心脏手术后急性肾衰竭患者的病因和预后相关因素分析

目的探讨心脏手术后急性肾衰竭(ARF)的病因和影响预后的因素。方法回顾性分析108例心脏手术后ARF患者的临床资料,采用Cox逐步回归分析心脏手术后ARF影响预后的因素。结果引起ARF的主要原因有心源性低血压50例(46.3%),其他16例,42例病因不明。肾功能恢复47例(43.5%),患者存活38例(占35.2%),死亡70例,死亡的主要原因有多脏器功能不全(MODS)33例,心源性死因26例,其他11例。ForwardCox逐步回归分析提示:功能不全脏器数、少尿、持续低血压和是否透析与死亡明显相关。结论心源性低血压是心脏手术后ARF的主要病因,多数患者死于MODS和心脏并发症;功能不全的脏器多、少尿、持续性低血压和不透析预示死亡率增加;少尿患者及时透析可降低病死率。     

急性心肌梗死后心源性休克患者早期发生急性肾功能衰竭与预后的关系

目的　了解急性心肌梗死后心源性休克患者中早期发生急性肾功能衰竭与预后的关系。方法回顾性分析解放军总医院 1993— 2 0 0 3年因急性心肌梗死或冠心病心绞痛住院、并出现心源性休克患者的临床资料。以 2 4 h内是否出现急性肾功能衰竭为标准 ,比较其住院期间病死率 ;并采用多元 logistic回归分析 ,评估早期发生急性肾功能衰竭对患者预后的影响。结果　 172例患者中 ,5 1例 ( 30 % )于 2 4 h内出现急性肾功能衰竭。早期是否发生急性肾功能衰竭患者的住院病死率分别为 90 % ( 4 6 / 5 1例 )和 5 6 % ( 6 8/ 12 1例 )。逐步回归分析表明 ,早期发生急性肾功能衰竭是影响急性心肌梗死后心源性休克患者预后的独立因素 ,相对危险度 ( OR) =6 .7,95 %可信区间为 2 .5～ 18.0 ,P<0 .0 0 1。结论　急性心肌梗死后心源性休克患者 ,早期急性肾功能衰竭的发生与患者住院病死率显著相关 ,可作为判断患者预后不良的指标     

外周血血小板增高对肾细胞癌的预后意义

目的探讨术前外周血血小板计数对肾透明细胞癌(CCRCC)预后的意义。方法回顾性分析初诊并术后病理证实的292例CCRCC患者的临床资料及随访情况,以患者血小板计数300×109/L为界值将患者分为正常和增高两组,应用Kaplan-Meier法进行生存分析并行Log-rank检验,Cox比例风险模型分析血小板增高及其他临床因素对患者总生存(OS)和无进展生存(PFS)预后的影响。结果该研究CCRCC患者中血小板增高发生率为9.59%(28/292),正常组1年、3年、5年的总生存率和无进展生存率分别为100%、99%、97%和99%、97%、86%,而增高组分别为89%、84%、84%和86%、81%、81%,两组OS(χ2=13.023,P=0.000)和PFS(χ2=3.968,P=0.046)比较有统计学意义。单因素分析显示,发病方式、肿瘤大小、肿瘤坏死情况、病理分级、T分期、TNM分期是OS的预后因素,而且肿瘤大小和TNM分期还是PFS的预后因素。多因素分析显示,病理T分期和TNM分期是PFS预后的独立因素,血小板计数是OS预后的独立因素。结论术前外周血血小板增高是CCRCC预后不良的独立预后因素。     

OKT3治疗肾移植术后急性排斥反应的观察及护理

目的探讨OKT3治疗肾移植术后急性排斥反应的护理方法。方法对4例慢性肾功能衰竭行同种异体肾移植术后发生急性排斥反应的患者应用OKT3进行治疗,治疗前给予心理护理,减轻患者的焦虑,使其很好地配合治疗;治疗期间重点做好不良反应的护理,预防及减轻不良反应的发生。结果治疗过程中未出现感染、肺水肿等不良反应。结论精心的护理可预防和减轻OKT3的不良反应的发生,提高治疗效果。     

The diagnosis of cyclosporin nephrotoxicity in patients after kidney transplantation

The authors review possibilities of thin needle aspiration biopsy of renal allotransplants in the diagnosis of cyclosporin nephrotoxicity. 151 thin needle aspiration biopsy specimens were explored in 55 patients following kidney transplantation. According to the authors, this method when applied in the early postoperative period may turn an informative one. However, if the time elapsed after operation exceeds 3 months, they recommend performing puncture biopsy of renal transplants.     

肝植移术后急性肾功能衰竭患者连续性肾脏替代治疗的护理

采用连续性肾脏替代疗法治疗原位肝移植术后急性肾功能衰竭患4例。通过连续监测生命体征，准确记录每小时出入量，严格按配方配制透析液和置换液，预防感染，保持血管通路通畅等护理措施，保证了连续肾脏替代治疗顺利进行。     

间歇性血液透析治疗急性肾功能衰竭的护理

目的 探讨间歇性血液透析治疗急性肾功能的观察护理要点。方法 对60例不同病因所致的急性肾功能衰竭患者采用间歇性血液透析治疗，针对不同病因和特点，治疗中采取相应护理，保证透析顺利进行。结果 60例中治愈38例，死亡13例，9例放弃治疗。结论 间歇性血液透析在急性肾功能衰竭的治疗中仍起着很大的作用，透析中密切观察病情变化并作好相应护理，使每次血液透析治疗顺利有效地进行，可为治疗成功提供保障。     

应用无肝素连续性肾替代治疗肝移植术后急性肾衰竭的护理

对21例同种异体原位肝移植术后急性肾衰竭患者,应用无肝素连续性肾替代治疗87例次,通过在治疗中严密观察生命体征、静脉压、动脉压、跨膜压的变化,严格执行无菌操作,定时用生理盐水冲管,保持血管通路通畅、出入量平衡等护理措施,保证了无肝素连续性肾替代治疗的顺利进行。     

肾小管标记物测定在慢性肾功能不全病人中的结果探讨

目的通过测定肾小管标记物THP、RBP、α1-MG、β2-MG,NAG、IL-6、ET-1及肾小管功能的项目(CH2O),判断肾功能不全病人的肾小管-间质损伤及炎症程度。方法应用放射免疫法测定IL-6、ET-1、THP、RBP、α1-MG、2β-MG,用ELISA沾测定RBP,用比色法测定NAG,用物理学方法测定CH2O。结果ET-l、RBP、2β-MG、CH2O的结果均是根据CRF病情分型逐渐上升,THP、IL-6是逐渐下降而1α-MG、NAG在CRF-Ⅱ以后均比CRF-I高但CRF-Ⅱ、Ⅲ、Ⅳ之间有高有低没有明显差异(p>0.05)。结论通过监测多种肾小管标记物及细胞因子可以对肾功能不全病人的肾间质损伤及炎性状态起到很好的诊断,对治疗有一定的指导作用。     

The long-term outcome after acute renal failure

PURPOSE OF REVIEW: Research priorities in critical care are increasingly focusing on long-term outcomes and prognosis for survivors of critical illness. This review will focus on long-term outcomes after acute renal failure. RECENT FINDINGS: Few studies have described the long-term outcomes after acute renal failure. Rates of survival are variable and range from 46 to 74%, 55 to 73%, 57 to 65% and 65 to 70% at 90 days, 6 months, 1 year and 5 years, respectively. All of older age, co-morbid illness, illness severity, septic shock, and renal replacement therapy after cardiac surgery have been associated with reduced survival. Recovery to independence from renal replacement therapy is expected in 60-70% of survivors by 90 days. Health-related quality of life is generally good and perceived as acceptable. Survivors often experience difficulty with mobility and limitations in activities of daily living. Renal replacement therapy is costly and achieves marginal cost-effectiveness in terms of quality-adjusted survival for those with a higher probability of survival. SUMMARY: The long-term survival after acute renal failure is poor. Yet, most survivors recover sufficient function to become independent from renal replacement therapy. While perceived health-related quality of life is good, survivors have a lower health-related quality of life compared with the general population. Further research is needed to explore the relationship between survival, markers of morbidity and costs after acute renal failure.     

连续性静-静脉血液滤过对危重患者合并急性肾功能衰竭治疗的护理

目的探讨连续性静-静脉血液滤过治疗的常见护理问题及解决方法。方法采用回顾性的方法,对2005年4月～2007年9月在我科行连续性静-静脉血液滤过治疗的26例病例进行分析。结果26例患者中,8例患者治愈,4例患者由于经济问题放弃治疗,6例病情危重死亡,8例患者仍需进行维持性血液透析治疗。结论科学的护理对连续性静-静脉血液滤过治疗的顺利进行及对危重患者的抢救成功至关重要。     

CD30基因多态性与慢性肾功能衰竭及肾移植术后急性移植排斥反应的相关性

目的:近年来,国际多个移植免疫学者发现可溶性CD30可作为一种新的与移植肾存活相关的风险预测指标。拟在基因水平上分析CD30基因启动区和5'侧翼区3个位点的多态性与肾功能衰竭的关系,以探讨其与慢性肾功能衰竭患者血清中可溶性CD30含量增高的相关性以及与肾移植术后发生急性移植排斥的关系。方法:选取2004-05/2006-04在南京市鼓楼医院首次接受肾移植手术的肾功能衰竭终末期患者78例,另选择95例健康体检者作为对照,均知情同意。提取两组观察对象的外周血基因组DNA,采用聚合酶链反应扩增CD30基因启动区-201位的AJ289159多态性位点和5'侧翼区rs946461和rs1208993多态性位点所在部分的DNA片段,采用高效液相色谱法检测各位点多态性,DNA测序验证。比较分析CD30基因型在慢性肾功能衰竭患者和正常人群中的分布,并探讨CD30基因多态性与慢性肾功能衰竭的关系。同时检测慢性肾功能衰竭患者血清中可溶性CD30的含量,探讨CD30基因多态性与可溶性CD30含量的关系。结果:两组观察对象均进入结果分析,无脱落。①CD30启动区-201位的AJ289159多态性位点在入选的173例中国人群中未发现存在碱基突变。②两个5'侧翼区的多态性位点rs946461和rs1208993虽然在慢性肾功能衰竭组和正常对照组中基因突变频率较高,但多态性分布在两组观察对象中差异无显著性意义(P>0.05)。③慢性肾功能衰竭患者血清中可溶性CD30水平显著高于正常对照组(P<0.01)。结论:CD30启动区的AJ289159位点和5'侧翼区的rs946461和rs1208993位点的基因多态性与肾功能衰竭患者中可溶性CD30含量的增高可能无关,可溶性CD30的增高也许在基因水平上存在着其他改变,或是受其他刺激因素的影响导致患者的免疫活化状态,进而关系到移植后急性排斥反应的发生和移植肾的长期存活。     

体外循环心内直视术后急性肾功能不全患者的护理

笔总结体外循环术后发生急性肾功能不全的31例患的护理体会，认为体外循环术后并发急性肾功能不全最主要的原因是术后低心排和低血压，因此防止术后低心排和低血压的发生，能有效预防急性肾功能不全的发生，提高治愈率，一旦发生急性肾衰，宜早期透析治疗。     

急性肾功能衰竭病因及预后分析

目的探讨急性肾功能衰竭(ARF)的病因和预后因素。方法回顾性总结115例ARF的临床资料,其中老年组40例,非老年组75例,对比分析两组患者的病因及预后。结果两组ARF病因明显不同:①老年组肾前性因素以大量失液或严重摄入不足(57.5%)、感染(42.5%)为主,非老年组则以创伤(65.0%)、感染(20.0%)为主;②老年组肾性因素以药物中毒(60.0%)、生物中毒(25.0%)为主,非老年组多见于急性肾脏疾病(65.3%)、生物中毒(13.3%);③老年组肾后性(12.5%)显著高于非老年组(4.1%)。④老年组原发慢性病(90.0%)及多器官障碍综合征(37.5%)高于非老年组(分别为16.0%、5.3%);⑤老年组病死率为57.5%显著高于非老年组的13.3%(P<0.01)。影响老年组ARF预后因素主要是MODS及原发慢性病。结论积极防治MODS和原发慢性病,是降低老年ARF发病率和病死率的关键措施。     

Acute renal failure in patients with acute leukemia

Acute renal failure may be a contributory cause of death in patients with acute leukemia. The purpose of this study was to define the causes and course of acute renal failure in group of patients with acute leukemia in order to identify preventive measures and reversible aspects of the renal insufficiency. Among 88 patients with acute leukemia whose courses were followed to the time of death, ten developed acute renal failure. Etiologic factors of the renal failure were uric acid nephropathy, sepsis with complicating hypotension and hypovolemia, and the administration of nephrotoxic antibiotics. In one patient ureteral obstruction from clots was responsible for renal failure, while in another patient disseminated aspergillosis led to renal failure. Other causes of acute renal failure in persons with acute leukemia, but not observed in this patient group, are hypercalcemia and leukemic infiltration of the kidneys.     

Plasma levels of endothelin in chronic renal failure and after renal transplantation: impact on hypertension and cyclosporin A-associated nephrotoxicity.

1. Plasma levels of endothelin were measured in 30 patients with chronic renal failure, 32 patients on chronic haemodialysis treatment and 25 renal graft recipients with stable renal graft function. 2. In patients with chronic renal failure as well as in patients on regular haemodialysis treatment, mean plasma levels of endothelin were significantly increased (4.59 +/- 2.09 pg/ml, 10.08 +/- 3.12 pg/ml, respectively) when compared with normal subjects (1.88 +/- 0.6 pg/ml, P less than 0.01, P less than 0.001, respectively). 3. In the group with chronic renal failure a positive correlation between the plasma level of endothelin and the plasma concentration of creatinine was observed (P less than 0.003). 4. Renal graft recipients on cyclosporin A with stable renal graft function had a normal plasma level of endothelin suggesting that cyclosporin A nephrotoxicity is not mediated by endothelin. 5. Hypertensive patients with chronic renal failure or on regular haemodialysis and hypertensive renal graft recipients did not differ from the corresponding normotensive population with regard to the plasma level of endothelin, demonstrating that an increased plasma level of endothelin does not play a major role in the pathogenesis of renal hypertension.     

持续肾脏替代治疗用于肛门成形术后急性肾功能衰竭患儿的护理

总结1例4个月婴儿经骶会阴后矢状入路肛门成形术后并发急性肾功能衰竭行持续肾脏替代治疗的护理.护理重点是高血压、低血压、低体温、血流量不足的预防与对症处理,抗凝药的合理应用等.患儿治疗过程中各并发症处理及时有效,未引起不良后果,经持续肾脏替代治疗28h后,肾功能指标及临床一般情况明显好转.     

Epidemiology of renal recovery after acute renal failure

PURPOSE OF REVIEW: Recovery of renal function after acute renal failure is an important clinical determinant of patient morbidity. Herein, the epidemiology of renal recovery after acute renal failure will be described, along with potential predictive factors and interventions. RECENT FINDINGS: Renal recovery has been variably defined, most often as recovery to independence from renal replacement therapy. A recent consensus definition for acute renal failure has been published and included provisions for defining renal recovery. Renal recovery to renal replacement therapy independence occurs in the majority by hospital discharge and peaks by 90 days. All of older age, female sex, co-morbid illnesses, especially chronic kidney disease, and late initiation of renal replacement therapy or conventional intermittent renal replacement therapy have been coupled with non-recovery. Analysis of the literature suggests several interventions may influence recovery. SUMMARY: The prognosis is generally good for recovery after acute renal failure. Most patients will be independent of renal replacement therapy by 90 days. Additional research is necessary, however, to understand recovery rates not only to independence from renal replacement therapy, but also to complete and partial recovery. Future studies need to consider the health economic implications for survival and non-recovery. Finally, questions on the role of various interventions require characterization in randomized controlled trials to determine how they may influence renal prognosis.