血液灌流对尿毒症患者氧化应激状态的影响

尿毒症患者血浆氧化应激水平与其心血管并发症的发生密切相关,并且氧化应激可能是导致尿毒症患者发生心血管并发症的重要环节[1-2].目前广泛认为,对维持性血液透析(MHD)患者应实行预防性抗氧化治疗.本研究中采用血液透析(HD)联合血液灌流(HP)对尿毒症患者进行治疗,观察其对氧化应激状态的影响,报告如下.     

维持性血液透析患者常见心血管并发症原因分析及护理

目的:探讨维持性血液透析(MHD)患者透析过程中出现心血管并发症的原因及护理方法。方法:分析106例MHD患者在透析中常见心血管并发症的发生情况,并给予针对性护理。结果:MHD患者较为常见的心血管并发症为高血压、低血压、心律失常、心力衰竭、心绞痛及心包炎,积极有效的护理干预可减少心血管并发症的发生。结论:在对MHD患者提供护理服务时应积极预防心血管并发症的发生。     

不同血液净化方式对维持性血液透析患者微炎症状态和贫血的影响

血液透析(hemodialysis,HD)已成功延长了尿毒症患者的生命并提高了生活质量。但是HD患者的并发症和病死率仍远高于同龄健康人群。研究表明,微炎症状态和贫血在维持性血液透析(maintenance hemodialysis,MHD)患者中发生率较高,其通过不同机制引起一系列的并发症,如心血管     

预见性护理在防治老年维持性血液透析患者心血管并发症中的效果观察

目的探讨预见性护理干预对防治老年维持性血液透析(MHD)患者心血管并发症中的应用效果。方法将本院血液净化中心2015年1~12月的52例老年MHD患者随机分为对照组和观察组各26例。对照组实施常规护理;观察组在常规护理基础上针对引起心血管并发症的危险因素进行相应的预见性护理。观察并比较两组患者心血管并发症的发生情况。结果观察组患者心血管并发症发生率明显低于对照组,差异有统计学意义(P0.05)。结论通过预见性护理干预,能够减少老年MHD患者相关危险因素的发生,降低心血管并发症的发生率,提高透析效果。     

维持性血液透析患者营养不良、炎症和心血管疾病的关系

目的 探讨维持性血液透析(MHD)患者营养不良、炎症和心血管疾病的发生情况及三者之间的关系.方法 67例MHD患者通过SGA评分、人体测量和血生化指标进行营养评估,测量高敏C反应蛋白(hs-CRP)作为炎症标记物并记录心血管并发症.分析营养状况、炎症及心血管并发症的关系.结果 根据SGA评分营养不良的发生率为49.3％.营养不良组hs-CRP高于营养正常组(P＜0.05).hs-CRP升高者22例(32.8％),其白蛋白(ALB)水平低于正常者(P＜0.05).hs-CRP与SGA分值、ALB、血肌酐(Scr)负相关(P＜0.05).合并心血管并发症者ALB、preALB低于无并发症者,而hs-CRP高于无并发症者(P＜0.05).67例患者营养不良、炎症及动脉粥样硬化(MIA)综合征的发生率为17.9％.结论 部分MHD患者存在MIA综合征,营养不良与炎症相互影响,二者可能共同参与心血管疾病的发生.     

老年维持性血液透析心血管并发症原因分析

目的 分析老年慢性肾衰竭维持性血液透析(MHD)患者心血管并发症发生的原因,以提高其生存率.方法 回顾性分析32例老年慢性肾衰竭MHD患者透析的原发病因与透析生存年限,分析其心血管并发症的发生原因.结果 患者在透析中发生心血管并发症,其中低血压占50.9%,高血压47.2%,心力衰竭20.9%,心律失常8.2%,心绞痛7.2%,脑出血1.8%.结论 老年慢性肾衰竭患者进行维持性血液透析仍是提高存活率的主要途径,但应积极防止心血管并发症     

生物电阻抗分析在维持性血液透析患者容量管理的应用现状

容量超负荷使维持性血液透析(maitaining hemodialysis dialysis,MHD)患者心血管和全因死亡率增加,而容量不足可使低血压相关不良事件增加、残肾功能减退,甚至导致心脏顿抑。因此精准的容量管理对于MHD患者的预后至关重要。通过临床评估患者容量状态,因其影响因素众多,故无法客观、准确评价容量状态。目前生物电阻抗分析(bioimpedance analysis,BIA)已成为临床最常用的客观评价血液透析患者容量状态的方法,具有精确、非侵入性、便捷、廉价等优势。本文就BIA在MHD患者容量和血压管理、对残肾功能以及长期预后如心血管、住院率、死亡率的影响做一综述。     

血液透析患者并发主动脉夹层分离2例的观察及护理

维持性血液透析(MHD)可引起一系列的心血管并发症,其中主动脉夹层分离是少见而严重的心血管急症。通过对2例患者的观察和护理,提出专业透析护士应加强对该种疾病的认识,密切观察患者的血压、症状变化,协助早期诊断,做好透析护理,使患者渡过急性期,降低病死率。     

慢性肾衰竭患者载脂蛋白与心脑血管并发症的相关性

目的：观察维持性血液透析（MHD）对载脂蛋白（Apo）及其比值的影响,探讨慢性肾衰竭（CRF）Apo与心脑血管并发症的相关性。方法：CRF肾衰竭期或终末期患者65名,分为CRF组及MHD组,每组以是否合并心脑血管并发症再分为并发症亚组及无并发症亚组,对照组21例,观察各组ApoB、ApoA1、ApoB／ApoA1,血浆白蛋白（Alb）水平。结果：与对照组相比,CRF组ApoB、ApoB／ApoA1升高（P〈0．05）,而MHD组上述指标得到改善;两并发症亚组的ApoB及ApoB／ApoA1均值较相对应的无并发症亚组升高,但无统计学意义。结论：MHD可以降低ApoB及ApoB／ApoA1,但其对CRF患者心脑血管并发症的预测意义尚不确定。     

碳酸镧结合骨化三醇治疗维持性血液透析患者继发性甲状旁腺功能亢进的临床研究

<正>维持性血液透析(MHD)是中国应用最广泛的肾脏替代治疗方法,随着透析治疗技术的提高及医保制度的不断完善,MHD患者的生存期也不断延长,目前其5年生存率已经达到75%以上[1]。继发性甲状旁腺功能亢进(SHPT)是MHD患者最常见的慢性并发症之一,也是引起肾性骨病、心血管并发症及患者死亡的重要原因[2]。研究[3]显示,高磷血症是MHD患者的常见并发症,     

老年维持性血液透析的特点和分析

目的分析老年维持性血液透析的特点。方法对2001年8月至2005年8月间因慢性肾衰竭行维持性血液透析患者28例的临床资料进行回顾性分析,对心血管并发症、营养不良、死亡情况进行比较分析。结果28例患者透析前后心血管并发症28例,营养不良26例,感染43例次,死亡20例。结论老年透析患者心血管并发症、感染、营养不良发生率高,应早期充分透析。     

慢性肾衰患者心脏结构与功能的超声影像学评价

慢性肾衰是一种累及多个系统和多个器官的疾病，其心血管并发症是患者死亡的主要原因之一。超声心动图作为首选的检查方法，被广泛应用于慢性肾功能衰竭患者心脏并发症的研究中，本文就慢性肾衰患者心脏并发症的超声影像学研究进展作一综述。     

血清视黄醇结合蛋白与维持性血液透析终末期肾病患者心血管事件的关系

目的:探究血清视黄醇结合蛋白(retinol binding protein,RBP)与维持性血液透析(maintenance hemodialysis,MHD)终末期肾病患者发生心血管事件的关系。方法:回顾性分析2017年3月至2020年3月于海南医学院第二附属医院行MHD治疗的100例终末期肾病患者的临床资料,收集所有患者一般资料与入院后24h内血清RBP水平,根据治疗期间是否发生心血管事件将患者分为事件组(n=41)和非事件组(n=59)。采用单因素及logistic回归模型分析相关指标与MHD终末期肾病患者发生心血管事件的关系,并采用受试者工作特征(receiver operating characteristic curve,ROC)曲线分析RBP对MHD终末期肾病患者发生心血管事件的评估价值。结果:与非事件组相比,事件组年龄明显更大,透析时间更长,三酰甘油(triglyceride,TG)、肌钙蛋白(Troponin,cTnT)、C反应蛋白(C-reactive protein,CRP)、血肌酐(serum creatinine,SCr)、免疫反应性甲状旁腺素(immunoreactive parathyroid hormone,iPTH)及RBP水平均明显更高(P<0.05)。Logistic回归分析显示:年龄(OR=1.369)、透析时间(OR=1.595)、cTnT(OR=1.082)、CRP(OR=1.059)及RBP(OR=2.793)均是MHD终末期肾病患者发生心血管事件的独立危险因素(P<0.05)。ROC曲线分析显示:血清RBP水平预测MHD终末期肾病患者发生心血管事件的曲线下面积为0.769(95%CI:0.662~0.855),敏感度为75.61%,特异度为70.73%,最佳截断值为178.08mg/L。结论:高水平RBP是MHD终末期肾病患者发生心血管事件的独立危险因素,对MHD终末期肾病患者发生心血管事件具有重要预测价值。     

Serum concentrations of asymmetric (ADMA) and symmetric (SDMA) dimethylarginine in patients with chronic kidney diseases

BACKGROUND: NO synthesis is inhibited by the dimethylarginine (DMA) ADMA, which accumulates, similar to SDMA, in the plasma of patients suffering from chronic renal failure (CRF). ADMA and possibly SDMA contribute to hypertension and atherosclerosis in patients with chronic renal disease: ADMA inhibits directly eNOS, whereas SDMA competes with the NO precursor arginine for uptake into the cells. METHODS: In 26 control persons and 221 patients with kidney diseases of different stage as were CRF, end stage renal disease (ESRD), and patients after renal transplantation (RT), the plasma concentrations of ADMA (c(ADMA)), SDMA (c(SDMA)) and 20 endogenous amino acids (AA) were measured by HPLC and correlated to blood pressure, cardiac events, endothelial dysfunction, and diabetes mellitus. RESULTS: Both ADMA (1.04+/-0.04 vs. 0.66+/-0.04 microM) and SDMA (2.69+/-0.12 vs. 0.49+/-0.03 microM) were significantly (p<0.001) elevated in all patients compared to healthy controls, whereas arginine concentration (51.4+/-2.3 vs. 76.0+/-5.2 microM) was decreased in dependence on the degree of kidney disease. In RT patients, SDMA levels were significantly decreased, but c(ADMA) remained enhanced. A strong correlation was found between SDMA and both serum urea and creatinine in CRF and RT patients. A linear correlation was found between ADMA and cholesterol concentrations in RT patients. Hypertension in CRF was accompanied by a further increase in the concentration of DMAs. There was no relation between DMAs and the occurrence of peripheral arterial occlusive disease or cerebrovascular diseases. In patients with cardiac diseases, c(SDMA) was additionally increased only in the CRF group. CONCLUSIONS: In patients with chronic kidney disease, c(ADMA) and c(SDMA) are significantly increased but cardiovascular diseases are evidently not correlated to changes in DMA concentrations in this group of patients.     

Cardioprotective effect of erythropoietin preparations in patients with chronic renal failure

AIM: To investigate effects of early correction of anemia on the rate of cardiovascular complications and survival on regular hemodialysis (RHD). MATERIAL AND METHODS: Eighty patients with chronic renal failure (CRF) on regular hemodialysis entered two groups: group 1 with hemoglobin (Hb) < 80 g/l (n = 36) and group 2 with Hb > 100 g/l (n = 44). 90% patients of group 2 were treated for renal anemia for 6-8 months of predialysis CRF. When placed on RHD, group 1 started therapy with epoetin, 39 patients of group 2 continued epoetin treatment. RESULTS: Patients of group 2 had a higher rate of eccentric left ventricular hypertrophy (LVH) with reduced ejection fraction and development of congestive cardiac failure and coronary heart disease. Eccentric LVH in group 1 patients regressed only in 80% when the patients were on hemodialysis and received epoetin for correction of anemia. Overall cardiac death in group 1 was twice that of group 2 patients. CONCLUSION: Early correction of anemia led to a 50% increase in 5-year survival. This fact can be explained with inhibited progression of eccentric LVH.     

Risk factors of vascular complications in patients at a predialysis stage of chronic renal failure

AIM: To specify risk factors of vascular complications at a predialysis stage of renal failure. MATERIAL AND METHODS: The trial enrolled 165 patients with chronic renal failure (CRF) aged 46 +/- 15 years, glomerular filtration rate (GFR) - 37.2 (35.02-40.83) and arterial hypertension (96%). The examination included ultrasound dopplerography of the common carotid arteries (CCA) and common femoral arteries (CFA) for detection of atherosclerotic plaques (AP), estimation of the thickness of arterial intima-media, elasticity and rigidity of the vascular wall. Factors of risk for atherosclerosis and cardiovascular complications were assessed. RESULTS: Aortic atherosclerosis was detected in 60 patients, that of cardiac vessels, brain, kidneys and lower limbs - in 35, 30, 23 and 8 patients, respectively. Acute cardiovascular complications occurred in 13 patients. Main atherosclerosis risk factors were age, body mass index, systolic and pulse arterial pressure, disturbances of phosphorus-calcium metabolism. Structure and function of CCA and CFA were studied with dopplerography in 37 CRF patients. Increased intima-media thickness was associated with age, male sex, overweight, hypercholesterinemia, systolic and pulse arterial pressure. Body mass index, GFR, creatinin level were independent factors of intima-media thickness. Abnormal elasticity of CCA was related to hypertension, CFA - to hypercholesterolemia.     

维持性血液透析患者循环内皮祖细胞变化的临床分析

目的 观察维持性血液透析患者循环内皮祖细胞(circulating endothelial progenitor cells,CEPCs)的变化.方法 以外周血中CD34+/CD133+/KDR + 为循环内皮祖细胞的标志物,对44例维持性血液透析患者和36例健康体检者采用流式细胞仪检测 CEPCs数量;将维持性血液透析患者的CEPCs数量与对照组比较,并根据维持性血液透析患者有无高血压或冠心病史、透析是否充分、血红蛋白水平进一步作亚组分析.结果维持性血液透析患者外周血CEPCs数量显著低于对照组( tCD34+=2.205,tCD34+/CD133+/KDR+ =2.148;均P＜0.05);合并高血压的维持性血液透析患者CEPCs数量较无高血压者显著降低(tCD34+ =2.183,tCD34+/CD133+/KDR+=2.023;均 P＜0.05);有冠心病史的维持性血液透析患者CEPCs数量低于无冠心病史者 (tCD34+=2.136,tCD34+/CD133+/KDR+ = 2.072;均P＜0.05);Kt/V≥1.3组患者CEPCs 数量明显高于Kt/V＜1.3组(tCD34+ =2.276,tCD34+/CD133+/KDR+=2.086;均 P＜0.05);血红蛋白≥110g/L组患者较血红蛋白＜110g/L组患者 CEPCs数量为高(tCD34+=2.707,t CD34+/CD133+/KDR+=2.859;均P＜0.05).结论 充分血液透析、积极控制高血压、改善肾性贫血使血红蛋白达标有助于提高维持性血液透析患者循环内皮祖细胞数量,有助于降低发生心血管并发症的风险.     

Cardiac troponins in renal failure – time for an optimistic consensus?

Elevated cardiac troponin concentrations are now accepted as the gold standard biochemical markers for the diagnosis of myocardial damage in patients with unstable coronary syndromes, having also a demonstrated value in early risk stratification and in adopting different therapeutic strategies. The specificity and sensitivity of cardiac troponins for diagnosis of acute coronary diseases in renal failure have been a point of confusion over the past decade, mainly because of moderate elevations of these cardiac biomarkers, commonly observed in patients with chronic renal dysfunction and without any significant myocardial damage. This review discusses the cardiac troponins, their biochemistry, their currently accepted cut-off values and their real significance in chronic renal failure (CRF), concluding that troponins maintain their diagnostic and prognostic values in patients with CRF, being predictive not only of cardiovascular mortality but also of general mortality in this patient group.