尿毒症患者的临床护理策略

目的:探讨尿毒症患者的治疗及临床护理策略.方法:分析我科近6年间收治的68例尿毒症患者的临床资料,了解疾病发生发展过程中伴随的患者心理状况的变化及导致的并发症.结果:本组68例患者均贯彻和执行本院肾内科全程的尿毒症临床护理策略,建立透析档案,通过血液透析、对症治疗,除其中1例因经济原因自动出院外,其他67例患者均有明显改善.结论:尿毒症患者治疗过程中贯彻以对症、血液透析护理为主,辅以心理护理,有利于疾病的治疗和康复.     

血液灌流联合血液透析对尿毒症并发症疗效观察

目的观察血液灌流联合血液透析对尿毒症并发症的治疗效果。方法选取维持性透析尿毒症患者40例,将灌流器串联于透析器前,血流量150～240ml／min,透析液流量500ml／min,肝素用量首剂16-20mg,追加6～8mg／h或低分子肝素3500-5000U,追加肝素6mg／h。灌流治疗时间为2～2．5h,之后继续血液透析1．5—2h,连续治疗2次（间隔1日）。观察治疗前后患者皮肤瘙痒、骨痛、不安腿综合征、食欲、睡眠及自主感觉等临床症状变化,检测肾功能、电解质、甲状旁腺素（PTH）、p2微球蛋白（β2-MG）及血常规。结果血液灌流联合血液透析治疗后多数患者皮肤瘙痒、骨痛、不安腿综合征症状减轻、食欲增加,睡眠改善,自主感觉良好;尿素、肌酐、血磷、血钾、血PTH、血β2-MG显著降低,无严重的不良反应。结论血液灌流联合血液透析可显著降低尿毒症患者血中PTH、β2-MG等中分子物质,对患者的皮肤瘙痒、骨痛、不安腿综合征等症状疗效显著,并且能够增进食欲、改善睡眠及自主感觉。     

尿毒症肺的临床X线表现(附36例报告)

本文报告一组36例尿毒症肺,其中间质性肺水肿5例,肺泡性肺水肿31例。后者可分为四种类型:蝶翼状阴影(5/31)、弥漫性阴影(21/31)、孤立小片状阴影(2/31)和大叶性阴影(3/31)。肺部阴影具有右肺多于左肺、内中带多于外带、中下野多于上野和变化较快的特点。X 线下,尿毒症肺和心源性肺水肿常难以区分。本文还对尿毒症肺的鉴别诊断要点进行了分析讨论,并强调临床资料的重要性。     

Peripheral neuropathy in uremic patients and in renal transplant recipients

Summary Eighteen patients, ten with clinical uremia and eight with functioning kidney transplants, were studied clinically for neuropathy and were subsequently subjected to a sural nerve biopsy. The biopsy specimens were studied using light and electron microscopic and morphometric methods. The clinical polyneuropathy was qualitatively and quantitatively most severe in the hemodialysis group. These results conformed with the light and electron microscopic observations. Clinical, morphological and morphometric indications of recovery from uremic neuropathy were observed in the transplant recipients. The pathophysiology of uremic peripheral neuropathy was marked axonal degeneration. Pathologic Schwann cells were also frequently found. Axonal degeneration and Schwann cell damage seemed to exist independently of each other. In morphometric analysis, axonal atrophy and abnormal myelin sheath thickness were observed in all patient groups. A close relationship was found between axonal atrophy and low conduction velocity. Unexpectedly low nerve conduction velocities were also observed, which cannot be explained by either loss of nerve fibers or demyelination. The findings of damaged endoneural blood capillaries supported the ischemic theory as one mechanism in the pathogenesis of uremic neuropathy.     

Experimental uremic neuropathy. Part 1. Decreased nerve conduction velocity in rats

Acute and chronic renal failure were induced in adult male albino rats by conventional surgical methods. The glomerular filtration rate of rats with chronic uremia was reduced to approximately 15% of normal. Despite this drastic degree of renal failure, the motor nerve conduction velocity (MCV) increased from 47.5 +/- 6.4 m/s, preoperatively, to 55.6 +/- 4.0 m/s after 4 weeks. In rats with acute uremia, MCV decreased from 51.4 +/- 3.0 m/s to 45.2 +/- 2.7 m/s after 48 h. The conduction velocity, measured in vitro of excised sciatic nerves was 55.2 +/- 4.4 m/s in acute uremia and 64.7 +/- 4.7 m/s in a control group. There was no difference in the refractory period between these groups. It is concluded that this decrease in the nerve conduction velocity was not caused by changes in the composition of the extracellular fluid but rather by changes in the nodal membrane function.     

118例慢性肾功能衰竭（CRF）死亡的高危因素及防治措施的探讨

本文对１１８例死于ＣＲＦ病例进行分析，病死率２４．１％。病死率高峰在３１～４０岁年龄组（２６．３％）。死亡的原发病主要是慢性肾炎（６３．６％），狼疮性肾炎（１４．４％）和慢性肾盂肾炎（５．１％），其它如高血压肾病、糖尿病肾病等占１６．９％。死亡原因主要是急性左心衰（２９．７％）和尿毒症脑病（２７．９％）。比较此两种死因的病死率：非透析组明显高于透析组（Ｐ＜０．０５），说明透析疗法可以降低病死率。同时还分析了许多诱发和促使死亡的危险因素，发现多数是可逆因素，如能及时有效防治，可以降低其病死率。     

尿毒症患者事件相关电位（P_（300））的研究

本文对３０例尿毒症患者和４０名年龄相匹配的正常人进行Ｐ_（３００）检查，结果发现正常对照组无１例Ｐ_（３００）异常，尿毒症组异常者１４例（４６．７％），以６１～７１岁年龄组异常率最高。统计结果表明尿毒症患者Ｐ_（３００）异常率与年龄、中枢神经系统（ＣＮＳ）症状及ＢＵＮ水平有关，而与性别，病程，透析治疗总次数、Ｃｒ水平无关。本组结果提示尿毒症患者可出现ＣＮＳ损害，Ｐ_（３００）可作为尿毒症早期发现ＣＮＳ损害的一项简便、安全可靠的检测手段。     

Biophysical Studies on the Correction of Uremic Human Serum Albumin Binding Defects by In Vitro Charcoal Adsorption Treatment

Abstract: Spectrofluorimetry, flow microcalorimetry, and differential scanning microcalorimetry (DSMC) were used to study the conformation, binding function, and ligand loading of uremic albumin obtained from the blood plasma of 2 end-stage renal disease (ESRD) patients before and after charcoal plasma treatment at different pH values (3.0–9.0). The spectrofluorimetric patterns of conformational N-F transition at low pH (4.2–3.5) are practically identical for both samples of uremic human serum albumin (HSA) and control HSA from healthy donors. After the charcoal treatment at pH 3.0 and 4.0, the enthalpies of complexing on uremic HSA with bromsulfa-lein and sodium dodecylsulfate approach that of donor HSA. The binding affinity of uremic HSA for sodium octanoate, phenol red, and salicylic acid following low pH charcoal treatment even exceed those of donor HSA.
At the same time the charcoal treatment of uremic plasma at neutral and alkaline pH does not notably improve the binding characteristics of isolated HSA. Adsorption at low pH values completely restores the tryptophan fluorescence spectrum position of uremic albumin and improves the thermodynamic characteristics of its melting process. Using DSMC data, it can nevertheless be concluded that some conformational changes or a certain amount of high-affinity bound endogenous ligands still remain after low pH uremic HSA purification. The latter conclusion requires additional improvements of adsorption treatment of uremic plasma.     

Light microscopic study of striated muscle in uremia

Summary Gastrocnemius muscle biopsies from 28 patients with chronic renal failure were analyzed with a light microscope after staining with Gomori trichrome stain and after histochemical reactions for ATPase and NADH diaphorase. Nineteen (68%) of the biopsies were pathological. Uremic myopathy was seen in eleven (39%) of the biopsies, eight of which were obtained from subjects on regular hemodialysis. Pure myopathic muscle damage was observed in three (11%), both myopathic and neuropathic muscle damage in eight (29%) and pure neuropathic muscle damage in eight (29%) of the biopsies. Fiber type atrophy and hypertrophy of both types were seen. The most common quantitative findings were Type II atrophy, small mean size and type grouping of Type II fibers, and Type I hypertrophy.     

尿毒症性心脏损害的超声心动图研究

本文应用超声心动图对５０例慢性透析治疗的尿毒症患者心脏损害进行观察，结果显示：心包积液１６例（３２％），心包膜增厚６例（１２％）。心脏各腔室内径与正常对照组比较，除女性右室无差异外，其余均有扩大（Ｐ＜０．０５～Ｐ＜０．０１），以左室、左房扩大为著。室间隔和左室后壁明显增厚，左心室重量和重量指数显著增加，左室容积／重量比值减小。心肌回声分为三型：Ⅰ型１４例（２８％），Ⅱ型２０例（４０％），Ⅲ型１６例（３２％）。左室功能主要为舒张功能显著降低