13例小儿急性肾功能衰竭的分析

１３例小儿急性肾功能衰竭的分析张志芬★关键词急性肾功能衰竭小儿病因中国图书资料分类法分类号Ｒ６９２．５小儿急性肾功能衰竭（ＡＲＦ）的病因很多，临床表现急而重，且持续时间愈久，肾功能损害愈重，有时会导致慢性肾功能衰竭（ＣＲＦ），严重影响小儿的生长、发育...     

肢体严重创伤并发急性肾功能衰竭的治疗

肢体严重创伤并发急性肾功能衰竭的治疗张坚杨效宁孙一公王纪湘肢体严重创伤并发急性肾功能衰竭，是创伤、休克和急性肾功能衰竭症侯群，病死率较高．笔者对我院１９８２年１月～１９９３年１月收治的１６例此类病人进行了回顾分析，现报告如下．临床资料（１）一般资料：...     

肾综合征出血热并发ARF血液透析的护理

目的：总结肾综合症出血热并发急性肾功能衰竭(HD)进行血液透析的护理体会。方法：通过分析22例患者在血液透析过程中酌情应用肝素，以防加重出血：严密监测血压，以防低血压等一系列措施。结果：22例患者均HD安全顺利。结论：肾综合症出血热并发急性肾功能衰竭，防止出血、稳定的血压是血液透析过程安全顺利的保证．     

肾功能衰竭神经系统并发症的临床分析

肾功能衰竭神经系统并发症的临床分析伦立德，刘景铎，张跃文肾病科主题词慢性肾功能衰竭／并发症，脑出血慢性肾功能衰竭的常见并发症以神经系统并发症为多见，未经透析时多表现为尿毒性脑病，随着血液透析和腹膜透析技术的普及，透前神经系统并发症变得少见，而透后神经...     

维持性血液透析患者并发急性左心衰竭的原因分析及护理

目的分析维持性血液透析患者并发急性左心衰竭的原因，找出相应护理对策。方法对48例患者急性左心衰竭的原因进行临床分析。并采取相应的护理措施。结果48侧患者急性左心衰竭均得到控制。结论以上护理方法可有效控制雏持性血液透析患者并发急性左心衰竭；利于延长患者生命，并提高生活质量。     

固态胺CO2净化系统中的蒸汽发生器研制

目的研究蒸汽发生器中功率匹配与水汽分离的关键技术，设计、研制了蒸汽发生器装置，并对其进行试验、研究与讨论。方法通过对固态胺解吸过程进行热力学分析与实验，掌握解吸能量的分配规律，实现对设计功率大小的确定。利用表面张力的作用，研制了陶瓷芯体，实现水、汽分离，并根据总的要求设计了蒸汽发生器。结果实验证明所设计的蒸汽发生器满足了系统的要求，有效地实现了水、汽分离并与系统功率的匹配合适。结论研究的结果与方案正确，在实际的应用中切实可行。     

人工肝支持系统生物反应器的研究进展

众所周知，肝功能衰竭是各种严重肝病的终末期表现，在我国以十分常见的重型肝炎为其典型代表，病死率高达60％-80％。迄今为止，传统内科对肝功能衰竭的治疗几无良策。肝脏移植虽为目前肝功能衰竭治疗的最有效手段，但受供体来源、免疫排异、围手术期以及移植费用等诸多因素的限制，尤其是供肝来源的紧缺，使不到10％的肝功能衰竭患者有幸获得肝移植（我国获得肝移植的患者比例更低）。多年来，国内外学者长期致力于体外人工肝支持系统即生物人工肝（bioartificial liver）的研究，以期为肝衰竭患者等待肝移植或通过自身肝再生恢复提供过渡的“桥梁”。     

血液透析患者心功能衰竭318例原因分析

心功能衰竭是慢性肾功能衰竭维持性血透患者常见并发症之一，边疆地区由于条件所限，表现尤为突出，发病率高，病死率也高，直接影响患者的长期存活率，现就我院2003～2008年所收治402例患者中318例心功能衰竭的情况分析如下。     

“120”出诊中急性左心衰的救治体会

目的探讨“120”出诊中急性左心衰竭的救治措施。方法回顾分析34例急性左心衰竭的出诊病例，均经过了病情快速判断、心理安抚、吸氧、辅助端坐体位、心电监护、急救药物治疗、正确转运等处理，少部分患者进行了电除颤、心肺复苏治疗。结果34例患者经过急救处理后病情均不同程度的得到了缓解，安全到达医院者31例，急救有效率91．18％。结论急性左心衰竭是常见的危急重症。提高急救意识、熟练抢救方法、医护担架工积极配合、完善的抢救设备是提高抢救有效率的保证。另外，与患者及家属的积极有效沟通也至关重要，可有效减少医患纠纷。     

磷脂酶A2在烧伤后多系统器官功能衰竭中的作用

磷脂酶A2(PLA2)是血小板活化因子、白三烯和前列腺素类合成的关键酶。并与脂质过氧化反应有关。在缺氧、缺血、休克、内毒素入侵等状态下，PLA2被激活，通过PLA2直接作用及其产物的间接作用，导致组织器官损伤。PLA2与多系统器官功能衰竭具有密切关系，可能作为炎症反应的核心酶参与了创伤或烧伤后多系统器官功能衰竭的发病过程，抑制PLA2活性可能对多系统器官功能衰竭具有防治作用。     

Reliability of mean power recorded during indoor and outdoor self-paced 40 km cycling time-trials.

The purpose of this study was to assess reliability of both indoor and outdoor 40 km time-trial cycling performance. Eight trained cyclists completed three indoor 40 km time-trials on an air-braked ergometer (Kingcycle) and three outdoor 40 km time-trials on a local course. Power output was measured for all trials using the SRM powermeter. Mean performance time across three indoor trials was 54.21 +/- 2.59 (min:sec) and was significantly different (P<0.05) to mean time across three outdoor trials (57.29 +/- 3.22 min:sec). However, there was no significant difference (P = 0.34) for mean power across three indoor trials (303+/-35W) when compared to outdoor performances (312 +/- 23 W). Within-subject variation for mean power output expressed as a coefficient of variation (CV) improved in both indoors and outdoors for trials 2 and 3 (CV = 1.9%, 95% CI 1.0 - 3.4 and CV = 2.1 %, 95 % CI 1.1 - 3.8) when compared to trials 1 and 2 (CV=2.1%, 95% CI 1.2-3.8 and CV=2.4%, 95% CI 1.3-4.3). These findings indicate that power output measured using the SRM powermeter is highly reproducible for both laboratory-based and actual 40 km time-trial cycling performance.     

Evaluation of an upper-body strength test for the cross-country skiing sprint

PURPOSE: The scope of the study was (a) to develop a test concept for specific upper-body power and strength diagnostics of cross-country (XC) skiing sprint athletes, (b) to check test reliability and validity, and (c) to test the hypothesis that maximal power, explosive strength, and power-endurance predict double-poling (DP) sprint performance over race distance. METHODS: Nineteen elite XC skiers performed test-retest of the two-phase test (2PT) on a rollerboard, with the four-repetition maximal test (4R(max)T) as phase 1 and the 40-repetition test (40RT) as phase 2, both for determination of specific upper-body power and explosive strength. To check validity, 31 subjects performed the 2PT and a DP sprint test for 50 m, and a subgroup (N = 19) also performed a DP maximal-speed test and a 1000-m DP sprint test, both on a treadmill. RESULTS: The 4R(max)T was highly reliable (r = 0.90-0.99, P < 0.001), except for explosive force and time to peak force. The 40RT was highly reliable for all variables concerning velocity and power (r = 0.92-0.99, P < 0.001). Peak lactate showed only low reliability (r = 0.69, P < 0.01). The peak values (maximal power, peak velocity, etc.) measured in the 4R(max)T contributed to up to 84% of the variation in 50-m DP sprint time and up to 61% of the variation in 1000-m performance. Moderate to high correlations in 1000-m DP sprint performance were found between the mean values and the fatigue indices of the 40RT. CONCLUSIONS: The 2PT is a reliable, valid, short-lasting test. The relationship between maximal power output (measured in the 4R(max)T) to 50- and 1000-m sprint performance suggests increasing the proportion of training aimed at the improvement of specific explosive strength and maximal power.     

Oral creatine supplementation improves multiple sprint performance in elite ice-hockey players

BACKGROUND: The purpose of this study was to assess the effect of oral creatine monohydrate supplementation on multiple sprint cycle and skating performance in ice-hockey players. METHODS: Participants: sixteen elite ice-hockey players were selected as subjects. Experimental design: subjects were randomly assigned to either a creatine (Cr) (n = 8) or a placebo (P) group (n = 8) in a double blind design. After familiarization and baseline tests, subjects loaded with 5 g of creatine monohydrate or placebo (glucose) four times per day for 5 days, after which a maintenance dose of 5 g per day for 10 weeks was administered. At baseline, and after 10 days and 10 weeks of supplementation, subjects performed i) a cycle test involving 5 all-out sprints of 15 sec duration separated by 15 sec recovery with the resistance set at 0.075 body mass (kg), and ii) 6 timed 80-m skating sprints with the sprints initiated every 30 sec and a split time taken at 47 m. RESULTS: A two-way ANOVA demonstrated no significant change in any of the variables in the P group over the period of study. However, in the Cr group, average mean power output over the 5 sprints was significantly higher at 10 days (1074 +/- 241 W) and 10 weeks (1025 +/- 216 W) than at baseline (890 +/- 172 W), (p < 0.01). Average peak power output over the 5 sprints improved significantly from baseline (1294 +/- 311 W) to 10 days (1572 +/- 463 W), (p < 0.01). Average on-ice sprint performance to 47 m was significantly faster at 10 days (6.88 +/- 0.21 sec) and 10 weeks (6.96 +/- 0.19 sec) than at baseline (7.17 +/- 0.27 sec), (p < 0.005). CONCLUSIONS: This study demonstrates that creatine supplementation has an ergogenic effect in elite ice-hockey players.     

Interval training program optimization in highly trained endurance cyclists

PURPOSE: The purpose of this study was to examine the influence of three different high-intensity interval training (HIT) regimens on endurance performance in highly trained endurance athletes. METHODS: Before, and after 2 and 4 wk of training, 38 cyclists and triathletes (mean +/- SD; age = 25 +/- 6 yr; mass = 75 +/- 7 kg; VO(2peak) = 64.5 +/- 5.2 mL x kg(-1) min(-1)) performed: 1) a progressive cycle test to measure peak oxygen consumption (VO(2peak)) and peak aerobic power output (PPO), 2) a time to exhaustion test (T(max)) at their VO(2peak) power output (P(max)), as well as 3) a 40-km time-trial (TT(40)). Subjects were matched and assigned to one of four training groups (G(2), N = 8, 8 x 60% T(max) at P(max), 1:2 work:recovery ratio; G(2), N = 9, 8 x 60% T(max) at P(max), recovery at 65% HR(max); G(3), N = 10, 12 x 30 s at 175% PPO, 4.5-min recovery; G(CON), N = 11). In addition to G(1), G(2), and G(3) performing HIT twice per week, all athletes maintained their regular low-intensity training throughout the experimental period. RESULTS: All HIT groups improved TT(40) performance (+4.4 to +5.8%) and PPO (+3.0 to +6.2%) significantly more than G(CON) (-0.9 to +1.1%; P < 0.05). Furthermore, G(1) (+5.4%) and G(2) (+8.1%) improved their VO(2peak) significantly more than G(CON) (+1.0%; P < 0.05). CONCLUSION: The present study has shown that when HIT incorporates P(max) as the interval intensity and 60% of T(max) as the interval duration, already highly trained cyclists can significantly improve their 40-km time trial performance. Moreover, the present data confirm prior research, in that repeated supramaximal HIT can significantly improve 40-km time trial performance.     

Maximal power and performance during a swim taper

This study examined how altering training intensity during a taper impacts maximal mechanical power (Pmax), torque at power maximum (T), velocity at power maximum (V), and swim performance (m . sec (-1)). Using an arm ergometer with inertial loading, measurements of Pmax, T, and V were made for 7 consecutive weeks prior to the taper and during the taper in 7 female competitive collegiate swimmers. Subjects were tested over two consecutive years. Swim performance was obtained from 3 competitive meets; a conference meet (CM), the conference championship meet (CONF) and the national championship meet (NAT). A 50 to 60 % increase in the amount of "high-intensity training" during the taper of 2005 (High-Intensity Taper - HIT) resulted in Pmax values that were 8 to 14 % higher (40 to 60 Watts) at all but one time point when compared to the 2004 taper (Low-Intensity Taper - LIT). Swim performance was significantly worsened at the NAT following LIT. However, with the HIT, swim performance, Pmax, and T were maintained prior to and at NAT. A large reduction in high-intensity training during a taper reduces the length of time that Pmax, T, and swim performance can be maintained at peak levels.     

Influence of testing protocol on ventilatory thresholds and cycling performance

PURPOSE: To compare the ventilatory response of two incremental exercise tests and determine their predictive validity on 40-km cycle time trial (40K) mean power output (40Kavgwatts). METHODS: Fifteen male cyclists performed two incremental exercise tests (T50x3:100 W +50 W x 3(-1) min, T25x1:20 W + 25 W x min(-1)) and a 40K over an 8-d period. Key variable was power at ventilatory threshold (VT). For VT determination during each test we used: VE/VO2 method, first clear breakpoint on the VE/VCO2 plot, V-slope method, RER = 1, and RER = 0.95. RESULTS: VO2max during T50x3 and T25x1 was not different (66.6 vs 67.6 mL x kg(-1) x min(-1)), although T25x1 peak power output (MaxT25x1; 402 W) was significantly higher than MaxT50x3 (363 W). T50x3 and T25x1 VT power outputs indicated that the power output at T25x1:RER = 1 and T25x1:RER = 0.95 were significantly higher compared with T50x3 (324 vs 304 W and 282 vs 264 W, respectively). Regression analyses between T50x3 variables and 40Kavgwatts were significant for T50x3:V-slope (R2 = 0.37; SEE 20.2 W), T50x3:VE/VO2 (R2 = 0.64; SEE 15.3 W), T50x3:RER = 0.95 (R2 = 0.42; SEE 19.4 W), T50x3:RER = 1 (R2 = 0.45; SEE 18.8 W), and MaxT50x3 (R2 = 0.51; SEE 17.8 W). Regression analyses between T25x1 variables and 40Kavgwatts were significant for T25x1:V-slope (R2 = 0.63; SEE 15.4 W), T25x1:VE/VO2 (R2 = 0.64; SEE 15.2 W), T25x1:RER = 0.95 (R2 = 0.53; SEE 17.4 W), T25x1:RER = 1 (R2 = 0.57; SEE 16.7 W), and MaxT25x1 (R2 = 0.65; SEE 15.0 W). There was no significant difference between 40Kavgwatts (282 W) and power outputs at T50x3:VE/VO2 (277 W), T50x3:V-slope (289 W), T25x1:VE/VO2 (276 W), and T25x1:RER = 0.95 (282 W). CONCLUSION: Generally, T25x1 based VT variables were superior to T50x3 variables regarding the prediction of 40Kavgwatts. We conclude that the VE/VO2 method is protocol independent and a valid 40Kavgwatts predictor.     

Diffusion-weighted MR imaging in monitoring the effect of a vascular targeting agent on rhabdomyosarcoma in rats

PURPOSE: To evaluate diffusion-weighted magnetic resonance (MR) imaging for monitoring tumor response in rats after administration of combretastatin A4 phosphate. MATERIALS AND METHODS: Study protocol was approved by local ethical committee for animal care and use. Rhabdomyosarcomas implanted subcutaneously in both flanks of 17 rats were evaluated with 1.5-T MR unit by using four-channel wrist coil. Transverse T2-weighted fast spin-echo sequences, T1-weighted spin-echo sequences before and after gadodiamide administration, and transverse echo-planar diffusion-weighted MR examinations were performed before, 1 and 6 hours, and 2 and 9 days after intraperitoneal injection of vascular targeting agent (combretastatin A4 phosphate, 25 mg/kg). Apparent diffusion coefficient (ADC) was automatically calculated from diffusion-weighted MR imaging findings. These findings were compared with histopathologic results at each time point. For statistical analysis, paired Student t tests with Bonferroni correction for multiple testing were used. RESULTS: T1-weighted images before combretastatin administration showed enhancement of solid tumor tissue but not of central necrosis. At 1 and 6 hours after combretastatin injection, enhancement of solid tissue disappeared almost completely, with exception of small peripheral rim. At 2 and 9 days after combretastatin injection, enhancement progressively reappeared in tumor periphery. ADC, however, showed decrease early after combretastatin injection ([1.26 +/- 0.16]x 10(-3) mm2/sec before, [1.18 +/- 0.17]x 10(-3) mm2/sec 1 hour after [P=.0005] and [1.08 +/- 0.14]x 10(-3) mm(2)/sec 6 hours after [P=.0007] combretastatin A4 phosphate injection), histologically corresponding to vessel congestion and vascular shutdown in periphery but no necrosis. An increase of ADC ([1.79 +/- 0.13]x 10(-3) mm2/sec) (P <.0001) 2 days after combretastatin A4 phosphate injection was paralleled by progressive histologic necrosis. A significant (P <.0001) decrease in ADC 9 days after treatment ([1.41 +/- 0.15]x 10(-3) mm2/sec) corresponded to tumor regrowth. CONCLUSION: In addition to basic relaxation-weighted MR imaging and postgadolinium T1-weighted MR imaging to enable prompt detection of vascular shutdown, diffusion-weighted MR imaging was used to discriminate between nonperfused but viable and necrotic tumor tissues for early monitoring of therapeutic effects of vascular targeting agent.     

Effect of contrast material injection duration and rate on aortic peak time and peak enhancement at dynamic CT involving injection protocol with dose tailored to patient weight

PURPOSE: To investigate the effect of duration and rate of contrast material injection on aortic peak time and peak enhancement in an injection protocol in which the contrast material dose is adjusted according to patient weight. MATERIALS AND METHODS: One hundred ninety-nine patients were randomly divided into three groups in which the fixed duration of contrast material injection was 25 seconds (group A) or 35 seconds (group B) or the fixed injection rate was 4.0 mL/sec (group C). Computed tomography (CT) at the L3 vertebral level was performed before and after contrast material injection. Aortic peak time, aortic peak enhancement, and period when aortic enhancement is 200 HU or greater (T200) were calculated. The Pearson product-moment correlation coefficient (r) was used to investigate relationships between patient weight and aortic peak time, aortic peak enhancement, and T200 in each group. RESULTS: A significant correlation between aortic peak time and patient weight (r = 0.91, P <.001) was observed in group C. No significant correlations between patient weight and aortic peak time were observed in group A (r = 0.16, P =.21) or B (r = -0.05, P =.69). A significant inverse correlation between aortic peak enhancement and patient weight (r = -0.70, P <.001) was observed in group C. No significant correlations between patient weight and aortic peak enhancement were observed in group A (r = 0.09, P =.48) or B (r = 0.10, P =.41). A significant correlation between T200 and patient weight (r = 0.72, P <.001) was observed in group C. No significant correlations between patient weight and T200 were observed in group A (r = 0.12, P =.34) or B (r = 0.001, P =.99). CONCLUSION: Aortic peak time, aortic peak enhancement, and T200 were closely related to injection duration in the protocol with contrast material dose determined according to patient weight.     

Tests of muscle power output: the role of body size

The effect of body size on the output of the tests of directly assessed muscle power has been mainly ignored in the applied research. We hypothesized that the muscle power output would reveal a positive relationship with body size closely in line with the theoretical predictions, as well as that the strength of the studied relationship could justify standardized normalization procedures applied in routine testing. Male physical education students (n = 111) were evaluated in 10 standard tests of direct assessment of muscle power output. A standard allometric relationship P = A SB was applied to assess the relationship between the tested power output P and selected indices of body size S ( B = allometric exponent; A = parameter). The correlation coefficients obtained between the tested power output and body size ranged within 0.21 - 0.56 for body mass and 0.10 - 0.49 for body height. The mean (SD) values of the allometric exponents B obtained with respect to body mass and body height were 0.55 (0.15) and 1.15 (0.62), respectively. This relationship proved to be strong enough to merit applying a standard normalization. The normalization method should be based on body mass as a preferred index of body size, while the allometric exponent could correspond to the theoretically predicted one (i.e., B = 0.67).