肾移植与腹膜透析患者生活质量比较的病例对照研究

目的 比较肾移植患者与腹膜透析患者的生活质量.方法 采用病例对照的研究方法,以性别、年龄、文化程度、工作与否、付费方式、肾替代治疗时间作为匹配条件,选择肾移植和腹膜透析患者各58例,以健康相关生活质量问(Short Form 36 Health Survey Questionnaire,SF-36)评估其生活质量.结果 肾移植与腹膜透析患者的生理综合得分和精神综合得分均无显著性差异,在涉及的8个维度中,肾移植患者的生理机能(t=3.060,P=0.003)、一般健康状况(t=2.579,P = 0.011)和精力(t=2.610,P=0.011)高于腹膜透析患者,而生理职能(Z=3.917,P=0.000)低于腹膜透析患者.结论 肾移植与腹膜透析患者总体生活质量无差异,仅个别维度有差异;良好的疾病管理能改善患者生活质量,应加强肾替代治疗患者的管理.     

腹膜透析和血液透析病人行肾移植回顾性研究

目的 通过对比分析腹膜透析病人和血液透析病人接受肾移植的术前、术后临床和血生化指标,了解对肾移植疗效的影响。方法 回顾分析本院1997年前接受肾移植并定期随访病人共452例,其中由腹透进入肾移植的病人共49例为腹透组,由血液透析进入肾移植的病人用计算机随机匹配98例为血透组,对二组病人肾移植前后生化指标、肝炎病毒感染率、术后感染等并发症、移植肾失功、医疗费用等进行评估分析。结果 移植前腹透组血浆白蛋白水平低于血透组,移植后血浆白蛋白水平二组无差异。在达到同样血红蛋白水平,腹透病人所需促红素较低;乙肝、丙肝感染率二组分别为28.57％、2.04％和35.71％、13.27％,腹透组显著低于血透组。术后肾功能恢复情况,移植肾失功率无显著差异。术后感染率腹透组为6.12％低于血透组的12.87％。结论 腹膜透析病人纠正贫血所需促红素量较低,血浆白蛋白水平较低但不影响移植效果。HBV、HCV感染率、术后并发症发生率低。移植后肾功能恢复和维持,移植肾失功率以及总医疗费用与血透病人无显著差异。     

腹膜透析早期患者的饮食护理

目的 :总结腹膜透析早期患者饮食护理的经验。方法 :行腹膜透析治疗终末期肾脏病患者 2 1例 ,透析后 2个月内只作一般指导 ,2个月时进行临床观察 ,然后饮食护理 2个月 ,比较护理前后临床效果。结果 :护理前后患者血浆白蛋白、血甘油三酯有差异 ,肾功能、血红蛋白、理想体重无明显差异。结论 :腹膜透析早期患者的营养状况与长期腹膜透析患者的营养状况不尽相同 ,对患者饮食予以个体化指导 ,合理膳食 ,不仅可以维持机体的营养 ,补充透析丢失 ,而且可减缓残余肾单位的损坏 ,有利于提高患者的生存质量     

高龄肾功能衰竭患者腹膜透析疗效分析

目的 评价腹膜透析(PD)在高龄肾功能衰竭患者治疗中的作用。方法 观察35例高龄肾衰患者PD治疗前及PD治疗后肾功能、肝功能、血红蛋白等评价指标的动态变化,并发症的发生情况及生存率的变化。结果 大多数高龄患者在行腹透治疗后血浆白蛋白、血清前白蛋白和血红蛋白等全身营养状况指标均较治疗前有明显降低,常见并发症有:低血钾、腹膜炎、呼吸道感染、心力衰竭、皮肤和肢体末端溃疡和腹壁疝。结论 腹膜透析治疗并非是高龄肾衰患者最合适的治疗手段,应综合考虑患者病情,选择适合的透析方式。     

Efficacy of roxadustat in treatment of peritoneal dialysis patients with renal anaemia

BACKGROUNDThere are no studies on the use of roxadustat in patients on regular peritoneal dialysis in China.AIMTo observe the efficacy and safety of roxadustat in treating renal anaemia in peritoneal dialysis patients.METHODSPatients with renal anaemia who were regularly followed at the Peritoneal Dialysis Center of the First Affiliated Hospital of China Medical University from November 1, 2019 to June 30, 2020 were selected. A before-and-after self-control design was performed to retrospectively analyse the treatment effects on anaemia in patients treated with recombinant human erythropoietin (EPO) and roxadustat.RESULTSA total of 31 patients with renal anaemia on long-term peritoneal dialysis treated with roxadustat were included. Haemoglobin (Hb) levels were maintained or increased in all patients (100%), and no patients had a decrease in Hb compared with the previous phase. Patients had a mean Hb of 86.2 ± 14.8 g/L with Hb compliance (Hb ≥ 110 g/L) of 16.1% during the EPO phase and a mean Hb of 112.4 ± 18.5 g/L with Hb compliance of 67.7% during the roxadustat phase. No major adverse cardiovascular events occurred in any patient.CONCLUSIONThe application of roxadustat in peritoneal dialysis patients with renal anaemia can effectively improve the Hb compliance rate.     

居家腹膜透析操作者规范洗手现状及原因分析

目的了解居家腹膜透析操作者操作前规范洗手的现状及其影响因素。方法采用自行设计的操作前规范洗手调查问卷、规范洗手评分标准,对2010年4月份期间北京大学人民医腹膜透析中心的76例居家腹膜透析操作者进行调查。结果腹膜透析操作者以女性居多(64.5%),以退休人员为主(65.8%),大多数由患者本人进行腹膜透析操作(73.7%)。现场观察洗手合格者仅有5例(6.6%)。被调查的操作者洗手平均用时8s,漏洗2个部位者,占57.8%;漏洗2个及以上部位者占81.6%,居家腹膜透析操作者漏洗率较高的部位依次是:指关节、指间、指尖。细菌菌落计数合格者14例,合格率18%。菌落计数与洗手得分呈负相关,洗手得分越低菌落计数越高。操作者的年龄、透析龄、文化程度、职业、性别、与患者的关系等因素与洗手得分无相关性。结论居家腹膜透析操作者洗手不规范,护士应关注操作者对规范洗手的重要性、操作方法等方面的认识,提高洗手的规范性。     

不同透析方式对肾移植预后影响的研究进展

终末期肾病患者的肾脏替代治疗方式包括透析及肾脏移植。由于供肾器官的短缺,患者在接受移植前,往往需要经过一段时间的透析等待。血液透析与腹膜透析作为肾移植前的透析方式,对于移植受者的早期及远期有何不同的影响,透析持续时间对于肾移植效果是否有影响,以及无透析肾移植对于肾移植预后有何影响,均尚无定论。本文将就前述问题的研究进展作一介绍。     

Serum amyloid P component in chronic renal failure and dialysis

A normal reference interval for serum amyloid P component (SAP) concentration in the serum was established in 500 healthy adult individuals (274 women, 226 men), by electroimmunoassay calibrated with standards of highly purified, isolated SAP. The mass of SAP in these was determined from the extinction coefficient of SAP at 280 nm measured here precisely for the first time by spectrophotometry and cryogenic drying. The mean (SD, range) SAP concentration was significantly lower in women: 24 mg/l (8, 8–55), compared to 32 mg/l (7, 12–50) in men P < 0.001). In renal insufficiency patients, 38 with chronic renal failure, 79 on hemodialysis and 66 on continuous ambulatory peritoneal dialysis, the mean values for SAP concentration were all significantly higher than normal (range of means, 39–59 mg/l in men and 35–42 mg/l in women), but did not correlate with serum creatinine, duration of dialysis or the presence of an acute phase response. The metabolism of SAP is thus altered in renal failure and is not normalized by dialysis, but it is not clear whether this is relevant to the pathogenesis of dialysis related arthropathy and amyloidosis.     

Performance of chest compressions by laypersons during the Public Access Defibrillation Trial

Background

Increasing evidence indicates that health professionals often may not achieve guideline standards for cardiopulmonary resuscitation (CPR). Little is known about layperson CPR performance.

Methods

The investigation was a retrospective cohort study of cardiac arrest patients treated by layperson CPR and one model of automated external defibrillator (AED) as part of the Public Access Defibrillation Trial (n = 26). CPR was measured using software that integrates the event log, ECG signal, and thoracic impedance signal. We assessed chest compression fraction (proportion of attempted resuscitation spent performing chest compressions), prompted compression fraction (proportion of attempted resuscitation spent performing compressions during AED-prompted periods), compression rate, and compressions per minute.

Results

Of the 26 cases, 13 presented with ventricular fibrillation and 13 with nonshockable rhythms. Overall, during the period when patients did not have spontaneous circulation, the median chest compression fraction was 34% (IQR 17-48%), median prompted chest compression fraction was 49% (IQR 30-66%), and the median chest compression rate was 96/min (IQR 90-110/min). Taken together, the median chest compression delivered per minute among all arrests was 29 (IQR 20-42). CPR characteristics differed according to initial rhythm: median chest compression per minute was 20 (IQR 13-29) among ventricular fibrillation and 42 (IQR 28-47) among nonshockable rhythms (p = 0.003).

Conclusions

In this study of trained laypersons, CPR varied substantially and often did not achieve guideline parameters. The findings suggest a need to improve CPR training, consider changes to CPR protocols, and/or improve the AED-rescuer interface.     

Defibrillation coil reversal: a rare cause of abnormal noise and inappropriate shocks

We report a rare case of inadvertent reversal of the defibrillator shock coils during generator change which then resulted in both intermittent, recurrent "noise" on both the rate sensing and the shock electrogram leads and multiple inappropriate shocks.     

血液透析和腹膜透析患者血浆游离和总肉毒碱水平的观察

目的 观察血液透析和腹膜透析患者血浆总肉毒碱(TC)和游离肉毒碱(FC)的水平.方法 200名正常对照组标本来自本院健康体检人群,受检病例为本院肾脏内科患者;TC和FC采用循环酶法测定,在日立7170全自动生化分析仪上测定.结果 200名正常对照组TC(56.52±9.61)μmol/L,FC(46.60±8.23)μmol/L;37例血液透析患者透析前TC(41.47±13.22)μmol/L,FC(24.58±8.91)μmol/L;与正常对照组比较差异有统计学意义(P＜0.01);118例腹膜透析患者TC(40.59±9.94)μmol/L,FC(25.52±7.45)μmol/L;与正常对照组比较差异有统计学意义(P＜0.01).血透患者透析后TC(14.62±5.32)μmol/L,比透析前下降(64.70±5.95)%,FC(8.62±3.01)μmol/L,比透析前下降(63.84±9.14)%,且TC与FC的水平与透析程呈负相关(r=-0.68,-0.73);118例腹膜透析患者TC与FC的水平与透程无关(P＞0.05).11例血液透析患者静脉给予左旋卡尼汀1 g,透析后TC(70.31±36.18)μmol/L,FC(35.53±19.25)μmol/L,与对照组比较差异无统计学意义(P＞0.05).结论 血液透析和腹膜透析患者普遍存在肉毒碱缺乏,血液透析患者随着透析程的延长,缺乏越严重.静脉给予左旋卡尼汀可有效纠正血液透析患者循环肉毒碱的下降.     

跨理论模型结合动机性访谈对终末期肾病行腹膜透析患者肾功能的影响

目的 探讨跨理论模型结合动机性访谈对终末期肾病(ESRD)行腹膜透析患者肾功能的影响.方法 选取我院2015年8月—2018年2月ESRD腹膜透析患者120例为研究对象,按照组间均衡可比的原则分为观察组与对照组,各60例.对照组给予常规护理,观察组给予跨理论模型结合动机性访谈,干预时间为4周.比较两组肾功能、治疗依从性...     

腹膜透析抢救急性肾功能衰竭并多器官功能障碍综合征48例分析

目的 探讨腹膜透析抢救急性肾功能衰竭并多器官功能障碍综合征(MODS)患者的疗效。方法 48例急性肾功能衰竭并MODS患者在病因治疗的基础上采用持续性不卧床腹膜透析。结果 治疗后血肌酐、血尿素氯明显降低，血碳酸氢根离子、血钾离子及血钠离子全部得到纠正。结论 腹膜透析能有效地清除急性肾功能衰竭并MODS患者体内毒素，纠正酸碱平衡失调及电解质平衡紊乱，提高存活率，是抢救急性肾功能衰竭并MODS的有效治疗方法。     

Hereditary angioedema: a survey of UK emergency departments and recommendations for management

Patients with hereditary angioedema may present to the emergency department (ED) with subcutaneous and submucosal swellings, the most important being the development of laryngeal oedema, which can rapidly obstruct the airways and cause death. The aim of this study was to establish whether local guidelines exist for the management of such patients and to determine where the C1 inhibitor concentrate (C1 INHC) was kept in the trusts. A questionnaire survey of the availability and use of C1 INHC was sent to 35 EDs across the UK with established immunology services within their trusts. A hundred percent response was received. Thirty-three trusts had a supply of the drug C1 INHC in varying quantities. Nineteen trusts had it in their ED. Only 17 departments had any guidance with regard to their use. There is a significant lack of guidance for C1 INHC use in the EDs surveyed. A guideline was developed as a result that can be used by EDs across Europe.     

Defibrillation probability and impedance change between shocks during resuscitation from out-of-hospital cardiac arrest

Objective

Technical data now gathered by automated external defibrillators (AEDs) allows closer evaluation of the behavior of defibrillation shocks administered during out-of-hospital cardiac arrest. We analyzed technical data from a large case series to evaluate the change in transthoracic impedance between shocks, and to assess the heterogeneity of the probability of successful defibrillation across the population.

Methods

We analyzed a series of consecutive cases where AEDs delivered shocks to treat ventricular fibrillation (VF) during out-of-hospital cardiac arrest. Impedance measurements and VF termination efficacy were extracted from electronic records downloaded from biphasic AEDs deployed in three EMS systems. All patients received 200 J first shocks; second shocks were 200 J or 300 J, depending on local protocols. Results presented are median (25th, 75th percentiles).

Results

Of 863 cases with defibrillation shocks, 467 contained multiple shocks because the first shock failed to terminate VF (n = 61) or VF recurred (n = 406). Defibrillation efficacy of subsequent shocks was significantly lower in patients that failed to defibrillate on first shock than in patients that did defibrillate on first shock (162/234 = 69% vs. 955/1027 = 93%; p < 0.0001). The failed VF terminations were distributed heterogeneously across the population; 5% of patients accounted for 71% of failed shocks. Shock impedance decreased by 1% [0%, 4%] and peak current increased by 1% [0%, 4%] between 200 J first and 200 J second shocks. Shock impedance decreased 4% [2%, 6%] and current increased 27% [25%, 29%] between 200 J first and 300 J second shocks. In all 499 pairs of same-energy consecutive shocks, impedance changed by less than 1% in 226 (45%), increased >1% in 124 (25%) and decreased >1% in 149 (30%).

Conclusions

Impedance change between consecutive shocks is minimal and inconsistent. Therefore, to increase current of a subsequent shock requires an increase of the energy setting. Distribution of failed shocks is far from random. First shock defibrillation failure is often predictive of low efficacy for subsequent shocks.     

The dynamic process of adherence to a renal therapeutic regimen: Perspectives of patients undergoing continuous ambulatory peritoneal dialysis

Background

The nature of end-stage renal disease and the need for continuous ambulatory peritoneal dialysis require patients to manage various aspects of the disease, its symptoms and treatment. After attending a training programme, patients are expected to adhere to the renal therapeutic regimen and manage their disease with the knowledge and skills learned. While patients are the stakeholders of their health and related behaviour, their perceptions of adherence and how they adhere to their renal therapeutic regimen remains unexplored.

Aims

To understand adherence from patients’ perspectives and to describe changes in adherence to a therapeutic regimen among patients undergoing continuous ambulatory peritoneal dialysis.

Design

This study used a mixed methods design with two phases – a survey in phase I and semi-structured interviews in phase II. This paper presents phase II of the study.

Settings

The study was conducted at a renal unit of an acute hospital in Hong Kong.

Participants

Based on the phase I survey results, maximum variation sampling was employed to purposively recruit 36 participants of different genders (18 males, 18 females), ages (35–76 years), and lengths of dialysis experience (11–103 months) for the phase II interviews.

Methods

Data were collected by tape-recorded semi-structured interviews. Content analysis was employed to analyse the transcribed data. Data collection and analysis were conducted simultaneously.

Findings

Adherence was a dynamic process with three stages. At the stage of initial adherence, participants attempted to follow instructions but found that strict persistent adherence was impossible. After the first 2–6 months of dialysis, participants entered the stage of subsequent adherence, when they adopted selective adherence through experimenting, monitoring and making continuous adjustments. The stage of long-term adherence commenced after 3–5 years of dialysis, when participants were able to assimilate the modified therapeutic regimen into everyday life.

Conclusions

The process of adherence was dynamic as there were fluctuations at each stage of the participants’ adherence. With reference to each stage identified, nursing interventions can be developed to help patients achieve smooth transition throughout all the stages.     

The use of opioid analgesia in end-stage renal disease patients managed without dialysis: recommendations for practice

The numbers of patients dying with end-stage renal disease (ESRD), particularly those managed conservatively (without dialysis) or withdrawing from dialysis is increasing rapidly in developed countries. There is growing awareness of the extensive symptom control needs of these patients. Pain is a common problem, and has been both under-recognized and under-treated. It is challenging to manage, largely because of the constraints very poor renal function places on use of medication. Although pharmacological reviews of opioid use in renal failure have been published, there is a need for clinical recommendations to aid palliative and renal specialists in providing effective pain control. This review describes the pharmacological evidence for and against the use of the different opioid medications, and translates this into clinical recommendations for ESRD patients managed conservatively, not for those on dialysis for whom there are different pharmacological considerations. Acetaminophen (paracetamol) is recommended at Step 1 of the World Health Organization ladder. Of the Step 2 analgesics, tramadol is the least problematic, although dose reduction and increased dosing interval are required, and caution should be exercised. Of the Step 3 analgesics, fentanyl, alfentanil and methadone are recommended. There is limited evidence for buprenorphine, although theoretical reasons why it may be a good choice for these patients. Hydromorphone and oxycodone cannot be recommended because of extremely limited evidence, although each is likely a better choice than morphine or diamorphine. Morphine and diamorphine themselves are not recommended because of known accumulation of potentially toxic metabolites.     

CAPD病人血清半胱氨酸浓度与营养状况的探讨

目的 连续性非卧床腹膜透析(continuous ambulatory peritoneal dialysis,CAPD)病人营养状况是影响病人存活率的重要因素之一,病人的营养状况与血清半胱氨酸(tHcy)浓度存在正相关性。本研究旨在探讨血清tHcy浓度在CAPD病人营养评估中的价值。方法 慢性肾功能不全(CRF)病人35例,健康志愿者50例为对照组。应用临床综合营养指数(Composite Nutritional Index,CNI)评估CAPD病人的营养状况,用高效液相法测定血清tHcy浓度。结果 CRF病人CAPD治疗前血清tHcy浓度与健康对照组无显著差别(P>0.05),CAPD治疗6个月后血清tHcy浓度较健康对照组明显增高(P<0.001),CAPD病人伴有心、脑血管病变者血清tHcy浓度较无心、脑血管病变者明显减低(P<0.01)。血清tHcy浓度与CNI呈负相关(R2~=0.5991)。结论 CAPD病人血清tHcy浓度与病人营养状况呈正相关。     

腹膜透析患者的转归及其危险因素分析

目的分析单中心27年间所有维持性腹膜透析患者的转归,探寻腹膜透析患者死亡的危险因素,讨论减少腹膜透析患者退出的策略。方法回顾性观察解放军第四五五医院自1985年1月开展第1例腹膜透析以来至2011年12月间所有行腹膜透析管置入术开始腹膜透析的患者,并除外维持性腹膜透析不足1月者。记录患者的转归及退出腹膜透析的原因,分析他们的人口学资料、实验室数据、透析充分性、残余肾功能、腹膜转运特性、营养状况等。结果共841例腹膜透析患者入选本研究,其中女性431例(51.2%)。开始腹膜透析时的平均年龄为58.53±16.67岁。原发病中慢性肾小球肾炎占第1位,为441例(52.4%),其次为高血压肾损害149例(17.7%),糖尿病肾病121例(14.4%)。患者的平均腹膜透析龄为18.63±20.35月。至2011年12月底,继续腹膜透析246例(29.2%),死亡296例(35.2%),转血液透析152例(18.1%),肾移植64例(7.6%),失访83例(9.9%)。心血管事件是首位死亡原因(41.6%);其次为感染(33.0%),包括肺部感染(23.2%)和腹膜炎(9.8%);第3位死亡原因是脑血管事件(9.5%)。转血液透析的最主要原因为腹膜透析相关感染(59.2%);然后是导管功能障碍(堵管、漂管等,25.7%);透析不充分(7.2%)。经COX回归模型分析提示,死亡的危险因素是老龄(HR:1.06,P<0.01);糖尿病(HR:1.88,P<0.01);血液透析转至腹膜透析(HR:1.49,P<0.01);低白蛋白血症(HR:2.44,P<0.01);血C反应蛋白增高(HR:2.07,P<0.01);低肌酐清除率(HR:1.89,P<0.05);腹膜高转运状态(HR:2.28,P<0.01)。结论在我中心,腹膜透析患者退出的最主要原因是死亡,其次是转至血液透析。心血管事件是第1位的死亡原因,腹膜透析相关感染是转血液透析的最主要原因。老龄、糖尿病、由血液透析转至腹膜透析、营养不良、炎症状态、透析不充分、腹膜高转运状态者有着更高的死亡风险。