高-低钠序贯透析在血液透析中的临床研究和应用

目的:研究高-低钠序贯透析在血液透析中的临床应用效果。方法:回顾性的分析22例慢性肾衰患者行1400例在血液透析过程中临床应用资料。结果:高-低钠序贯透析有效减少了慢性肾衰患者血液透析中一些并发症的发生,增加代谢产物的清除率。结论:高-低钠序贯透析能有效预防并发症的发生,改善了慢性肾衰竭行血液透析患者的透析质量和生活质量,同时没有增加血液透析费用,操作简单实用易行。     

血液透析期间急性左心衰79例治疗体会

目的 探讨血液透析期间并发急性左心衰竭的特点.方法 对79例血液透析期间并发的急性左心衰竭回顾分析.结果 高血压、容量负荷过重是急性左心衰竭的主要原因和死亡原因.实行序贯透析73例73例心衰得以纠正,2例转归为腹膜透析,4例死亡.结论 序贯透析是治疗血透期间并发急性左心衰竭的首选方法.     

血液透析并发左心衰的防治

:目的:分析维持性血液透析患者并发急性左心衰的原因,探讨其护理对策.方法:回顾性分析50例维持性血液透析病人的临床资料.结果:高容量负荷、高血压、贫血、透析不充分、动静脉内瘘分流过量及钙磷代谢紊乱等均容易并发急性左心衰竭.结论:高容量负荷、高血压、贫血、透析不充分、动静脉内瘘分流过量及钙磷代谢紊乱等均是引起维持性血透病人急性左心衰的危险因素,应采取相应的护理措施.     

老年人腹膜透析并急性左心衰的临床特点和治疗

目的探讨老年腹膜透析并发急性左心衰的特点。方法对26例老年腹膜透析并发急性左心衰进行回顾性分析。结果容量负荷过重、高血压是急性左心衰的主要原因,改为间歇性腹透(IPD)或临时血液透析后,18例心衰得到纠正,8例死亡。结论调整透析方案、增加超滤脱水是治疗的关键。     

肾功能衰竭合并急性左心力衰竭采用序贯透析治疗的临床价值分析

目的：对肾功能衰竭合并急性左心力衰竭采用序贯透析治疗的临床价值进行研究分析。方法：从我院肾功能衰竭合并急性左心力衰竭患者中选取24例进行研究,分析肾功能衰竭合并急性左心力衰竭采用序贯透析治疗的临床价值。结果：本次研究选取的24例肾功能衰竭合并急性左心力衰竭患者临床治疗总有效率为95.84%,13例为显效,10例为有效,1例为无效;对比患者治疗前后血清K＋、尿素氮、HCO3-和肌酐变化状况,P〈0.05。结论：序贯透析治疗方法在治疗肾功能衰竭合并急性左心力衰竭疾病临床上具有良好作用,对患者心功能状况具有显著改善作用,延长患者有效生命周期。     

血液透析患者发生急性左心衰竭的原因及护理

目的 探讨血液透析患者发生急性左心衰竭的原因及护理.方法 笔者所在医院血液净化中心2007年9月～2009年9月收治血液透析患者发生急性左心衰86例,其中男53例,女33例,年龄19～73岁,据心力衰竭的诊断标准,全组患者出现明显的临床症状及实验室检查异常.结果 及时进行对症治疗,行血液透析,调整透析次数及剂量,均能耐受,全部患者心衰的症状和体征得到明显改善.结论 积极处理血液透析患者体液潴留,电解质紊乱,控制高血压,治疗贫血,调整透析方案及积极全面的透析患者护理是治疗急性左心衰竭成功的关键.     

血液透析相关性低血压的临床研究

目的探讨血液透析过程并发低血压的原因,提出防治措施.方法选择维持性血液透析的患者98例,按有无低血压分为低血压组(46例)及对照组(52例),比较两组病因、年龄、透析间期体重增长率、透析超滤量(UFV)、超滤率(UFR)、血钠(Na )、白蛋白(Alb)、血红蛋白(Hb)、血尿素氮(BUN)、血肌酐(Scr).结果与对照组相比,合并糖尿病、左室肥厚及动脉粥样硬化的老年人易发生透析相关性低血压.两组比较,透析间期体重增长率、透析中UFV、UFR有统计学差异(P＜0.01);Na 、Alb、Hb有统计学差异(P＜0.05);BUN、Scr无统计学差异(P＞0.05).结论控制透析间期体重增长、减慢超滤速度、改变血液净化方法、采用高-低钠序贯透析、低温透析、适当用药、改善心功能、纠正贫血、低蛋白血症及营养不良等可防治透析相关性低血压.     

血液透析过程中低血压的干预与护理

目的:探讨维持性血液透析患者在透析过程中低血压发生的原因,建立相应的护理措施,减少维持性血液透析过程中低血压的发生.方法对维持性血液透析患者采用费森透析机、FX10透析器、碳酸透析液进行透析治疗,对低血压发生的原因进行分析总结,并建立相应的护理措施.结果维持性透析患者在血液透析过程中发生低血压的原因主要包括:超滤量过大(>干体重的5％)、透析中降压药的不正确使用、血容量不足、低血压、低血糖.结论通过正确的评估干体重、宣教患者严格控制水分的摄入、血透过程中正确地服用降压药,胰岛素,给予低温序贯、单纯超滤透析等方法减少低血压的发生.     

维持性血液透析诱发急性左心衰的危险因素及护理对策

对造成38例血液透析患者急性左心衰的相关因素进行了分析总结,认为主要因为透析间期容量负荷过重,高血压、严重贫血、感染及患者对于相关知识缺乏等,针对诱因提出相应的护理措施①保持体液平衡;②有效控制高血压;③纠正贫血;④充分透析;⑤满足患者的健康需求.     

急性左心衰合并慢性阻塞性肺病的救治探讨

目的探讨急性左心衰合并慢性阻塞性肺病的临床诊治措施及效果。方法选取该院2008年1月—2010年12月收治的急性左心衰合并慢性阻塞性肺病38例,对其明确诊断后采取综合诊治措施,观察临床效果,指导临床诊治实践结果 38例急性左心衰合并慢性阻塞性肺病患者经综合治疗后,显效6例,好转28例,无效4例,临床治愈率达到89.47%。结论正确及时的诊断病情和综合干预治疗可以显著改善急性左心衰合并慢性阻塞性肺病患者症状及预后,值得临床应用。     

老年多器官衰竭首发器官及序贯分析

目的 随访研究老年多器官衰竭(MOFE)首发器官及序贯发生规律,为临床早期诊断和治疗及二级、三级预防提供科学依据.方法 回顾性分析发生MOFE 153例患者的临床资料,用1:3配比病例对照随访研究方法进行分析.结果 153例MOFE患者发生诱因以感染为首位占89.5%(137/153),其中肺部感染占93.4%(128/137).纵向百分比首衰器官为肺(39.0%,60/154),其次为心(19.5%,30/154)、中枢(14.9%,23/154)、肾(10.4%,16/154)、胃肠(8.4%,13/154)、肝(6.5%,10/154)等;横向百分比首衰器官为肺(42.9%,60/140)、心(40.9%,56/137)、肾(32.6%,30/92)、中枢(21.9%,23/105)、胃肠(14.5%,9/62)等.首衰器官由短到长生存时间分别为肺、中枢、心、肾.结论 MOFE多为肺首衰.器官序贯衰竭顺序为肺、心、脑、肾等.     

Acute renal failure

Acute renal failure (ARF) can be defined as the sudden loss of adequate renal function to clear metabolic wastes and maintain normal fluid and electrolyte balance. ARF may occur in otherwise healthy children, may complicate underlying chronic kidney disease, or may result from multiorgan disorders. The underlying cause of the renal injury remains the major factor that determines outcomes for patients with ARF. Overall mortality in children with ARF varies from 8% to 89%, with greater than 50% mortality associated with three-organ system failure. Management of the adolescent with ARF ranges from conservative management in mild cases to more intensive care in hospitalized patients with complications of fluid overload, hypertension, metabolic acidosis, or life-threatening hyperkalemia.     

Diastolic heart failure

Diastolic heart failure is predominantly a disease of the elderly: at the age of 70 years, almost half of all patients with heart failure have diastolic heart failure. Hypertension and obesity are common underlying disorders in patients with diastolic heart failure. Patients with diastolic heart failure have an equal, or only slightly better, prognosis in terms of mortality compared to patients with systolic heart failure. Echocardiography can distinguish diastolic heart failure from systolic heart failure. Patients with heart failure and a normal ejection fraction almost certainly have a diastolic dysfunction. There is a lack of reliable data about the optimal medicinal treatment strategy for patients with diastolic heart failure. Angiotensin-converting enzyme (ACE) inhibitors, beta-blockers, and (non-dihydropyridine) calcium antagonists have therapeutic potential. Digoxin may be contraindicated.     

Diastolic heart failure

The rhythmic contraction and relaxation of the heart supply the body with the appropriate amount of blood. If the pump function deteriorates, heart failure occurs. After a symptom-free period of varying length, the clinical case of decompensatio cardiaca develops. The pathophysiological basis of the disease is abnormal systolic and/or diastolic function. The pathophysiology and therapy of systolic heart failure is well-known, however, the consequence of impaired diastolic function has not been fully revealed. Both cardiogenic shock and pulmonary edema can be caused by acute left heart failure. The main difference between the two disorders is that while cardiogenic shock is caused by systolic dysfunction, pulmonary edema is the consequence of impaired diastolic function. The importance of diastolic dysfunction is highlighted by the fact that the disorder can be caused by the most frequent diseases (hypertension, diabetes mellitus, coronary heart disease, myocardiac infarction). Consequently, in case of risk factors, it is very important to consider the possibility of diastolic dysfunction and be aware of the diagnostic and therapeutic options.     

Premature ovarian failure

Premature ovarian failure is characterized by secondary oligomenorrhoea or amenorrhoea and serum follicle stimulating hormone (FSH) levels above 40 IU/l before or at the age of 40. The incidence is 1:1000 below age 30 and 1:100 below age 40. In the majority of cases a cause can not be identified. The chance to conceive spontaneously after premature ovarian failure is estimated at 5-10%. There is no treatment available to restore ovarian function and increase the pregnancy rate. In vitro fertilisation using oocyte donation is the only successful fertility treatment option. Climacteric symptoms can be treated with hormone replacement therapy. In the absence of symptoms and when bone mineral density is normal there is no need for hormone replacement therapy. In the near future cryopreservation of ovarian tissue will offer some hope to women at risk to develop premature ovarian failure, e.g. women from families with familial premature ovarian failure and women scheduled to undergo chemotherapy or radiotherapy at a young age.     

Premature ovarian failure

Premature ovarian failure (POF) is the occurrence of amenorrhoea, elevated gonadotrophins and hypoestrogenism in women under 40 years of age. It has important physical and psychological consequences and is increasingly common due to improved survival following treatment for malignancy. Despite this, it remains a poorly understood condition. Here we review the presentation and investigation of POF, discuss recent advances in the management of affected women, and suggest how our knowledge of the condition could be improved.