蔗糖铁联合大剂量EPO治疗血透患者肾性贫血的疗效

目的比较静脉注射蔗糖铁与口服硫酸亚铁补铁联合大剂量EPO治疗维持性血液透析患者肾性贫血的疗效及安全性。方法将80例维持性血液透析患者随机分为试验组和对照组,每组各40例。试验组将蔗糖铁100 mg加入100 ml生理盐水中,于血透结束前5 min从血透静脉端注入血液中,2次/w,血透2～4次/w;对照组采用口服硫酸亚铁缓释片0.45 g,2次/d。两组患者均同时给予静脉注射重组人红细胞生成素1万U,2次/w。观察两组患者治疗前、治疗后不同时间血红蛋白水平、肾功能指标及不良反应。结果两组患者的血红蛋白水平在治疗4、8 w后,均较治疗前显著升高（P〈0.05或P〈0.01）,血球压积也较治疗前明显升高（P〈0.05或P〈0.01）,但试验组的血红蛋白及血球压积较对照组升高更显著（P〈0.05）。两组患者的肾功能指标及不良反应均无明显差异。结论在使用大剂量EPO治疗贫血过程中,注射用蔗糖铁是治疗维持性血液透析患者肾性贫血的有效补铁药物。     

多糖铁复合物对妊娠期缺铁性贫血的疗效观察

目的比较妊娠期缺铁性贫血患者口服多糖铁复合物与复方硫酸亚铁叶酸片对改善贫血的疗效及不良反应。方法收集2009—2011年我院妇产科缺铁性贫血住院患者108例,随机分为治疗组（口服多糖铁复合物300mg／d治疗）和对照组（口服复方硫酸亚铁叶酸片900mg／d治疗）。治疗4W后复查血红蛋白（Hb）、红细胞计数（RBC）、红细胞压积（HCT）,并进行疗效比较,同时记录药品不良反应。结果多糖铁复合物与复方硫酸亚铁叶酸片均可使Hb、RBC、HCT升高（P〈0．05）;两组治疗后比较,治疗组Hb、RBC升高更加明显（P〈0．05）,HCT无显著性差异（P〉0．05）。两组总有效率无显著性差异（P〉0．05）,治疗组的不良反应发生率明显低于对照组（P〈0．01）。结论口服多糖铁复合物改善妊娠期缺铁性贫血的效果优于复方硫酸亚铁叶酸片,是一种安全高效、不良反应少的补铁制剂。     

口服与静脉铁剂治疗血液透析患者肾性贫血的疗效比较

目的：比较维持性血液透析患者口服和静脉补铁治疗肾性贫血的疗效和安全性。方法：将29例病情稳定的维持性血透患者随机分为口服组（15例）和静脉组（14例）,观察期6 w,口服组给予力蜚能（含铁150 mg/片）300 mg/d;静脉组于透析后静脉补充科莫菲100 mg/次,总量1 000 mg。检测两组患者治疗前后血红蛋白（Hb）、红细胞压积（Hct）、血清铁蛋白（SF）、血清转铁蛋白饱和度（TSAT）。两组促红素用量为100-150 U/kg,静脉或肌注给药,其他用药不变。结果：治疗后两组患者的上述指标均有显著升高（P〈0.05）,而静脉组升高幅度高于口服组（P〈0.01）;静脉组治疗过程中无副作用发生,口服组有2例轻微胃肠道反应。结论：静脉铁剂和口服铁剂都能有效纠正血液透析患者的铁缺乏,而静脉铁剂较口服铁剂疗效更显著,两者均能显著改善患者肾性贫血状况,不良反应发生率低,安全性好。     

右旋糖酐铁肌注治疗慢性肾衰竭肾性贫血临床研究

目的观察深部肌内注射右旋糖酐铁对于慢性肾衰竭引起的肾性贫血的治疗效果。方法将47例慢性肾衰竭肾性贫血患者,随机分为观察组（n=24）和对照组（n=23）,观察组采用肌肉注射右旋糖酐铁治疗,对照组采用口服琥珀酸亚铁片治疗,治疗时间为10周。结果治疗后观察组的临床有效率明显优于对照组（P〈0．05）,并且较治疗前观察组的血红蛋白（Hb）和红细胞压积（Het）都显著地提高（P〈0．05）。结论肌肉注射右旋糖酐铁对于慢性肾衰竭引起的肾性贫血的治疗效果突出,应推广使用。     

蔗糖铁治疗产后缺铁性贫血疗效观察

目的：观察蔗糖铁治疗产后缺铁性贫血的f临床价值和不良反应。方法：选择产后贫血110例,随机分为观察组和对照组各55例,观察组采用静脉滴注蔗糖铁治疗,对照组采用口服铁剂治疗,观察两组治疗前后血红蛋白、血细胞比容变化情况。结果：观察组治疗7天时,血红蛋白升至（97．4±3．1）g／L,平均上升13．8g／L;第14天升至（100．8±3．1）g／L,平均上升17．5g／L,与对照组比较,差异非常显著（P〈0．01）;治疗第21天,两组血红蛋白比较,差异不显著（P〉0．05）;观察组血红蛋白达正常时间（12±5）天,对照组（20±7）天,两组比较,差异非常显著（P〈0．01）。观察组治疗7天,血细胞比容增加（2．5±0．8）％,对照组增加（1．2±0．7）％,两组比较,差异非常显著（P〈0．01）;治疗14天,观察组增加（4．3±0．9）％,对照组增加（2．4±0．9）％,两组比较,差异非常显著（P〈0．01）;治疗21天,两组比较,差异不显著（P〉0．05）。观察组不良反应显著少于对照组。结论：静脉滴注蔗糖铁治疗产后缺铁性贫血疗效好,有助于产后恢复。     

右旋糖酐氢氧化铁改善血透患者肾性贫血的临床研究

目的 评价右旋糖酐氢氧化铁注射液治疗血透患者铁缺乏,改善贫血的临床疗效.方法 将110例血透患者随机分为静脉补铁组(n=60)和口服补铁组(n=50),分别采取静脉注射右旋糖酐氢氧化铁注射液及口服右旋糖酐铁进行治疗,疗程2个月.对两组治疗前后的血红蛋白(Hb)、血细胞比容(Hct)、血清铁(SF)、血清铁蛋白(SFA)、转铁蛋白饱和度(TSAT)等相关指标分别进行测定和比较.结果 口服补铁组治疗后各项指标与治疗前相比无明显差异(P＞0.05).静脉补铁组治疗1个月后Hb、Hct、SF、SFA、TSAT较治疗前显著增加(P＜0.05);治疗2个月较治疗1个月时显著增加(P＜0.01).结论 静脉补铁优于口服补铁,静脉注射右旋糖酐氢氧化铁能有效纠正血透患者的铁缺乏,提高铁的利用率及基因重组红细胞生成素(rHuEPO)的治疗效果,改善了贫血状态.     

床旁纤维支气管镜引导经鼻气管插管抢救慢性阻塞性肺部疾病呼吸衰竭的临床应用

目的：探讨床边纤维支气管镜（简称纤支镜）引导下经鼻气管插管抢救慢性阻塞性肺部疾病（COPD）呼吸衰竭的临床价值。方法：总结48例喉镜经口插管和床旁纤维支气管镜引导经鼻气管插管所需时间、对生命体征影响、插管成功率、插管结束后并发症。结果：A组和B组插管所需时间差异无显著性（P〉0．05）。A组和B组插管结束后并发症（P〈0．01）。A组和B组插管成功率差异无显著性（P〉0．05）。A组和B组插管前后呼吸频率增加（P〈0．05）。A组和B组插管前后心率增加差异有非常显著性（P〈0．01）。A组和B组插管前后血压增加差异有显著性（P〈0．05）。A组和B组插管前后SPO2降低差异有非常显著性（P〈0．01）。结论：纤维支气管镜引导下经鼻气管插管抢救COPD呼吸衰竭，操作简单、快速、准确、安全，值得临床推广应用。     

肾性贫血治疗中静脉铁剂的合理应用

肾性贫血的治疗,不仅需要合理应用促红细胞生成素(EPO),还需要及时有效地补充铁剂,否则,即使长期大剂量使用EPO,贫血也难以纠正.据统计,在美国接受EPO治疗的终末期慢性肾衰患者中,50%以上存在缺铁[1].对于如何应用EPO,临床上已积累了较为丰富的经验[2],但对于如何补充铁剂临床上还认识不足.由于口服补铁尚未证实有效,静脉补铁近年受到人们愈来愈多的关注,并且临床也证实有效[3,4].本文从临床实用角度,介绍肾性贫血治疗中静脉铁剂的合理应用.     

蔗糖铁注射液治疗血液透析后贫血20例

慢性肾衰患者并发严重的肾性贫血,其主要原因之一为促红细胞生成素缺乏^[1]。自从重组人促红细胞生成素（rHuEPO）用于临床以来,使肾性贫血的治疗取得了突破性进展．极大地改善了肾衰患者的状况;而铁也是血红蛋白生成所必需的,补充铁剂对rHuEPO疗效至关重要。笔者总结分析了静脉用蔗糖铁与口服琥珀酸亚铁治疗尿毒症血液透析患者贫血的临床疗效。     

昆明地区糖尿病患者血液流变学指标检测分析

目的：观察昆明地区糖尿病患者血液流变学指标变化情况。方法：正常对照组36例和糖尿病组30例进行8项血液流变学指标检测并作了比较分析。结果：糖尿病患者血液流变学指标与对照组比较，低切变率下全血粘度、红细胞聚集指数和红细胞变形指数有非常显著性差异（P〈0．01）；中切变率下全血粘度和血浆比粘度有显著性差异（P〈0．05），高切变率下全血粘度和红细胞压积无显著性差异（P〉0．05）。结论：中、低切变率下血流变指标异常，是糖尿病患者发生大血管病变和微血管病变的危险因素。     

Neuroimaging features of neurodegeneration with brain iron accumulation

NBIA characterizes a class of neurodegenerative diseases that feature a prominent extrapyramidal movement disorder, intellectual deterioration, and a characteristic deposition of iron in the basal ganglia. The diagnosis of NBIA is made on the basis of the combination of representative clinical features along with MR imaging evidence of iron accumulation. In many cases, confirmatory molecular genetic testing is now available as well. A number of new subtypes of NBIA have recently been described, with distinct neuroradiologic and clinical features. This article outlines the known subtypes of NBIA, delineates their clinical and radiographic features, and suggests an algorithm for evaluation.     

Theory of nonexponential NMR signal decay in liver with iron overload or superparamagnetic iron oxide particles.

A quantitative theory is proposed for the nonexponential NMR proton signal decay observed in liver with iron overload or superparamagnetic iron oxide particles. This effect occurs for Carr-Purcell-Meiboom-Gill (CPMG) sequences and is argued to be a direct consequence of the strong magnetic field inhomogeneities generated by the iron, rather than being due to tissue compartments. An approximate mathematical form is given for the signal decay, which is fit to experimental data for samples of rat liver with iron oxide particles, for samples of marmoset liver with hemosiderosis, and for in vivo human liver with hereditary hemochromatosis. The fitting parameters obtained are consistent with the pattern of iron deposition determined from histology. For the case of hereditary hemochromatosis, a good correlation is found between a parameter characterizing the nonexponential decay and the iron concentration. Implications for practical MR quantification of hepatic iron are discussed.     

Enhancement of phase-contrast MR angiography with superparamagnetic iron oxide

The effect of superparamagnetic iron oxide particles (AMI-227) was assessed in three-dimensional (3D) phase-contrast (PC) MR angiography (MRA), with various scanning parameters for rats at 1.5 T. The blood T1 and T2 before and after 20 μmol Fe/kg of AMI-227 injection were measured sequentially at .47 T. The visualization of abdominal aorta, renal artery, inferior vena cava, and portal vein was respectively evaluated before and after AMI-227 injection qualitatively by the four confidence levels and quantitatively by analysis of signal-to-noise ratio (SNR) of vessels. The blood T1 and T2 were sufficiently shortened for at least 1 hour after AMI-227 injection. The visualization of each vessel was improved by AMI-227 at various velocity encoding (VENC) value, suggesting the extended application of PC-MRA in various conditions. The optimal flip angle was increased from 20° to 30° in higher VENC after AMI-227 injection, resulting in higher signal from blood flow. Quantitative analyses showed that the optimal flip angle to achieve the maximum SNR seemed to be 20° in unenhanced images, but the optimal flip angle of the high speed flow was increased by contrast enhancement. The postcontrast PC-MRA provides the increased sensitivity of slow flow components, even with a high VENC gradient. AMI-227 can significantly improve SNR to blood vessels during 3D-PC-MRA with various scanning parameters.     

MRI of primary spleen angiosarcoma with iron accumulation.

A case of splenic angiosarcoma with siderotic nodules is reported. The tumor was hyperechoic on ultrasound and had high density on CT and very low intensity on MR. Gandy-Gamna nodules (siderotic nodules) were demonstrated histopathogically.