肠道微生态制剂对老年慢性肾衰竭腹膜透析病人残余肾功能、微炎症及氧化应激的影响

目的 观察老年慢性肾衰竭终末期腹膜透析病人经肠道微生态制剂治疗的效果.方法 选取2019年1月至2020年1月期间于我院接受腹膜透析的100例老年慢性肾衰竭终末期病人,采用数字奇偶法分为观察组(奇数)与对照组(偶数),每组各50例.对照组行腹膜透析+常规治疗,观察组接受腹膜透析+常规治疗+肠道微生态制剂治疗,2组均治疗...     

不同透析方法对终末期糖尿病肾病患者的治疗疗效

目的探讨不同透析方法对终末期糖尿病肾病患者的治疗疗效。方法 2016年1—12月间选取该院诊断为糖尿病终末期肾衰竭患者150例,随机分为研究组(接受血液透析滤过串联灌流器治疗)10例和对照组(接受常规血液透析)50例。分析两组透析前后一般情况;两组透析前后实验室指标改善情况。结果两组透析前一般情况比较差异无统计学意义(P0.05);两组透析后一般情况比较差异有统计学意义(P0.05);两组透析前实验室指标比较差异无统计学意义(P0.05);两组透析后实验室指标比较差异有统计学意义(P0.05)。结论与单纯常规血液透析相比,血液透析滤过串联灌流器治疗终末期肾衰竭患者效果更为肯定,使患者能获得更好的疗效,改善体内血脂、蛋白水平。     

血液透析管理

自1943年Kolff首次将透析用于临床以来,血液透析用于治疗终末期肾病至今已有近 80 年历史,2017年估计全球肾衰竭的患病率为0.07％,达到970万例[1],预计到2030年,全世界需要肾脏替代治疗的患者将达到543.9万(389.9万～764.0万)例[2].目前约89％的终末期肾病患者采取的肾脏替代治疗方式...     

前列腺E1疗终末期慢性肾衰竭患者的临床疗效

目的 评价应用前列腺素E1(PGE1)治疗终末期慢性肾衰竭(ESRF)的临床疗效.方法 22例终末期慢性肾衰竭(ESRF)老年患者,分为两组,对照组10 例,根据病情常规用药、控制血压、纠正贫血、酸中毒、电解质紊乱等.实验组12 例,在未使用组基础上加用PGE1 200 μg加入10%葡萄糖液500 ml中静脉滴注,1次/d,用药3个疗程,随访3个月,观察两组的临床症状、实验室检查、病死率等相关指标.结果 实验组水肿、腰酸乏力、尿量、食欲、皮肤瘙痒等症状改善程度均比对照组明显.实验组尿素氮(BUN) 、血肌酐(Scr) 、内生肌酐清除率(Ccr) 、尿蛋白等高于对照组,差异有显著性(P<0.05).实验组死亡率25%,对照组死亡率50 %,两组比较差异显著(P<0.05).结论 应用PGE1能减缓慢性肾功能不全的进程,改善肾功能,降低终末期慢性肾衰竭的病死率,改善预后.     

前列腺素E_1治疗终末期慢性肾衰竭患者的临床疗效

目的评价应用前列腺素E1(PGE1)治疗终末期慢性肾衰竭(ESRF)的临床疗效。方法 22例终末期慢性肾衰竭(ESRF)老年患者,分为两组,对照组10例,根据病情常规用药、控制血压、纠正贫血、酸中毒、电解质紊乱等。实验组12例,在未使用组基础上加用PGE1200μg加入10%葡萄糖液500 ml中静脉滴注,1次/d,用药3个疗程,随访3个月,观察两组的临床症状、实验室检查、病死率等相关指标。结果 实验组水肿、腰酸乏力、尿量、食欲、皮肤瘙痒等症状改善程度均比对照组明显。实验组尿素氮(BUN)、血肌酐(Scr)、内生肌酐清除率(Ccr)、尿蛋白等高于对照组,差异有显著性(P0.05)。实验组死亡率25%,对照组死亡率50%,两组比较差异显著(P0.05)。结论应用PGE1能减缓慢性肾功能不全的进程,改善肾功能,降低终末期慢性肾衰竭的病死率,改善预后。     

利伐沙班和达比加群酯治疗高龄非瓣膜性房颤病人的安全性及疗效观察

目的分析高龄非瓣膜性房颤病人应用利伐沙班和达比加群酯治疗的有效性和安全性。方法入选既往在我院心内科住院治疗的高龄非瓣膜性房颤病人79例,分为利伐沙班治疗组(34例)和达比加群酯治疗组(45例),观察血栓栓塞性并发症及出血性并发症出现的比例,并观察其对凝血功能、血红蛋白、血小板计数的影响。结果两组治疗后比较,在新发血栓栓塞性疾病和新发出血性疾病发病率差异无统计学意义(P0.05),两组间实验室指标凝血功能、血红蛋白、血小板计数比较差异无统计学意义(P0.05)。结论在高龄非瓣膜性房颤病人中应用利伐沙班与达比加群酯可以预防血栓栓塞性疾病,均安全有效。     

不同类型血管通路的老年长期血液透析患者并发症比较

目前临床上肾衰竭的治疗主要依赖于血液透析.建立可靠的血管通路是维持血液透析治疗效果的关键环节之一.本研究旨在比较不同手术方式建立血管通路的临床效果与并发症的差异. 1资料与方法 1.1临床资料回顾性分析2010年1月至2011年12月我院进行长期血液透析的253例患者建立长期动静脉内瘘(AVF)的临床资料.均为各种肾脏疾病导致的终末期慢性肾衰竭,其中男136例,女117例,年龄60～78岁,平均(66.4±22.8)岁.     

冠心病合并2型糖尿病高龄病人经皮冠状动脉介入治疗的临床观察

目的观察冠心病合并2型糖尿病的高龄病人经皮冠状动脉介入治疗(PCI)的临床疗效及安全性。方法选择我院2012年3月—2014年3月行PCI治疗的冠心病合并2型糖尿病高龄病人30例作为观察组,再选取同期行PCI治疗的冠心病未合并2型糖尿病的高龄病人50例作为对照组,比较两组病人的手术成功率及临床疗效。结果两组病人手术成功率比较差异无统计学意义(P0.05),观察组病人半年内再发心绞痛、心肌梗死、恶性心律失常及心源性猝死总发生率高于对照组病人,差异无统计学意义(P0.05)。结论冠心病合并2型糖尿病的高龄病人行PCI治疗效果可靠,安全性高,可作为冠心病病人的治疗方法。     

浅谈糖尿病透析肾移植及预后

糖尿病肾病进展到晚期,进入到终末期肾病阶段时,就必须采取肾脏替代 疗法,即透析或肾移植,来满足机体代谢需要,延缓病人的生命。 目前对终末期糖尿病肾病比较理想的治疗措施是同时进行胰肾联合移植,但是由于各种条件的限制只有很少的病人能得到这种治疗,而大多数患者,只能接受透析治疗。目前糖尿病患者透析治疗主要有两种方式,即长期规律性血液透析和持续不卧床腹膜透析(CAPD)。     

CRRT治疗慢性肾衰竭合并心力衰竭的临床价值分析

目的观察连续性肾脏替代疗法(CRRT)在慢性肾衰竭合并心力衰竭中的临床价值。方法研究对象即本院2017年5月至2019年5月收治的101例慢性肾衰竭合并心力衰竭患者,经数字盲选方式,划分A组(n=50,治疗方法:常规血液透析)和B组(n=51,治疗方法:CRRT),比较两组患者血生化指标、临床疗效。结果 B组患者的PH值、血氧饱和度显著高于A组;B组患者的尿素氮、血肌酐水平则低于A组;B组患者的临床治疗总有效率高于A组。比较两组之间数据差异可统计(P<0.05)。结论在慢性肾衰竭合并心力衰竭治疗中应用CRRT,有助于改善各项心功能指标,临床效果显著。     

Effect of Renin‐Angiotensin System Inhibitor on Residual Glomerular Filtration Rate in Hemodialysis Patients

Residual renal function preservation in patients with renal failure has been shown to be related to better outcomes not only in the pre‐dialysis phase but also after hemodialysis initiation. However, the effect of factors such as antihypertensive agents on residual renal function preservation has not been investigated adequately in prevalent hemodialysis patients. This study examined factors related to the rate of residual renal function preservation in 1‐year hemodialysis patients who had residual renal function. We enrolled 191 consecutive maintenance hemodialysis patients who underwent hemodialysis for 1 year and maintained a urine output of more than 200 mL/day, to assess residual renal function loss. The rate of residual renal function loss was 19.9%. Multivariate analysis using residual renal function as the dependent variable revealed significant independent relationships with renin‐angiotensin system inhibitor use (hazard ratio, 0.438; P = 0.027), history of cardiovascular disease (hazard ratio, 2.475; P = 0.024), and rate of weight gain between dialysis sessions (hazard ratio, 1.348; P = 0.013). No relationship was observed with calcium channel blocker use. Renin‐angiotensin system inhibitor use, rate of body weight gain between dialysis sessions, and cardiovascular diseases are independently associated with residual renal function preservation in patients with residual renal function after 1 year of hemodialysis. A further intervention study is required to investigate whether treatment with renin‐angiotensin system inhibitors and suppression of body weight gain preserves residual renal function for a longer time in hemodialysis patients.     

呋塞米联合小剂量多巴胺间歇静脉泵入治疗终末期心力衰竭合并利尿剂抵抗

目的观察比较间歇微量泵静脉泵入呋塞米和多巴胺与分次静脉推注呋塞米治疗终末期心衰伴利尿剂抵抗患者的疗效。方法将56例利尿剂抵抗性心力衰竭患者随机分为两组,对照组28例患者在进行常规抗心力衰竭治疗基础上,单纯分次静脉推注呋塞米治疗;观察组28例患者在常规抗心力衰竭治疗的基础上同时给予呋塞米和多巴胺间歇静脉泵入治疗。两组患者均治疗5 d。观察治疗前后两组患者在心功能分级（NYHA）、心功能指标、肾功能、尿量和体重等方面的变化。结果与对照组比较,观察组患者心功能分级（NYHA）明显改善,LVEF增加,6 min步行试验距离延长,尿量明显增加（P均〈0.05）。结论对终末期心衰伴利尿剂抵抗的患者,间歇静脉泵入呋塞米和多巴胺治疗的疗效优于单纯静脉推注呋塞米治疗。     

川芎嗪联合非洛地平可增强维持性血液透析患者抗氧化应激能力

目的：探讨川芎嗪联合非洛地平对维持性血液透析（MHD）患者抗氧化应激能力及残余肾功能（RRF）的影响。方法：选取2018年4月至2020年6月淮南新华医疗集团新华医院血液透析中心采取相同透析方案的70例MHD患者，随机分为对照组和观察组，每组35例。2组患者均给予常规血液透析、非洛地平降压等基础治疗，观察组在基础治疗上加用川芎嗪注射液治疗，40mg/次，3次/周，于透析治疗结束后静脉滴注。比较2组患者治疗前及治疗6个月后尿量、RRF、血液透析充分性 [尿素下降率（URR）、尿素清除指数（KT/V）]、外周血超氧化物歧化酶（SOD）、丙二醛（MDA）及生活质量 [生理健康总测量（PCS）、心理健康总测量（MCS）]评分变化及不良反应发生情况。结果：治疗后，2组患者尿量、RRF均较治疗前下降，且观察组高于对照组（P均<0.05）。观察组URR、KT/V较治疗前显著提高，且治疗后明显高于对照组（P均<0.05）。2组患者SOD水平较治疗前升高，且观察组高于对照组（P均<0.05）；MDA水平较治疗前降低，且观察组低于对照组（P均<0.05）。治疗后，2组患者PCS、MCS评分较干预前降低，且观察组PCS、MCS评分高于对照组（P均<0.05）；2组治疗期间均未见明显的药物不良反应。结论：川芎嗪联合非洛地平可增强MHD患者的抗氧化应激能力，延缓其RRF的下降，提高血液透析充分性及生存质量，且安全性较好。     

高龄终末期肾脏病患者肾脏替代治疗时机和治疗方式的选择

高龄(≥80岁)终末期肾脏病(ESRD)患者人数不断增加,年龄是透析患者生存率的独立危险因素,有关高龄ESRD患者治疗时机与治疗方式选择的报道较少。本文从保守治疗与肾脏替代治疗对高龄患者生存率的差异、透析时机对患者生活质量及预后的影响、肾脏替代治疗方式的选择、血液透析和腹膜透析治疗效果和并发症的差异等方面总结了国内外的相关文献报道,以期为高龄ESRD患者的治疗决策提供参考。     

Epidemiology and management of end-stage renal disease in the elderly

Elderly patients with end-stage renal disease (ESRD) are at increased risk of developing aging-related problems, such as frailty, impaired physical function, falls, poor nutrition and cognitive impairment. These factors affect dialysis outcomes, which can be very poor in frail, elderly patients who often experience a decline in overall health and physical function and have short survival. The default treatment option for these patients is hospital-based hemodialysis, often with little consideration of how this modality will affect the survival or quality of life of individual patients. A comparison of quality of life of elderly patients on hemodialysis versus peritoneal dialysis shows that those on peritoneal dialysis have less illness intrusion. Assisted peritoneal dialysis enables a greater number of frail, elderly patients to have dialysis in their own homes. Dialysis may not extend survival for those with multiple comorbidities, so conservative care (nondialysis treatment) should be considered. To improve the outcomes of elderly patients with ESRD, it is necessary to develop a realistic approach to overall prognosis, quality of life and how the patient copes with the disabilities associated with aging. This approach includes having discussions regarding choice of treatment and end-of-life goals with patients and families.     

Proton-pump inhibitors for prevention of upper gastrointestinal bleeding in patients undergoing dialysis

AIM:To investigate the preventive effects of low-dose proton-pump inhibitors(PPIs) for upper gastrointestinal bleeding(UGIB) in end-stage renal disease.METHODS:This was a retrospective cohort study that reviewed 544 patients with end-stage renal disease who started dialysis at our center between 2005 and 2013.We examined the incidence of UGIB in 175 patients treated with low-dose PPIs and 369 patients not treated with PPIs(control group).RESULTS:During the study period, 41 patients developed UGIB, a rate of 14.4/1000 person-years.The mean time between the start of dialysis and UGIB events was 26.3 ± 29.6 mo.Bleeding occurred in only two patients in the PPI group(2.5/1000 person-years) and in 39 patients in the control group(19.2/1000 person-years).Kaplan-Meier analysis of cumulative non-bleeding survival showed that the probability of UGIB was significantly lower in the PPI group than in the control group(log-rank test, P 0.001).Univariate analysis showed that coronary artery disease, PPI use, anti-coagulation, and anti-platelet therapy were associated with UGIB.After adjustments for the potential factors influencing risk of UGIB, PPI use was shown to be significantly beneficial in reducing UGIB compared to the control group(HR = 13.7, 95%CI:1.8-101.6; P = 0.011).CONCLUSION:The use of low-dose PPIs in patients with end-stage renal disease is associated with a low frequency of UGIB.     

Chronic ambulatory peritoneal dialysis in patients aged over seventy

Thirteen patients with end-stage renal disease aged 70 years have been successfully treated by chronic dialysis treatment. Despite many problems associated with the elderly, a good quality of life was achieved.     

肾康注射液对血液透析患者残余肾功能的保护作用

目的 观察肾康注射液对血液透析患者残余肾功能（RRF）的保护作用.方法 61例血液透析患者随机分为对照组和治疗组,治疗组给予肾康注射液治疗6个月.比较两组患者治疗前、后日均尿量、RRF以及血红蛋白、血白蛋白、三酰甘油、胆固醇、超敏C反应蛋白（hsCRP）、肿瘤坏死因子（TNF）-α水平.结果 治疗前两组患者间日均尿量、RRF及血红蛋白、血白蛋白、三酰甘油、胆固醇、hsCRP和TNF-α间比较差异均无统计学意义;治疗后治疗组血红蛋白、血白蛋白、三酰甘油和胆固醇与对照组比较差异无统计学意义,日均尿量和RRF水平高于对照组,hsCRP和TNF-α水平低于对照组（P＜0.05）.结论 肾康注射液可以保护血液透析患者残余肾功能,其机制可能与减轻患者体内炎症反应有关.