慢性肾衰患者血液透析配合腹水浓缩回输治疗疗效分析

目的：评价慢性肾衰行腹水浓缩回输治疗的疗效。方法：将2007-05～2009-05我科收治慢性肾衰尿毒症患者20例,分为实验组10例（血液透析加腹水浓缩回输治疗）与对照组10例（常规血液透析治疗）。分析两组患者治疗效果、生存率和不良反应的差别。结果：血液透析加腹水浓缩回输治疗能有效延缓残余肾功能,短期内纠正低蛋白血症,改善营养不良,延长生存期。结论：血液透析加腹水浓缩回输治疗是治疗尿毒症患者合并大量腹水的有效方法,值得临床推广应用。     

腹膜透析改做血液透析肝素用量增加的原因分析

目的:分析退出腹膜透析的尿毒症患者改做血液透析时肝素抗凝治疗用量增加的原因。方法:回顾分析24例退出腹膜透析改做血液透析患者病历资料,以24例维持性血液透析患者作对照,统计两组患者血液透析时肝素用量。全部患者测定凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)、血浆纤维蛋白原(FIB)、血浆白蛋白(Alb)、胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)、载脂蛋白A(ApoA)、载脂蛋白B(ApoB)。结果:退出腹膜透析组PT、APTT缩短(P<0.05),FIB增加(P<0.05)。Alb显著下降(P<0.01),TG、ApoB升高(P<0.01)。结论:退出腹膜透析的尿毒症患者凝血常规异常,有低蛋白血症和血脂异常,血液呈高粘状态,行血液透析时,需增加肝素用量。     

高通量血液透析联合血液灌流治疗尿毒症严重皮肤瘙痒症的疗效观察

 目的 观察高通量血液透析联合血液灌流治疗尿毒症严重皮肤瘙痒症的效果.方法 36例维持性血液透析患者随机分为对照组(常规血液透析)和观察组(高通量血液透析联合血液灌流),在治疗1、3个月后分别对两组患者瘙痒症状进行评分,检测BUN、Ga2+、P3-、β2-MG、PTH、CRP等生化指标并进行比较.结果 观察组在清除尿毒症的大中分子毒素和改善瘙痒症临床症状方面优于对照组,两组比较差异有统计学意义(P＜0.05).结论 高通量血液透析联合血液灌流能有效地清除尿毒症的大中分子毒素,显著改善尿毒症严重皮肤瘙痒症的临床症状.     

通心络胶囊治疗血液透析心绞痛

心绞痛是尿毒症维持性血液透析患者常见的并发症。笔者自2000年开始应用通心络胶囊治疗此类患者,取得良好的疗效。1 对象与方法1.1 对象尿毒症维持性血液透析患者20例,男13例,女7例,年龄36～73岁。合并高血压7例,高胆固醇血症5例,高三酰甘油11例,有冠心病史11例。透析年限1～12年。其中14例在透析过程中发生心绞痛,6例不透析时和透析过程中均发生心绞痛,伴胸闷、心悸、气急、虚汗。20例患者心电图提示 ST-T 缺血性改变,T 波在以 R 波为主的导联上低平。患者长期口服硝酸异山梨酯、硝苯地平。1.2 治疗方法 20例患者均采用重碳酸盐血液透     

透析器复用对尿毒症血液透析患者P选择素水平的影响

 目的观察维持性血液透析治疗尿毒症患者血清P选择素水平的变化,探讨透析器复用对血液透析患者血小板活化程度的影响.方法采用双抗体夹心ELISA法检测尿毒症维持性血液透析患者初用和复用透析器时患者血清P选择素水平的变化,并加以比较.同时检测健康查体和尿毒症非透析患者的P选择素水平作为对照.结果尿毒症血液透析治疗患者透析前及尿毒症非透析患者血清P选择素水平均较健康查体对照组显著增高.尿毒症患者透析开始15 min后,P选择素水平与透前比较即显著升高(P＜0.05);随着透析时间的延长,P选择索水平进一步上升.复用透析器透析时,透析患者P选择素水平升高的趋势随使用次数的增多而逐渐下降(P＜0.05).结论血液透析可导致尿毒症患者P选择素水平显著升高,血液透析过程中血-透析膜间相互作用所致的血小板活化可能是导致血透患者发生出、凝血相关透析并发症的重要原因之一,而透析器复用可在一定程度上减少这一现象的发生.     

血液透析对血浆甘丙素的影响

本实验首次应用人甘丙素(GAL)及其抗血清建立了放免法,测定了30例尿毒症患者及22例原发性高血压患者GAL水平,观察了血液透析对GAL的影响,测定了正常大鼠及自发性高血压大鼠的血浆、胸主动脉组织内GAL浓度,显示尿毒症患者GAL较正常人明显增高,伴心衰、水肿和高血压者更著,血液透析后GAL明显下降,提示尿毒症患者GAL与肾小球滤过率下降有关,GAL升高可能是高血压的发病原因之一,血管紧张素Ⅱ可能参与了其升压作用.血液透析后GAL下降可能与GAL被透析掉有关.     

高龄尿毒症患者小剂量联机血液透析滤过疗效分析

目的　分析小剂量联机血液透析滤过对高龄尿毒症患者治疗的有效性和安全性。　方法　采用德国Fresenius 4 0 0 8S血透机 ,碳酸氢盐透析方式 ,透析液流量 5 0 0ml/min ,血流量 2 0 0～ 2 30ml/min ,透析时间 4h 血液透析滤过治疗用F6 0透析器 ,置换液总量 6 0 0 0ml,血液透析治疗用F6透析器。观察并比较两种透析方式对血 β2 微球蛋白、尿素氮和血清肌酐的清除效果及不良反应发生情况。结果　小剂量联机血液透析滤过对 β2 微球蛋白、尿素氮和血清肌酐的清除效果明显 ,而常规血液透析的 β2 微球蛋白清除效果不明显。小剂量联机血液透析滤过治疗无不良反应发生。　结论　小剂量联机血液透析滤过对中、小分子尿毒性物质清除明显 ,是高龄尿毒症患者一种有效而安全的透析方式     

高通透性滤过器血液透析尿毒症32例临床观察

目的 观察高通透性滤过器血液透析对尿毒症病人的治疗效果。方法 选择32例尿毒症病人并进行高通透性滤过器血液透析。结果 血尿素氮,肌酐,磷及β2微球蛋白均明显下降。结论 高通透性滤过器血液透析能有效清除血液中代谢废物成份,能大大提高病人的生活质量,能减少由于长期透析所产生的并发症。     

不同类型透析膜对维持性血液透析患者血清C-反应蛋白水平变化的影响

 目的观察尿毒症维持性血液透析患者血清C-反应蛋白(C reactive protein,CRP)水平的变化以及不同类型透析膜初次与复用对其的影响,从机体免疫功能的角度对透析膜的生物相容性进行评价.方法采用免疫速率散射比浊法测定尿毒症维持性血液透析患者初用和复用醋酸纤维素膜(CA)、血仿膜(HE)和聚砜膜(PS)透析器进行透析时患者血清CRP水平的变化,并加以比较.同时检测健康查体和尿毒症非透析患者的CRP水平作为对照.结果尿毒症血液透析治疗患者透析前及尿毒症非透析患者血清CRP水平均较健康查体对照组显著增高.尿毒症患者透析开始后4.5 h血清CRP水平与透析前相比明显升高(P＜0.05),HD后1.5 h后差异更为明显.使用醋酸纤维素膜(CA)透析器患者的血清CRP水平更明显高于使用血仿膜(HE)和聚砜膜(PS)透析器的患者(P＜0.05).结论血液透析可导致尿毒症血透患者血清CRP水平的增高,这种变化与透析膜的生物相容性有关,而透析器复用可在一定程度上减轻这种变化.     

25例尿毒症患者血液透析的护理体会

尿毒症是各种肾病发展到终末期的一种严重的临床综合征,血液透析是治疗尿毒症最常用的一种治疗手段。注重血液透析室的规范管理,在病人进行血液透析过程中,对血透通路实施正确的护理措施,密切观察病情变化,随时处理并发症,关注病人的心理支持,提供合理的饮食指导,可提高患者对透析治疗的依从性,提高血液透析的效果,从而延长患者生命,提高其生活质量。     

Optimization of the system of medical service of students of Cadet Schools of the Ministry of Defense of the Russian Federation

One of the factors of the successful military career guidance Cadet schools students is preserving and promoting their health. Medical support of children and adolescents aged 10-17 years should include the full range of medical and preventive measures defined for this group. The state of providing outpatient care for pupils at the Cadet School in St. Petersburg was studied. These results show that full medical care in accordance with the standards can be based only on children's health clinics. It is important that the organization of medical support pupils cadet schools should be cooperate with civilian health care.     

带状疱疹83例误诊原因分析

带状疱疹是由水痘—带状疱疾病毒引起的皮肤科常见疾病。其主要的病理损害,一是受累神经的严重炎症性浸润,继而导致受侵犯神经节内神经细胞变性、坏死;二是皮肤的水泡。迅速抑制神经节和相应的感觉神经纤维的充血、水肿和坏死,防止粘连形成,达到迅速镇痛、改善皮损,缩短病程及防止后遗症的发生是治疗的关键。因而,尽早明确诊断,     

Estimation of accumulated dose of radiation by method of ESR-spectrometry of dental enamel of mammals

ESR-spectrometry was used to investigate radiation-induced paramagnetic centers in enamel of mammals: carnivores (polar bear and fox), ungulates (reindeer, European bison, moose), and man. Values at half the microwave power saturation of the radiation signal, P_1/2, evaluated at room temperature, was found to range from 16 to 26 mW for animals and man. A new approach to discrimination of the radiation induced signal from the total ESR spectrum of reindeer enamel is proposed. ‘Dose-response’ dependencies of enamel of different species mammals were measured within the dose range from 0.48 up to 10.08 Gy. Estimations of ‘radiosensitivity’ enamel of carnivores and ungulates showed good agreement with radiosensitivity enamel of man by ESR method.     

Analysis of the results of the international comparison of activity measurements of a solution of Fe

The results of an international comparison of activity measurements of a solution of ⁵⁵Fe organized by the BIPM in 2005 are reported and analysed. This exercise, which follows the procedures of the CIPM mutual recognition arrangement to update older comparisons, is a renewal of the comparison organized by the BIPM that took place in 1978. A EUROMET comparison was organized in 1996 specifically to compare activity measurements of a ⁵⁵Fe solution by means of liquid-scintillation techniques. Results of these three comparisons are presented and discussed in this paper.

The radionuclide solution was provided by the NPL, which also distributed the samples to the participants. The activity of the ampoules was measured by 16 laboratories using 12 methods producing 25 results. Some general considerations on uncertainty assessments pertaining to the different techniques used are drawn. The outcome of four different estimators is compared from which the presence of at least one outlier can be confirmed. Further measurements should be made to try to reduce the discrepancy between the results. To date the outcome of the present comparison does not show an improvement to that of the 1996 comparison.     

Evaluation of the results of various technics of non-surgical therapy of varicocele

A new method of non-surgical treatment of varicocele syndrome is described: it consists in sclerotherapy of spermatic vein by trans-femoral percutaneous catheterization with balloon-catheters. In 8 cases venous thrombosis has been induced by direct electric clotting. The techniques and a 6 months follow-up are discussed. It is pointed out that this procedure should be considered as the method of choice for tubular lesions and sub-fertility prophylaxis in young people and in childhood.     

延迟性脾破裂误漏诊原因分析

目的探讨延迟性脾破裂误漏诊原因和预防措施.方法回顾性分析总结12例延迟性脾破裂中的诊断和误漏诊的经验与教训.结果本组延迟性脾破裂的误漏诊5例(41.66%).对多发伤与脾破裂并存可能认识不足,外伤史轻微或伤员隐瞒外伤史,缺乏腹痛-缓解-突然再腹痛的典型病史,缺乏“对冲性脾破裂”力学分析和整体化诊断思路等为其误漏诊的主要原因.结论详细的外伤史和全面系统检查,重视腹以外多发伤掩盖腹内脏器伤及延迟性脾破裂可能.确立外伤-腹内脏器伤-脾破裂整体化诊断思路.不间断地辅以B超检查脾形态学变化和腹内有无积液,腹腔穿刺确定有无血腹、X线胸腹部检查观察左侧胸肋角和膈肌运动情况、必要时CT检查以尽早发现脾包膜下血肿,降低延迟性脾破裂误漏诊率.