discovery of bilateral urinary tract obstruction was of particular importance and, in the majority of cases (16/24), led to some type of definitive interventional procedure. Sonography in patients with renal insufficiency, whether normal or abnormal, provides useful information to the practicing physician with a potentially significant impact on the patient's clinical course.     

万古霉素对脓毒症患者肾功能的影响

目的 探讨脓毒症患者万古霉素治疗时急性肾损伤（AKI）发生的原因.方法 51例耐甲氧西林金黄色葡萄球菌（MRSA）感染的脓毒症患者,初始使用万古霉素2 g/d,分4次给药,5个半衰期后监测万古霉素谷、峰血药浓度,根据血药浓度调整万古霉素使用剂量,记录7d内万古霉素使用总剂量.检查记录使用万古霉素前及治疗7d后C反应蛋白（CRP）、最高体温,记录治疗7d中脑钠肽（BNP）、中心静脉压（CVP）、乳酸平均值.根据血药浓度调整万古霉素每日使用剂量.万古霉素治疗7d中根据48 h SCr增加超过26.4μmol/L确定为AKI,并分组为AKI组（n=28）和非AKI组（n=23）,比较两组之间万古霉素血药浓度、乳酸、CRP、BNP、CVP、当日最高体温的差异.结果 使用万古霉素5个半衰期后所有患者平均谷浓度（9.18 ±6.15） μg/ml,峰浓度（25.73 ±20.30） μg/ml,调整剂量5d后平均谷浓度（10.26±5.10）μg/ml,峰浓度（23.52±6.83） μg/ml.A组与B组之间万古霉素血药浓度差异无统计学意义.两组之间CRP、BNP、CVP、乳酸、最高与最低体温差值均有统计学差异.结论 使用适当剂量万古霉素治疗脓毒血症时AKI的发生与否可能与感染控制效果及患者血容量是否充足有关.     

肾功能不全对心力衰竭预后的影响

目的探讨肾功能不全对心力衰竭预后的影响。方法根据肾功能将心力衰竭患者分为心肾综合征组70例和单纯心力衰竭组131例，观察其治疗和预后情况。结果心肾综合征组与单纯心力衰竭组相比，年龄、血肌酐、水肿发生率，糖尿病和高血压患病率及住院天数显著增高（P〈0．05或0．01），血红蛋白浓度显著降低（P〈0．01）；而2组间性别、心力衰竭时间、心功能、冠心病及高脂血症的患病率差异无显著性。随访心肾综合征组生存率明显低于单纯心力衰竭组（P〈0．001），在成功应用血管紧张素转换酶抑制剂的患者中也有类似关联。Cox回归模型分析显示，心功能分级、射血分数、血肌酐水平和血红蛋白浓度与心力衰竭死亡独立相关。结论肾功能不全明显增加心力衰竭病死率。     

尿肾损伤分子-1水平变化与狼疮肾炎合并肾功能不全患者预后的关系

目的:观察狼疮肾炎(LN)合并肾功能不全(RI)患者尿中肾损伤分子(KIM-1)变化趋势及临床意义。方法:收集本院LN患者31例,分正常肾功组(A组)、RI+肾功改善组(B组)、RI+肾功未改善组(C组),检测血肌酐(SCr)、尿KIM-1等指标。比较各组尿KIM-1变化,探讨其与肾小球滤过率估计值(eGFR)关系及判断预后价值。结果:入院时三组尿KIM-1较对照组明显增加(P<0.05),B组最高(P<0.001)。14d后B组SCr、eGFR好转时尿KIM-1下降(均P<0.05),尿KIM-1与eGFR负相关(r=-0.385,P=0.048)。ROC曲线分析示尿KIM-1、NAG、GAL、SCr预测LN患者肾功能改善曲线下面积分别为0.93、0.86、0.77、0.57。结论:LN合并RI患者入院时尿KIM-1水平升高与14d内肾功能改善密切相关;合理治疗后,尿KIM-1水平在肾功能明显改善的LN患者中有显著下降;尿KIM-1是预测肾功能改善的准确指标。     

Increased serum levels of S100B are related to the severity of cardiac dysfunction, renal insufficiency and major cardiac events in patients with chronic heart failure

Objective

To investigate the correlations between S100B and the severity of cardiac dysfunction, renal insufficiency (RI) and prognosis in chronic heart failure (CHF).

Method

Serum levels of S100B, TNF-α, high sensitivity CRP and NT-proBNP were determined in CHF patients with (n = 96) and without RI (n = 146). Patients with RI only (n = 62) and control subjects (n = 64) served for comparison. Patients were followed up for one year.

Results

S100B levels were higher in CHF patients with a further elevation in those with RI (P < 0.01). Serum S100B levels correlated with left ventricular ejection fraction, left ventricular end-diastolic volume and NT-proBNP in CHF patients, and eGFR in patients with RI (all P < 0.05). Increased S100B levels were associated with major cardiac events (MCE), and were independently associated with the presence of CHF (all P < 0.05).

Conclusion

Increased serum S100B levels were associated with the severity of cardiac dysfunction, RI and an adverse prognosis in CHF patients. It represents an independent risk factor for CHF.     

A comparison of insulin doses for treatment of hyperkalaemia in intensive care unit patients with renal insufficiency

BackgroundHyperkalaemia is a complication in patients with chronic kidney disease or acute kidney injury and occurs frequently in the intensive care unit. One treatment approach includes intravenous (IV) insulin to shift potassium intracellularly.ObjectivesThe primary outcome was hypoglycaemia (blood glucose <70 mg/dL) after insulin administration. Secondary outcomes included change in serum potassium levels and incidence of severe hypoglycaemia.MethodsThis was a single-centre, retrospective study evaluating critically ill adult patients with chronic kidney disease stage III–V, end-stage renal disease, or acute kidney injury who received IV insulin for treatment of hyperkalaemia from March 2008 to September 2018. Patients were divided into two insulin-dosing regimen groups: 5 units or 10 units.ResultsOf the 174 patients included, hypoglycaemia after insulin administration occurred in eight of 87 patients (9.2%) in the 5-unit group and 17 of 87 patients (19.5%) in the 10-unit group (p = 0.052). There was no difference in rates of severe hypoglycaemia or change in serum potassium levels.ConclusionsIn critically ill patients requiring treatment for hyperkalaemia, a lower dose of IV insulin does not result in lower statistically significant rates of hypoglycaemia. However, lower insulin doses provide a similar potassium-lowering effect and cause a meaningful decrease in hypoglycaemic episodes. Intensive care unit providers may consider 5 units of IV insulin over 10 units although further larger controlled studies are needed.     

肾功能不全患者置入药物洗脱支架及其对支架血栓的影响

目的 了解药物洗脱支架(DES)在肾功能不全患者中的使用状况及其安全性和有效性,尤其置入DES后各时期支架血栓的发生情况及其影响因素.方法 连续入选2003年7月至2005年6月期间在北京安贞医院接受冠状动脉介入(PCI)并置入至少1枚DES的所有患者.根据肌酐清除率(Ccr)将患者分为2组:Ccr≥60 ml/min组(肾功能正常或轻度肾功能不全)和Ccr＜60 ml/min组(中重度肾功能不全).记录所有患者的临床资料,并根据ARC Dublin定义判定支架血栓事件.比较2组患者的主要不良心脑血管事件(MACCE)及各期支架血栓(ST)发生率.结果 共入选2377例患者,Ccr≥60 ml/min组2020例(85.0%),Ccr＜60 ml/min组357例(15.0%).Ccr＜60 ml/min组患者的随访期病死率高于Ccr≥60 ml/min组[4.5%(15/334)与1.2%(22/1859),P＜0.001],但2组患者间急性期、亚急性期、晚期和晚晚期ST的发生率均无差异(P均＞0.05).Cox多因素回归分析结果提示,肾功能本身并非死亡的危险因素,冠状动脉多支病变(OR=1.929,95%CI=1.178～3.157,P=0.009)、糖尿病(OR=1.914,95%CI=1.055～3.470,P=0.033)和年龄(OR=1.051,95%CI=1.005～1.099,P=0.030)为中重度肾功能不全患者置入DES后死亡的独立危险因素.结论 高危患者使用DES的远期病死率较高,但风险的增加并不归咎于支架血栓的增加.