彩超对慢性肾功能衰竭诊断的观察（附30例报告）

目的：利用彩色多普勒血流显像,对慢性肾功能衰竭者肾脏的血液动力学进行观察。方法：使用仪器是Acuson128彩色多普勒超声仪,探头频率为3．5HMz,对30例慢性肾功能衰竭的患者肾脏的大小、肾回声强度及肾脏血流动力学参数进行了检测。结果：肾功能衰竭的第Ⅰ期病人上述指标均无明显改变;第Ⅱ期肾脏大小较第Ⅰ期减小,肾回声出现改变,但肾脏的RI指数与正常对照组比较无显著差异（P＞0．05）;第Ⅲ期肾脏大小较第Ⅱ期减小,肾回声出现明显异常,RI指数增高（P＜0．01）;第Ⅳ期,即尿毒症晚期,肾脏萎缩,肾实质回声明显增强,肾内血供明显减少,RI指数明显增高（P＜0．01）。结论：利用彩色多普勒血 流像可对慢性肾功能衰竭的分期进行诊断。     

慢性肾功能衰竭患者环丙沙星药物动力学研究

对８例健康志愿者，１１例慢性肾功能衰竭患者（Ｃｃｒ＜１０ｍｌ／ｍｉｎ）静脉恒速滴注乳酸环丙沙星２００ｍｇ（３０ｍｉｎ）注射液后的临床药物动力学进行了研究，用高效液相色谱法对血清中环丙沙星进行测定，主要药动学参数分别是滴注完时浓度Ｃｏ健康人组为２．２６ｍｇ／Ｌ，未透析组为２．５２ｍｇ／Ｌ，血透组为２．３７ｍｇ／Ｌ，腹透组为２．３５ｍｇ／Ｌ。清除相半衰期健康人为２．７±０．８ｈ，未透析组为１５±４ｈ，血透组为５．０±１．９ｈ，腹透组为６．３±２．７ｈ。表明慢性肾功能衰竭患者的环丙沙星药物动力学过程较健康者有明显的改变，根据以上数据提出慢性肾功能衰竭时的一些给药方案     

慢性肾损害肾血流动力学改变的观察

对９２例健康人及慢性肾损害肾功不全各期５１例患者，进行肾内各分级动脉血流测定。结果显示肾功代偿期肾血流各参数与正常对照组差异无显著性，而肾功不全氮质血症期和尿毒症期，与正常对照组及二组之间血流各参数均有显著性差异。而随着肾损害肾功不全的加重，Ｖｍａｘ，Ｖｍｉｎ、ＴＡＭＸ渐近下降，ＰＩ，ＲＩ、Ｓ／Ｄ逐渐增高，因此通过肾内血流的测定，观察血流动力学的改变，可反映肾损害的程度和肾功能状况。     

90例高血压病患者脑血流动力学观察与分析

<正>高血压是引起脑血管病变的重要危险因数之一。为了了解高血压病患者的脑血流动力学状况,本文对90例高血压病患者进行经颅多普勒超声(transcranial doppler sonography,TCD)检测并进行对照分析,报道如下。1资料与方法1.1临床资料本组患者90例,均为临床诊断的高血压病患者,其中男性56例,女     

经颅多普勒超声对脑死亡患者颅内血流动力学的观察

目的 观察脑死亡患者的脑血流频谱演变过程.方法 采用经颅多普勒超声(TCD)检测脑死亡患者双侧大脑中动脉(MCA)的血流情况.结果 20例临床诊断脑死亡患者的MCA血流速度6～37 cm/s,平均(12.13 ±3.15) cm/s.频谱变化有振荡波(舒张期反向波)、钉子波(收缩期尖小波形)、无血流信号三种TCD特征性频谱,并随病情进展依次出现.20例患者均在出现振荡波频谱后8d内出现心跳不可逆停止,其中有90％(18例)的患者血流频谱出现振荡波-钉子波-无血流信号的演变过程.结论 振荡波、钉子波及血流信号消失这三种规律性演变的特征性TCD血流频谱能辅助脑死亡的诊断.     

慢性乙型肝炎门脉血流动力学及病理学研究

目的　研究慢性乙型肝炎 (CHB)门脉系多普勒超声 (CDFI)血流动力学改变与肝组织病变的关系。方法　本组 82例CHB皆为住院患者 ,在实施CDFI检测的同时进行肝组织活检诊断。CDFI检测与病理学诊断采用双盲法。肝CDFI检测CHB患者的门静脉主干 (MPV)、门静脉左支矢状部 (LPV)、门静脉右支(RPV)、脾门处脾静脉 (SPV)、血流动力学变化 ,即内径 (D ,cm)及流速 (cm/s)。结果　CDFI提示各组CHB患者上述静脉的V与对照组相比除CHB轻型外皆显著降低 (P <0 0 1) ,D示扩大 ,但仅在门脉高压组差异有显著意义 (P <0 0 1)。结论　CDFI提供的数量化信息能较好地鉴别CHB不同的组织病理学表现 ,有着重要的实用价值     

慢性肾功能衰竭患者的护理

慢性肾功能衰竭是常见的一种临床综合征,一般为不可逆病变,病程长达数年,给患者精神和生活带来很大的痛苦。通过针对性护理,能显著延长患者的生存时间,提高患者的生存质量。     

慢性肾功能衰竭患者心理健康调查报告

1资料与方法 资料主要来自江西省人民医院肾内科住院的50例慢性肾功能衰竭患者(住院时间为31.5±4.6d)进行调研.其中,男性28例,女性22例,年龄24～62岁,平均41.30±11.46岁.病程5.46±5.15a.入院检查,血肌酐590.10±286.42μmol/L,尿素氦28.50±16.26mmol/L,内性肌酐清除率21.88±13.36mol/L.并选择50名健康人作为对照组,男28名,女22名,年龄22～64岁,平均42.92±12.36岁,其年龄,性别与研究组相比差异无显著性(P＞0.05)采用心理测评工具[1]:(1)症状自评量表Scl-90.(2)抑郁自量表(SDS).(3)焦虑自评量表(SAS).(4)艾森克人格量表(EPQ).(5)生活事件量表(LES).以上量表均由被试者根据自己实际状况填写,并将所得数据进行统计分析.     

Effects of nitrendipine and cilazapril on renal hemodynamics and albuminuria in hypertensive patients with chronic renal failure.

In 11 hypertensive patients with chronic renal failure we studied the short-term effects of the calcium antagonist nitrendipine, the angiotensin-converting enzyme inhibitor cilazapril, and the combination of both drugs on blood pressure, renal hemodynamics, and proteinuria in a randomized, double-blind, placebo-controlled way. After one week of treatment, blood pressure at 2-5 h after drug administration amounted to 159 +/- 5/101 +/- 3 mm Hg (means +/- SEM) during placebo. Nitrendipine, cilazapril, and the combination lowered mean arterial pressure by 1.4 +/- 1.6 (NS), 6.0 +/- 1.7 (p less than 0.10), and 10.3 +/- 2.1% (p less than 0.01), respectively. Glomerular filtration rate did not change. As compared to placebo, renal blood flow increased and renal vascular resistance decreased significantly during the combination. Filtration fraction amounted to 22.7 +/- 1.2% during placebo and was 22.0 +/- 1.4 (NS), 20.4 +/- 1.2 (p less than 0.01), and 20.5 +/- 1.4% (p less than 0.05) during nitrendipine, cilazapril, and the combination, respectively. During nitrendipine, albuminuria was slightly higher than during placebo: 0.86 +/- 0.39 vs. 0.58 +/- 0.25 mg/min (NS). During cilazapril alone and during the combination of both drugs, albuminuria was lower as compared to nitrendipine: 0.38 +/- 0.14 mg/min (p less than 0.01) and 0.44 +/- 0.18 mg/min (p less than 0.01), respectively. The data suggest that the combination of nitrendipine and cilazapril is an effective treatment in renal hypertension. In addition, cilazapril alone as well as the combination with nitrendipine reduced albuminuria, possibly by decreasing filtration fraction and/or reduction of blood pressure.     

卡维地洛对慢性心衰合并肾功能不全患者肾功能的影响

目的:评价卡维地洛对慢性心衰(CHF)合并慢性肾功能不全(CRF)患者肾功能的影响。方法:入选27例CHF合并CRF患者,在充分抗心力衰竭治疗的基础上,加用卡维地洛,观察不同阶段左室射血分数(LVEF)和肾功能的变化。结果:卡维地洛治疗后,LVEF在治疗3个月后开始升高,12个月后显著高于基线水平(p<0.01)。治疗后1个月,血肌酐(Scr)升高(p<0.05),3个月时回落到基线水平以下(p<0.05),12个月时仍低于基线水平(p<0.05);治疗后1个月,内生肌酐清除率(Ccr)先轻度下降(p<0.05),3个月时回升高于基线水平(p<0.01),12个月时仍显著高于基线水平(p<0.01)。卡维地洛对尿微量白蛋白和24h尿蛋白定量影响不大(p>0.05)。结论:第三代β-受体阻滞剂卡维地洛,可改善慢性心衰合并慢性肾功能不全患者的心功能,早期引起肾功能的轻度降低,随后肾功能显著改善。     

Metabolism of procainamide in patients with chronic heart failure,chronic respiratory failure and chronic renal failure

Summary Fractional hydrolysis and acetylation of procainamide, acetylation of procainamide-derived p-aminobenzoic acid and plasma hydrolysis of procaine were studied in 20 patients with chronic heart failure (CHF), 20 patients with chronic respiratory insufficiency (CRI) and 20 patients with chronic renal failure (RF). The results were compared with those obtained in a group of 20 normal volunteers. Hydrolysis of procainamide and procaine were reduced in patients with CHF and CRI, but not in patients with RF. Moreover, more marked decreases in procainamide and procaine hydrolysis were seen in subgroups with secondary hepatic dysfunction. The diminution of hydrolysis of procainamide was not paralleled by changes in acetylation of procainamide or p-aminobenzoic acid. It is concluded that in patients with hepatic involvement secondary to advanced CHF or CRI, hepatic and plasmatic hydrolysis activity is decreased to a degree equivalent to primary liver failure.Preliminary results presented at the Seventy-eight Annual Meeting of the American Society for Clinical Pharmacology and Therapeutics, Dallas, Texas 1977.Supported in part by a grant from Centre de Recherche Merrell International.Recipient of a Merck Sharp & Dohme International Fellowship in Clinical Pharmacology.     

左卡尼汀联合疏血通治疗慢性肾功能衰竭的疗效观察

目的观察左卡尼汀联合疏血通治疗慢性肾功能衰竭的临床疗效及安全性。方法94例慢性肾功能衰竭患者按随机原则分为A组和B组各47例,A组采用左卡尼汀联合疏血通治疗,B组采用疏血通治疗。观察两组治疗总有效率、不良反应发生率及血清尿素氮、肌酐、高半胱氨酸水平。结果两组治疗30d后,A组治疗总有效率高于B组（P〈0．05）,A、B两组不良反应发生率差异无统计学意义（P〉0．05）。血清尿素氮、肌酐、高半胱氨酸水平治疗后A组与B组比较,差异均有统计学意义（均P〈0．05）。结论在慢性肾功能衰竭患者中采用左卡尼丁联合疏血通治疗效果明显,不良反应少。     

肾活检用于慢性肾脏病急性肾衰竭患者中的诊断效果分析

目的探讨肾活检用于慢性肾脏病急性肾衰竭患者中的诊断效果。方法选取本院2010年1月~2016年1月接诊的慢性肾脏病急性肾衰竭患者50例,分别对其进行肾活检及血清胱抑素C检测,比较两种方法的诊断结果,并分析患者的临床诊治及转归情况。结果肾活检对急性肾衰竭的检出率为100%,血清胱抑素C检测肾衰竭的检出率为82%,差异有统计学意义(P0.05)。50例患者经过肾活检检查后,对原有的诊断进行修正,同时改变了原来的治疗方案,积极治疗的原发病的同时,将病因去除,其中38例患者的肾功能恢复基础水平,9例患者血肌酐水平下降超过15%,2例患者肾功能无变化,1例患者进行维持性透析。结论血清胱抑素C检测可作为早期筛查急性肾衰竭的重要指标,对于慢性肾脏病急性肾衰竭诊断困难的患者,可采用肾活检进行诊断,其创伤小、操作简单,易被患者接受,可明确肾脏疾病病理类型,为治疗方案的制定提供可靠的依据,使患者尽早的接受治疗,恢复肾功能,改善生活质量。     

Teicoplanin pharmacokinetics in patients with chronic renal failure

The pharmacokinetic profile of teicoplanin, a new glycopeptide antibiotic active against Gram-positive aerobic and anaerobic bacteria, was studied in 5 healthy male volunteers and 29 adult patients with various degrees of renal impairment, given a single 3 mg/kg intravenous dose. Teicoplanin was assayed in plasma and urine specimens by a microbiological method. Pharmacokinetic parameters for teicoplanin were estimated both by a 3-compartment open pharmacokinetic model and by non-compartmental analysis. Elimination half-life increased with the decrease in creatinine clearance and mean values ranged from 41 hours in volunteers to 163 hours in anuric patients. Renal failure did not affect either the volume of distribution of the central compartment (mean approximately 0.09 L/kg) or the steady-state volume of distribution (mean approximately 0.9 L/kg). Both total and renal clearance decreased with severity of disease, particularly the latter, while non-renal clearance was unaffected by renal failure. Average values were from 19 to 6 ml/min for total clearance and from 12 to 0.4 ml/min for renal clearance. There was a linear correlation between the total clearance of teicoplanin and creatinine clearance, as well as between renal clearance and creatinine clearance. The total urinary excretion of active teicoplanin averaged 65% of the administered dose in normal subjects, but was significantly reduced in the presence of renal insufficiency. Guidelines for administration of teicoplanin in patients with renal failure are given.     

卡维地洛对慢性心力衰竭患者神经内分泌和血流动力学的影响

目的　比较卡维地洛 (Carvedilol)与美托洛尔 (Metoprolol)对慢性心力衰竭 (CHF)患者神经内分泌激素和血流动力学的影响。方法　 80例 CHF患者 ,随机分为卡维地洛组和美托洛尔组。观察治疗前后脑钠素 (BNP)、去甲肾上腺素 (NE)和左室射血分数 (LVEF)、平均肺动脉压(MPAP)、肺楔压 (PCWP)的变化。结果　卡维地洛组较美托洛尔组显著降低 BNP、NE、MPAP和 PCWP(P<0 .0 5) ,较美托洛尔组明显提高 L VEF(P<0 .0 5)。结论　卡维地洛抗交感活性作用强于美托洛尔 ,能显著降低 BNP、NE水平 ,血流动力学改善优于美托洛尔     

Pharmacokinetics of aztreonam in patients with chronic renal failure

The elimination kinetics of aztreonam (SQ 26,776), a new, completely synthetic, monocyclic beta-lactam antibiotic, were studied after the administration of a single 1g intravenous dose. Five healthy volunteers and 20 patients with various degrees of renal insufficiency were enrolled in this study. Concentrations of aztreonam in serum and urine were determined by both microbiological and high pressure liquid chromatography (HPLC) assays. The pharmacokinetic parameters for aztreonam were calculated on the basis of a 2-compartment open model. Serum concentrations of aztreonam at 10 minutes after administration were approximately 100 micrograms/ml in all subjects, regardless of renal function (HPLC assay). The mean serum half-life during the alpha-phase showed no important variation with renal function. The mean serum half-life during the beta-phase was 1.8 hours in normal subjects and 8.4 hours in haemodialysis patients (HPLC assay). There was a linear correlation between the serum clearance of aztreonam and creatinine clearance. The mean cumulative urinary recovery of aztreonam in 48 hours was 60 to 70% of the administered dose in normal subjects but this was reduced in the presence of renal insufficiency. SQ 26,992, the microbiologically inactive metabolite of aztreonam resulting from hydrolytic opening of the beta-lactam ring, was undetectable in the serum of normal subjects but was found in low levels in uraemic patients. Half of a 1g intravenous dose of aztreonam was eliminated during 4 hours of haemodialysis. Guidelines for administration of aztreonam in the presence of renal failure are given.     

Pharmacokinetics of quinine in patients with chronic renal failure

Methods: We investigated the pharmacokinetics of quinine (Qn) following administration of a single oral dose of 600 mg Qn sulphate in six male Thai patients with a moderate degree of chronic renal failure (CRF), and six male Thai subjects with normal renal function. Results: The drug was well tolerated in both groups of subjects; no major adverse reactions were observed. A marked alteration in the pharmacokinetics of Qn was found in patients with CRF compared to healthy subjects; there were six signifiicant changes in the pharmacokinetic parameters. Absorption was delayed, but increased in CRF (t_max 4.5 vs 1.6 h, C_max 6.17 vs 3.45 g·ml^–1). Total clearance was significantly reduced 0.94 vs 2.84 ml·min^–1·kg^–1, whereas V_z/f remained unchanged (1.82 vs 2.78 1·kg^–1). This resulted in the increased values of AUC and prolongation of the t_1/2z and MRT in the patients (AUC 181.5 vs 61.8 g·min^–1·ml^–1, t_1/2z 26 vs 9.7 h, MRT 36.4 vs 11.3 h). Median concentrations of plasma unbound fraction of Qn collected at 4 h after drug administration in patients and healthy subjects were 7.3 vs 9.8%, respectively.