血液透析治疗鱼胆中毒致急性肾衰竭13例疗效观察

近十年来,我们采取血液透析治疗13例重症鱼胆中毒并急性肾衰竭的患者,报道如下。     

血液透析串联血液灌流治疗鱼胆中毒评价

进食生鱼胆在我国南方地区特别是农村十分常见,民间流传鱼胆有“清热解毒,明目止咳”的作用,时有生食或以酒吞服,常有鱼胆中毒事情发生,病死率约169／6。我院采用血液透析（HD）串联血液灌流（HP）治疗鱼胆中毒合并急性肾衰竭患者48例,疗效满意。     

血液净化抢救鱼胆中毒疗效观察

因民间有鱼胆能明目的说法,因此鱼胆中毒是农村一种常见的急症.本院从1998年至2003年,共收治20例鱼胆中毒致急性肾功能衰竭患者,予以血液透析(HD)加血液灌流(HP)治疗,取得良好疗效.     

冬虫夏草及其制剂在肾脏病中的应用及机制探讨（下）

3临床应用研究 3．1肾小管间质疾病 3．1．1急性肾小管损伤沈颖等将鱼胆中毒、庆大霉素肾损伤及流行性出血热所致急性肾衰竭病人，分成常规治疗（包括血液透析，16例）及常规加冬虫夏草治疗（31例）两组进行观察，共观察5周，结果显示加用冬虫夏草组的病人尿渗透压升高及N-乙酰-β-葡萄糖苷酶（NAG）下降均比常规治疗组快，提示冬虫夏革可能促进肾小管上皮细胞修复。     

鱼胆中毒急性肾功衰应用血液透析的护理

近年来,我室先后应用血液透析法治疗了鱼胆中毒所致急性肾功能衰竭,肝肾综合症患者3例,取得比较好的效果。现将治疗中的护理体会介绍如下: 一、临床资料: 本组病例:男,2例,女,1例,年龄50～55岁。2例患者因服鱼胆为药方清目,1例食未烧熟鱼胆在内的鱼杂。均于2小时后出现腹胀不适,恶心、呕吐,继而尿少、尿闭。发病后6天,血尿素氮升高为19.64～33.92mmol/L,肌酐升高为760.26～1290.67μmol/L,病情加重故应用血液透析疗法治疗。     

血液透析与血液灌流治疗砷化物中毒效果观察

目的探讨联合应用血液透析与血液灌流治疗砷化物中毒的临床应用及护理特点。方法对27 例急性砷化物中毒患者联合应用血液透析与血液灌流治疗(观察组),并与19 例非透析治疗患者比较(对照组)住院天数及肾功能等检查指标。结果观察组住院天数缩短,肾功能及血、尿砷恢复正常时间均明显优于对照组(P< 0. 05,P<0.01)。结论联合应用血液透析和血液灌流是治疗急性砷化物中毒的基础,而其治疗过程中的基础护理、心理护理、透析和灌流护理是抢救成功的重要环节。     

内皮素受体拮抗剂阿魏酸钠在鱼胆中毒所致急性肾衰竭中疗效观察

笔者对我院 1995年～ 2 0 0 3年 2月收治的 98例鱼胆中毒所致急性肾衰竭患者用阿魏酸钠治疗组 ,并与对照组 6 4例进行对照分析 ,兹报道如下。资料与方法1　一般资料　均为 1995年～ 2 0 0 3年我院收治病例 ,均具备下列条件 :(1)病前肾功能均正常 ,均在服用鱼胆后血肌酐迅速升高 ,肾小球滤过率下降超过原来的 5 0 %以上。根据王海燕的《肾脏病学》第 2版诊断标准 ,均符合急性肾衰竭诊断。 (2 )所有病例均排除肾前性因素、肾后性梗阻所致急性肾衰竭。其中男 70例 ,女 92例 ,年龄 10岁～ 6 8岁。将病例随机分为治疗组和对照组。治疗组 98例 ,其…     

联合血液净化治疗急性鱼胆中毒合并多器官功能障碍综合征的效果

目的 探讨联合血浆置换、连续血液净化和血液灌流治疗急性鱼胆中毒合并多器官功能障碍综合征的临床疗效.方法 采用回顾性分析,以27例接受血浆置换+连续血液净化+血液灌流的鱼胆中毒患者为治疗组,20例接受连续血液净化+血液灌流的鱼胆中毒患者为对照组,比较两组患者治疗效果.结果 与对照组比较,治疗组患者血液净化时间、痊愈时间、各脏器功能恢复正常时间显著缩短(均P＜0.05).结论 联合血浆置换+连续血液净化+血液灌流治疗鱼胆中毒合并多器官功能障碍综合征的临床疗效显著优于连续血液净化+血液灌流治疗方案.     

35例各种中毒引起的急性肾衰竭临床分析

目的:探讨各种中毒引起的急性肾衰竭(acuterenalfailure,ARF)的临床特点。方法:对35例各种中毒引起急性肾衰竭患者的临床资料进行回顾性比较分析。结果:35例引起ARF病例中,鱼胆中毒22例、蛇咬伤8例、狗咬伤1例、毒蕈中毒1例、黄蜂蛰伤1例、农药中毒1例、一氧化碳中毒1例。其中以农民居多(30例)。ARF临床表现为少尿型32例,非少尿型3例。患者就诊时血尿素氮(BUN)平均为(26.9±11.5)mmol/L,血肌酐(Scr)平均为(1216.5±395.4)μmol/L,伴肝功能损害26例(以鱼胆中毒者发生率最高为19/12)。治愈32例,死亡3例,早期洗胃和及时的血液净化治疗有助于各种中毒引起ARF的恢复。结论:各种中毒引起ARF的主要病因是鱼胆中毒及蛇咬伤。临床表现为少尿型ARF及肝毒性ARF,恢复较快,预后相对较好。在农村普及卫生知识是预防ARF的关键。     

血液净化治疗急性鱼胆中毒并多脏器功能衰竭的临床观察

近年来，笔者采用血液灌流（HP）联合血液透析（HD）、血流滤过（HF）治疗急性鱼胆中毒并多脏器功能衰竭（MSOF）患者8例，取得良好的效果，报道如下。     

Rehabilitation renal failure due to poisoning

The cases of acute renal failures due to poisoning treated at the artificial kidney department of the University, Department of Urology in Budapest are received. The patients were readmitted later to check their renal function. Prognosis was best in the group with mercury poisoning where renal function of the survivors was completely restored. Similarly promising are the results in other types of poisoning if the patients can be made to survive the acute period. It is emphasized that if poisoning results in symptoms indicating acute renal failure, the patient must be transferred to an artificial kidney department as soon as possible.     

Clinical spectrum of accidental hemlock poisoning: neurotoxic manifestations, rhabdomyolysis and acute tubular necrosis.

In the past, hemlock poisoning was only known for its neurotoxic effects; quite recently non-neurological features, consisting of rhabdomyolysis and acute renal failure, have been also described. Here we report our experience with these clinical findings, which we frequently observe in accidental hemlock poisoning. Between 1972 and 1990 we studied 18 patients: 17 of them were poisoned by conline (an alkaloid of Conium maculatim) in Apulia (Italy), and one by cicutoxin (the active principle of water hemlock) in New Mexico (USA). In the non-rapidly-fatal cases we tested myoglobinuria, serum muscle enzymes, and renal function. In the patients with acute renal failure we performed microscopical examination of kidney specimens; immunohistochemistry was carried out to identify myoglobin and actin in tubules. Coniine was detected in urine, serum, or tissues. Neurological features were present in all of our cases: coniine had a curare-like effect on the neuromuscular junction, whereas cicutoxin was convulsant on the central nervous system. In addition rhabdomyolysis was noted in the 17 subjects poisoned by coniine. Acute renal failure was observed in five patients; it was confirmed by histological evidence of tubular necrosis with intratubular deposition of myoglobin and actin released by rhabdomyolysis. Our cases seem to be the first with histopathologically proven acute tubular necrosis in coniine intoxication. In conclusion, in hemlock poisoning neurotoxic manifestations may be accompanied by rhabdomyolysis and acute tubular necrosis; increased awareness of these clinical features is recommended in order to improve the diagnostic and therapeutic procedure.     

Artificial renal supports in surgery--present status and problems

Clinical and surgical situation and problems of the blood purification as an artificial renal supports, including hemodialysis, hemofiltration and hemoadsorption, were studied especially fields related with treatment of acute renal failure (ARF), surgeries in the patients treated with chronic hemodialysis and supportive care for the cadaveric renal transplantation. ARF: Our experimental data using septic rats showed that hemoadsorption activated host's reticuloendothelial function and consequently increased survival rate of septic rats. Clinically, similar results were observed by the combination of hemodialysis and hemoadsorption, and the survival rate of ARF with multiple organ failure increased to 68% (21 out of 31 cases) from 30% (8 out of 27) in the patients treated with only hemodialysis. Surgery in the chronic hemodialysis patients: One hundred twenty two operations have been done among the patients treated with chronic hemodialysis in our clinic. However, 15 in emergency cases were died within post operative period. There is no operative death in scheduled operations including total esophagectomy and simultanous radical operation of gall bladder cancer and colon cancer. Pre- and post operative supportive management with immunopotentiator, opsonic protein, coagulative factors and intravenous hyperalimentation with branched chain rich amino acid solution should be added routinely to artificial renal supports in pre- and post operative period. Cadaveric renal transplantation: Eighty-seven percent of cadaveric renal transplantation in our clinic were needed artificial renal support in early phase of post transplantation period because of insufficient renal function by acute tubular necrosis. Necessity of the acceptance of brain death category in Japan is strongly pleaded.     

Acute dichromate poisoning after use of traditional purgatives. A report of 7 cases

Seven cases of dichromate poisoning after the use of purgative solutions obtained from nyanga (traditional township healers) are reported. The patients all presented in established renal failure requiring dialysis, and all had abnormal liver function tests. One patient who took dichromate orally died from massive gastro-intestinal haemorrhage. Six patients took dichromate solutions as rectal enemas, 2 were left with impaired renal function and 1 required a permanent colostomy as a result of extensive peri-anal necrosis. The clinical presentation of acute renal failure, gastro-intestinal haemorrhage and hepatocellular dysfunction should alert the physician to the possibility of dichromate poisoning. The diagnosis, management and the role of dialysis in dichromate poisoning are reviewed.     

Current management of gall bladder perforations

BACKGROUND: Gall bladder perforation is a serious complication of acute cholecystitis. The purpose of the present study is to evaluate the presenting symptoms, diagnosis and management of patients with gall bladder perforations. METHODS: A retrospective study was undertaken of 31 consecutive patients with gall bladder perforation in a single unit of a tertiary referral hospital, between January 1996 and December 2001. RESULTS: The incidence of gall bladder perforation was 5.9% of all cases of acute cholecystitis. Associated comorbidity was quite common (58%). Ultrasound and computed tomography scans of the abdomen are sensitive investigations. Ultrasound guided percutaneous drainage helps in tiding over the emergency. The morbidity (35%) and mortality (9.6%) is considerable. CONCLUSION: The patterns of presentations, diagnosis and management of gall bladder perforation are changing. But there is scope for improvement.     

腹腔镜胆道镜联合治疗胆囊息肉34例报告

目的:探讨内镜保留胆囊治疗胆囊息肉的方法。方法:2003年11月至2004年10月为34例胆囊息肉样病患者行腹腔镜结合胆道镜联合治疗,摘除息肉。结果:共摘除息肉107枚,仅1例增生活跃,术后康复快,息肉切除率100%。结论:利用腹腔镜和胆道镜联合治疗胆囊息肉可达到微创摘除息肉,保留了胆囊的功能,具有重要的临床意义。     

Anesthetic management of exploratory laparotomy for a patient with panperitonitis with hyperkalemia: a case report of spontaneous rupture of the urinary bladder

A 71-year-old woman was admitted with panperitonitis, hyperkalemia and acute renal failure. Immediately after a large amount of ascites had been drained by laparotomy, hyperkalemia and acidosis were remarkably improved. During the operation, rupture of the urinary bladder was detected and repaired. The level of potassium and renal function became normal the next morning, and it seemed that peritoneal-self-dialysis had been related to hyperkalemia and acute renal failure. Rupture of the urinary bladder is very rare but should be considered in any cases of acute abdomen with hyperkalemia and acute renal failure.     

经皮经肝胆囊穿刺置管引流治疗合并肝硬化的急性胆囊炎

【摘要】〓目的〓探讨经皮经肝胆囊穿刺置管引流治疗对合并肝硬化门静脉高压症的急性胆囊炎患者的安全性及疗效。方法〓回顾性分析于2013年9月到2014年12月进行经皮经肝胆囊穿刺置管引流术治疗的合并肝硬化高压症急性胆囊炎患者12例。其中,肝功能Child-pugh A级7例,Child-pugh B级5例,分析12例患者经皮经肝穿刺胆囊置管引流术后并发症发生情况、术后炎症消退情况、术前后肝功能变化情况。结果〓12例患者均通过皮经肝胆囊穿刺置管引流术治疗后胆囊炎症消退,并择期成功行腹腔镜下胆囊切除术。其中,有2例患者因穿刺出现腹腔内出血,后经保守治疗后出血停止。无胆瘘发生。术后部分患者肝功能有所改善。结论〓经皮经肝穿刺胆囊置管引流治疗对合并肝硬化的急性胆囊炎是一种安全的治疗方法,可作为后续安全地施行腹腔镜下胆囊切除术的过渡。     

Paracetamol (acetaminophen) poisoning resulting in acute renal failure without hepatic coma

We report two cases of acute renal failure following paracetamol (acetaminophen) poisoning. Both received adequate treatment with N-acetyl cysteine and neither showed any evidence of fulminant liver damage, yet acute renal failure due to tubular necrosis developed.     

血液透析及肾移植患者的胆道结石手术

目的:探讨血液透析及肾移植患者的胆道结石手术的可行性。方法:对10例血液透析及16例肾移植患者的胆道结石手术进行总结。结果:除1例患者伤口裂开,1例患者胆囊窝积液,1例并发上呼吸道感染外,其余患者均恢复良好。结论:血液透析及肾移植患者的胆道结石手术在充分准备和加强安全的措施下是可行的。