心脏外科手术后急性肾衰竭54例治疗效果分析

目的 探讨心脏外科手术后急性肾衰竭(ARF)的治疗方法及疗效。方法 回顾性分析2004年1月-2014年1月在解放军总医院心外科行心脏外科手术后发生ARF的54例患者的临床资料,其中男35例,女19例,年龄1个月~79岁,中位年龄52岁。行冠状动脉旁路移植术(CABG)10例,瓣膜手术22例,CABG+瓣膜手术4例,主动脉手术14例,法洛四联症根治术4例。50例采用床旁连续肾脏替代疗法(CRRT)治疗,4例采用腹膜透析治疗。结果 住院期间死亡9例,病死率16.7%,术后开胸探查止血8例,拔管失败4例。9例死亡患者中6例死于多脏器功能衰竭,2例死于脑出血,1例死于急性呼吸衰竭。采用CRRT及腹膜透析治疗后,血肌酐(SCr)和血尿素氮(BUN)下降明显(P<0.05);所有患者治疗过程中血流动力学稳定,未发现出血或栓塞等并发症。结论 心脏外科手术后ARF应早期发现、及时处理,CRRT及腹膜透析是治疗心脏外科手术后ARF安全、方便、有效的方法,可降低病死率。     

腹膜后纤维化致急性肾功能衰竭(附2例报告)

目的　总结腹膜后纤维化的临床特征 ,以提高对其的早期诊、治水平。方法　通过文献复习对 2例腹膜后纤维化致急性肾功能衰竭的诊断、治疗和预后进行回顾性分析。结果　原发性腹膜后纤维化致急性肾功能衰竭 1例 ,采用带蒂大网膜包裹治疗 ,随访 9月 ,肾功能正常。继发性腹膜后纤维化致急性肾功能衰竭 1例 ,行肾盂造口 ,肾功能恢复良好 ,6个月后死于癌症广泛转移。结论　逆行肾盂造影是腹膜后纤维化的重要诊断手段 ,确诊需经手术和病理。对继发性腹膜后纤维化应警惕是否合并消化道肿瘤。早期诊断和治疗是减少腹膜后纤维化致急性肾功能衰竭的关键。带蒂大网膜包裹术是有效的治疗方法。     

高压氧综合治疗移植肾功能延迟恢复的临床观察

目的 探讨高压氧(HBO)治疗肾移植术后肾功能延迟恢复(DGF)的临床效果.方法 对临床诊断为DGF且经过常规透析等治疗平均(40.4±27.1)d肾功能不见恢复的14例患者给予HBO治疗,同时观察HBO治疗前后尿量、血肌酐(Cr)、血尿素氮(BUN)的变化.结果 HBO治疗前尿量、Cr与BUN与开始治疗后第1、2天,第1周相比差异有统计学意义(P＜0.05);与治疗第2周相比差异也有统计学意义(P＜0.01).结论 HBO治疗DGF有明显疗效.     

茅丹黄治疗氯化高汞致家兔急性肾功能衰竭的研究

为防治流行性出血热患者急性肾脏功能衰竭,探讨其发病机理及中药治疗效果,笔者以中药茅丹黄治疗氯化高汞诱致的兔急性肾功能衰竭,以茅丹黄浸膏连续灌胃5d,观察尿素氮、肌酐、尿肌酐、左肾动脉血流动力学参数、心率和肾动脉内径、普通病理及电镜观察超微结构。结果治疗组低固定比重尿持续时间短,肾功能恢复早,肾血流动力学改善及病理损伤恢复较快。     

经皮穿刺植管腹膜透析救治急性肾功能衰竭(附36例报告)

老年急性肾功能衰竭和重型颅脑外伤性或严重创伤性急性肾功能衰竭患者因具特殊性而十分难治,死亡率较高。我院于1987-09～1999-10采用经皮穿刺快速植入腹膜透析管方法腹膜透析救治了36例急性肾功能衰竭患者,明显提高了救治成功率,降低了死亡率。优于血液透析、常规腹膜透析组。现报告如下：     

输尿管镜下钬激光治疗结石梗阻性急性肾功能衰竭

目的:探讨输尿管镜下钬激光治疗上尿路结石梗阻并发急性肾功能衰竭的有效性和安全性。方法:回顾性分析我院2008-01~2009-06应用输尿管镜直视下钬激光治疗上尿路结石梗阻并发急性肾功能衰竭23例患者的临床资料。结果:手术均获成功,术中无一例出现输尿管穿孔、断裂、黏膜撕脱,无中转开放手术,术后随访1~3月,患者血清尿素氮(BUN)、肌酐(Cr)均恢复正常或接近正常,尿量恢复,结石排净率91.3%(21/23)。结论:输尿管镜下钬激光治疗上尿路结石梗阻并发急性肾功能衰竭具有安全、疗效可靠、损伤小、能同时处理双侧输尿管病变的优点,是梗阻性急性肾功能衰竭的有效治疗方法。     

急诊床旁置管腹膜透析在多脏器功能障碍综合征中的临床应用分析

急诊床旁置管腹膜透析自临床应用以来,在救治多脏器功能障碍综合征(MODS)时,发挥了积极作用,具有不受年龄限制、不需要特殊设备、操作简便、安全、经济的独特优势,是行之有效的治疗方法。1　资料和方法1 1　病例资料　治疗观察6 4例MODS患者,均表现急性肾功能衰竭(ARF) ,在短期内(数小时至数天)肾小球滤过率下降5 0 %以上,血清肌酐、尿素氮迅速升高。其中男性4 8例,女性16例。年龄17～76岁,17～5 9岁30例,为中青年组;6 0～76岁34例,为老年组,平均年龄4 7 33±8 6 5岁。发病诱因:败血症2 2例,急性坏死性胰腺炎14例,脑血管意外10例,急性…     

促红细胞生成素治疗心脏术后急性肾功能衰竭的临床观察

目的总结6例心脏术后急性肾功能衰竭患者应用促红细胞生成素（EPO）治疗的临床资料,以探讨EPO对心脏术后急性肾功能衰竭的疗效。方法2010年5月～2011年4月,收集心脏术后并发急性肾功能衰竭患者6例,给予EPO5000U／次,隔日1次,同时辅助其他综合治疗,如强心、利尿、维持水电解质平衡等。结果6例患者的尿素氮、肌酐、血红蛋白、尿量检测结果均恢复正常。结论EPO可能对心脏术后并发的急性肾功能衰竭有一定的改善作用。     

10例地震伤挤压综合征致急性肾功能衰竭患者早期连续血液净化的疗效

目的：观察地震伤挤压综合征致急性肾功能衰竭患者早期连续血液净化的疗效。方法：10例地震伤后挤压综合征致肾功能急性衰竭的患者早期采用连续血液净化疗法（CRRT）,测定治疗前后血白细胞计数、血钾、尿素氮、血肌酐、肌酸激酶、肌红蛋白。结果：10例患者经CRRT治疗血白细胞计数、BUN、SCr、CK、MYO、高血钾、代谢性酸中毒等均较治疗前显著降低。结论：尽早行CRRT治疗地震伤后挤压综合征致急性肾功能衰竭,不但可迅速纠正患者内环境的紊乱,恢复肾功能,还可减轻全身炎性反应,缩短病程,改善预后,提高救治成功率。     

急性肾脏出血合并肾功能不全的超选择性肾动脉栓塞：临床疗效和安全性分析

目的 探讨超选择性肾动脉栓塞在治疗急性肾脏出血合并肾功能不全患者的疗效及并发症,评价其对肾功能的影响.方法 回顾性分析2000年1月至2009年12月接受肾动脉栓塞并有完整临床及影像学资料的13例合并肾功能不全的急性肾出血患者,重点分析栓塞的临床疗效、栓塞前后肾功能变化及栓塞范围和并发症的关系.结果 所有患者均获成功栓塞,技术成功率100%,平均栓塞范围22%.术后3 d患者血红蛋白、红细胞压积、血压、心率有所恢复,前后相比差异均有统计学意义(P均< 0.01).与术前相比,术后3 d肌酐水平增高(P ＝ 0.000),尿素氮轻度降低(P ＝ 0.346),术后7 d,肌肝呈轻度降低(P > 0.05),BUN则降低明显(P ＝ 0.011).5例出现栓塞后综合征,1例肾功能进行性恶化,最后接受透析治疗.发生并发症患者的栓塞范围较大(U ＝ 1.500,P ＝ 0.006).结论 超选择性肾动脉栓塞治疗急性肾脏出血合并肾功能不会明显加重肾功能恶化,控制栓塞范围是减少并发症的最重要措施.     

Knee injury and Osteoarthritis Outcome Score (KOOS) - validation of a Swedish version

The Knee injury and Osteoarthritis Outcome Score (KOOS) is a self-administered instrument measuring outcome after knee injury at impairment, disability, and handicap level in five subscales. Reliability, validity, and responsiveness of a Swedish version was assessed in 142 patients who underwent arthroscopy because of injury to the menisci, anterior cruciate ligament, or cartilage of the knee. The clinimetric properties were found to be good and comparable to the American version of the KOOS. Comparison to the Short Form-36 and the Lysholm knee scoring scale revealed expected correlations and construct validity. Item by item, symptoms and functional limitations were compared between diagnostic groups. High responsiveness was found three months after arthroscopic partial meniscectomy for all subscales but Activities of Daily Living.     

Endovascular management of carotid-cavernous fistulas

Objective To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas （CCF） and their complications such as pseudoaneurysms. Methods： Over a five-year period, 22 patients with traumatic direct CCFs were treated endovascularly in our institution. Thirteen patients were treated once with the result of CCF occluded, 8 twice and 1 three times. Treatment modalities included balloon occlusion of the CCF, sacrifice of the ipsilateral internal carotid artery with detachable balloon, coll embolization of the cavernous sinus and secondary pseudoaneurysms, and covered-stem management of the pseudoaneurysms. Results All the direct CCFs were successfully managed endovascularly. Four patients developed a pseudoaneurysm after the occlusion of the CCF with an incidence of pseudoaneurysm formation of 18.2% （4/22）. A total number of 8 patients experienced permanent occlusion of the ICA with a rate of ICA occlusion reaching 36.4% （8/22）. Followed up through telephone consultation from 6 months to 5 years, all did well with no recurrence of CCF symptoms and signs. Conclusion Traumatic direct CCFs can be successfully managed with endovascular means. The pseudoaneurysms secondary to the occlusion of the CCFs can be occluded with stent-assisted coiling and implantation of covered stents.     

The acutely limping child

Acute limping may be the result of multiple pathologies in children. The differential diagnosis varies based on the age of the child. Irrespective of age, the initial imaging work-up includes AP and frog leg radiographs of the pelvis and ultrasound; MRI may sometimes be helpful. In children less than 3 years, infections and trauma are most frequent. MRI is the imaging modality of choice when osteomyelitis is clinically suspected. Between the ages of 3 and 10 years, transient synovitis of the hip and Legg-Calvé-Perthes disease are main considerations but infection, inflammation and focal bony lesions are also considered. In children over 10 years, slipped capital femoral epiphysis also is considered.     

Do Balance Board Training Programs Reduce the Risk of Ankle Sprains in Athletes?

Introduction Ankle sprains are the most common musculo-skeletal injury that occurs in athletes,particularly in sports that require jumping and landing on one foot such as soccer,and basketball(1-4).These injuries often result in significant time loss from participation,long-term disability,and have a major impact on health care costs and resources(5-8).     

High Intensity Interval Training:New Insights

KEY POINTS ·High-intensity interval training(HIT)is characterized by repeated sessions of relatively brief，intermittent exercise.often performed with an“a11 out”effort or at an intensity close to that which elicits peak oxygen uptake(i.e.，≥90%of VO2 peak).     

Developmental validation of the PowerPlex(®) ESI 16 and PowerPlex(®) ESI 17 Systems: STR multiplexes for the new European standard

In response to the ENFSI and EDNAP groups’ call for new STR multiplexes for Europe, Promega^® developed a suite of four new DNA profiling kits. This paper describes the developmental validation study performed on the PowerPlex^® ESI 16 (European Standard Investigator 16) and the PowerPlex^® ESI 17 Systems. The PowerPlex^® ESI 16 System combines the 11 loci compatible with the UK National DNA Database^®, contained within the AmpFlSTR^® SGM Plus^® PCR Amplification Kit, with five additional loci: D2S441, D10S1248, D22S1045, D1S1656 and D12S391. The multiplex was designed to reduce the amplicon size of the loci found in the AmpFlSTR^® SGM Plus^® kit. This design facilitates increased robustness and amplification success for the loci used in the national DNA databases created in many countries, when analyzing degraded DNA samples. The PowerPlex^® ESI 17 System amplifies the same loci as the PowerPlex^® ESI 16 System, but with the addition of a primer pair for the SE33 locus. Tests were designed to address the developmental validation guidelines issued by the Scientific Working Group on DNA Analysis Methods (SWGDAM), and those of the DNA Advisory Board (DAB). Samples processed include DNA mixtures, PCR reactions spiked with inhibitors, a sensitivity series, and 306 United Kingdom donor samples to determine concordance with data generated with the AmpFlSTR^® SGM Plus^® kit. Allele frequencies from 242 white Caucasian samples collected in the United Kingdom are also presented. The PowerPlex^® ESI 16 and ESI 17 Systems are robust and sensitive tools, suitable for the analysis of forensic DNA samples. Full profiles were routinely observed with 62.5 pg of a fully heterozygous single source DNA template. This high level of sensitivity was found to impact on mixture analyses, where 54–86% of unique minor contributor alleles were routinely observed in a 1:19 mixture ratio. Improved sensitivity combined with the robustness afforded by smaller amplicons has substantially improved the quantity of data obtained from degraded samples, and the improved chemistry confers exceptional tolerance to high levels of laboratory prepared inhibitors.