血液透析血管通路及其并发症

血液透析血管通路及其并发症沙国柱季大玺关键词血液透析血管通路并发症中图法分类号Ｒ４５９．５南京军区南京总医院解放军肾脏病研究所（南京，２１０００２）１９４３年ｋｏｌｆ等采用玻璃或金属管道分别插入动静脉，首次建立血液透析通路，用于终末期肾病（ＥＳＲＤ）...     

血液透析血管通路的选择和并发症的诊治

血液透析血管通路的选择和并发症的诊治汤兵关键词血液透析；血管通路选择；并发症血管通路对透析效果和患者长期存活率有着重要影响。随着血液净化疗法的迅速发展，老年透析患者的逐年增加，以及原发疾病的变迁，血液透析血管通路日趋复杂。现就血管通路的建立和选择，以...     

血管通路血流监测减少了通路并发症和医疗费用

血管通路并发症导致患者每年医疗费用超出8000美元的风险。近年来随着血管通路血流监测(VABFM)程序的应用,在血栓形成前辨认和处理狭窄,通路血栓形成率已有所改善。作者应用超声稀释(ultrasound dilution)法研究VABFM对血栓形成相关并发症事件和医疗费用的影响,并比较有动态静脉压力监测(DVPM)和无监测(NM)对动静脉瘘(AVF)和植入物的影响。     

用血管内超声作血液透析通路评价

植入物失败最常见的并发症是血管和(或)植入物狭窄和血栓形成,血管内超声(IVUS)是检测血管结构微细改变最灵敏的影像技术,本文作者研究用IVUS影像评价血液透析患者血管通路的安全性、可行性和准确度。 方法 22例血液透析患者(男17例,女5例),平均年龄(58±8)岁,所有患者均行前臂合成植入物修复术,平均植入时间为(20±16)个月(1～54个月),基于肾病学家疑为临床血管通路并发症,进行血管造影检查。31次检查中有12次在放射学室进行,19次在透析单位无菌条件下进行。使用3.0或3.5F、20-或30-MHz的IVUS导管,对全部血液透析植入物进行一次投影血管成像评价,以Philip数字血管造     

用Gore—TexPTFE人造血管建立血管通路

用醋酸－地衣红染色的方法对近江牡蛎人工授精的卵子减数分裂和受精过程进行了详细的细胞学观察。精子入卵前，卵子处于第一次减数分裂的前期，精子入卵后，胚泡消失，然后进行两次减数分裂，在海水温度为２８．８℃的情况下，授精后３３ｍｉｎ和４５ｍｉｎ，绝大部分受精卵已排出第一极体和第二极体，雄原核可在第一极体排出后及第二极体排出前任何时期内形成，雌雄原核以联合的方式将两组染色体俣并，授精后１ｈ，大部分卵子完成第     

血液透析血管通路的再循环

血液透析血管通路的再循环赵学智，梅长林关键词血液透析，血管通路，重复循环血液透析时血管通路的再循环（ｄｉａｌｙｓｉｓａｃｃｅｓｓｒｅｃｉｒｃｕｌａｔｉｏｎ）测定、评价及其应用，已引起愈来愈多学者的注意，它可以指导医师对不同透析患者个体化处方的制定，并...     

不同类型血管通路的老年长期血液透析患者并发症比较

目前临床上肾衰竭的治疗主要依赖于血液透析.建立可靠的血管通路是维持血液透析治疗效果的关键环节之一.本研究旨在比较不同手术方式建立血管通路的临床效果与并发症的差异. 1资料与方法 1.1临床资料回顾性分析2010年1月至2011年12月我院进行长期血液透析的253例患者建立长期动静脉内瘘(AVF)的临床资料.均为各种肾脏疾病导致的终末期慢性肾衰竭,其中男136例,女117例,年龄60～78岁,平均(66.4±22.8)岁.     

人造血管透析通路的建立及其临床应用

对于因自身血管条件差或其它原因而不能建立理想自身血管内瘘的维持性血透患者，我们采用聚甲氟乙烯人造血管（ｐｏｌｙｔｅｒｔｒａｆｌｕｏｒｏｅｔｈｙｌｅｎｅ）为这类患者建立了永久性动静脉血管透析通路，并应用于临床取得满意效果。人造血管内瘘具有组织相容性好、通畅率高、血流量大、穿刺方便和使用时间长等特点。     

应用彩色多谱勒超声监测血管通路并发症

应用彩色多谱勒超声监测血管通路并发症关天俊血管通路是维持性血液透析患者的生命线，由于可供动－静脉内疹手术的部位有限，因而延长现有动。静脉内瘘或人造血管内疹的使用寿命在临床上具有重要意义。目前，临床上现有的检测血管通路的方法，要么不准确（如临床通过触诊...     

血液透析患者血管通路感染的诊断及治疗措施

感染是血液透析 (血透 )患者常见的合并症 ,也是导致患者死亡的主要原因之一。美国肾脏病资料库 (ＵＳＲＤＳ)的统计显示 ,1993～ 1995成年人终末期肾脏疾病 (ＥＳＲＤ)患者死亡原因中感染占 15 5 % [1] 。血管通路则是造成血透患者感染的主要危险因素 ,大量研究资料证实 ,4 8%～ 73%的血透患者菌血症是因血管通路感染诱发 ,绝大多数致病菌为葡萄球菌。这些患者的死亡率 (8%～ 2 5 % )及感染复发率(14 5 %～ 4 4% )均高 ,严重的迁移性感染合并症 (细菌性心内膜炎、化脓性关节炎、硬膜外脓肿、细菌性肺栓塞、骨髓炎等 )的发生率则高达 14 …     

Vascular Ehlers-Danlos syndrome: pathophysiology, diagnosis, and prevention and treatment of its complications

The Ehlers-Danlos syndrome consists of a group of inherited connective tissue disorders caused by defects in the synthesis of collagen. The vascular type 4 form of Ehlers-Danlos syndrome (VEDS) is associated with serious vascular complications in young adults, such as the spontaneous rupture of large-caliber and medium-caliber arteries, often without true aneurysm formation or dissection. VEDS is inherited as an autosomal dominant trait that is caused by mutations in the COL3A1 gene. It affects the synthesis and structure of the pro a1 (III) chain of collagen type III, which causes vascular wall weakness. The diagnosis of VEDS is made from major and minor clinical criteria and can be confirmed by abnormalities in procollagen production and molecular genetic testing. Recently, the results of a study using the b-blocker celiprolol demonstrated a reduction in vascular complications of VEDS. The mechanisms of benefit may be related to a reduction in vascular hemodynamic stress with exercise and/or through a reduction in transforming growth factor-b. Inhibitors of the renin-angiotensin system may also be beneficial in VEDS. Surgery may be beneficial in treating the complications of VEDS.     

Vascular complications in diabetes and their prevention

Diabetes mellitus is increasing throughout the world. Cardiovascular disease (CVD) accounts for up to 80% of excess mortality in this high-risk population. Patients with diabetes have the same CVD risk factors as those people without diabetes. However, these risk factors are much more powerful in diabetic patients. CVD risk is especially high for diabetic women, and premenopausal diabetic women lose all the protection normally afforded to them by female sex hormones. Controlled clinical trials have clearly demonstrated that rigorous treatment of blood pressure, dyslipidemia and platelet hyperaggrebility strikingly reduces CVD risk in diabetic patients. Strategies directed at interrupting the renin-angiotensin system (both tissue and systemic systems) and the use of 3-hydroxy-3-methyl-glutaryl coenzyme A (HMG-CoA) reductase inhibitors have proven to be especially beneficial for this high-risk population.     

�����ȵ�����Ӱ���Ƶ��ܹܽ�ʯ�IJ���֢��Ԥ��

内镜下逆行胰胆管造影镜(ERCP)作为一种微创治疗手段,其并发症的发生往往是不可避免的.ERCP术中及术后并发症的发生率报道不一,为6%～11%.ERCP治疗胆总管结石是一种比较成熟的内镜下治疗手段,已在大型医院中普遍开展,尽管治疗性ERCP技术在不断提高,但是在ERCP取石治疗中,仍会出现多种并发症,有的甚至会危及患者生命.在此,需要对ERCP治疗胆总管结石的常见并发症和预防措施进行分析和探讨.     

Vascular dementia: prevention and treatment

Background:

Vascular dementia (VaD) is the most common cause of dementia in the elderly, second only to Alzheimer’s disease (AD). Between 1% and 4% of people of 65 years of age suffer from VaD and the prevalence appears to double every 5–10 years after the age of 65.

Summary:

Prevention aims to reduce the disease by eliminating its cause or main risk factors, particularly hypertension as well as diabetes mellitus, atherosclerosis, coronary artery disease, smoking, lipid abnormalities, and hyperhomocystinemia. Initial studies of several agents for symptomatic treatment were disappointing. However, there is growing evidence for cholinergic involvement in VaD and recent studies with cholinesterase inhibitors have shown improvement in cognitive, global function, and activities of daily living as compared with placebo and have been well tolerated.

Conclusion:

VaD is a common condition and its prevalence is likely to increase. As physicians we need to be diligent with regards to recognition of risk factors and vigorous intervention. Promising results have been seen in several clinical trials of cholinesterase inhibitors and no safety of tolerability issues have been noted.     

红景天对糖尿病血管并发症的防治作用及机制概述

由于生活方式的改变,糖尿病（DM）已经成为威胁国人健康的高发病。DM自身症状并不显著,但其引起的并发症,尤其是血管并发症具有较高的致残、致死率。糖尿病血管并发症（DVC）根据血管类型不同分为大血管病变（冠状动脉疾病和外周血管疾病）和微小血管病变（糖尿病肾病、糖尿病视网膜病变、糖尿病神经病变及糖尿病心肌病）。然而,目前临床上仍缺少治疗糖尿病血管病变的特效药物。红景天是一种临床应用较广的传统药物,可用于治疗动脉粥样硬化（AS）、DM、肾病、缺血/再灌注损伤等多种疾病。红景天具有降血糖、抗氧化应激、抑制血管平滑肌增殖、保护血管内皮细胞、抗AS、促进NO释放等多种作用机制,对DVC具有较好的防治作用。本文回顾了近十年来国内外关于红景天治疗DVC的研究,希望能为当前DVC的研究和治疗提供更多的思路。     

老年血管性认知功能损害及其预防

1 概述与概念 世界各地流行病学资料显示,65岁以上者老年痴呆患病率约为8%.根据现行诊断标准和分类方法,阿尔茨海默病(Alzheimer's disease,AD)是最常见的痴呆类型,占所有病例的1/2～2/3,其次为血管性痴呆(vascular dementia,VaD),约占总痴呆病例的30%,VaD旧称"脑动脉硬化性痴呆"或"多发脑梗死性痴呆",诊断VaD的现行标准要求患者有记忆力下降和其他认知功能损害,其严重程度足以符合痴呆的标准,同时有脑血管疾病的临床或颅脑影像学证据,并且脑血管疾病可能是认知功能损害的原因.