血液透析治疗尿毒症者心率变异性与心律失常关系的探讨

目的分析血液透析(HDL)治疗尿毒症者的心律失常与心率变异性(HRV)的特点。方法对40例HDL者(A组)及50例健康对照者(B组)进行动态心电图(DCG)监测,对心律失常发生情况及HRV各项指标:24h内全部正常R-R间距标准差(SDNN),24h每5min窦性R-R间距平均值的标准差(SDANN),24h每5min窦性R-R间距平均值的标准差的均值(SDNN index),两个相邻窦性R-R间距互差>50ms的心跳数占所分析信息间期内心搏数的百分比(PNN50),相邻窦性R-R间距差值的均方根(RMSSD)进行对比分析。结果尿毒症者的心律失常(房性心律失常及室性早搏)的发生率明显高于B组,HRV各项指标与B组比较有显著差异性(P<0.01)。结论 HRV明显降低,心律失常发生率高,提示尿毒症者自主神经功能受损。     

透析对尿毒症患者凝血系统的影响

目的观察尿毒症透析前患者组、血透（HD）组、腹透（CAPD）组凝血、纤溶功能的变化。方法采用ELISA法检测患者血浆TAT、D-二聚体水平,同时检测患者常规凝血项目（PT、APTT、TT、Fbg）。结果尿毒症患者透析前后TAT、D-二聚体水平均升高,以CAPD组升高尤为明显,患者透析前TT、APTT缩短,透析后APTT情况有所好转。结论尿毒症患者体内存在高凝继发高纤的状态,透析尤其是腹膜透析可加剧这种紊乱。TAT、D-二聚体的测定较常规凝血检查能更准确反映患者体内凝血、纤溶状态。     

尿毒症肺误诊为肺部感染原因分析

目的探讨尿毒症肺的临床和影像特征,减少误诊漏诊。方法回顾分析1例尿毒症肺误诊病例资料。结果患者1年前诊断肾衰竭尿毒症期。因发热、呼吸道症状1月余入院,在外院按肺部感染抗感染治疗无效。入我院后经综合分析CT和实验室检查结果,确诊尿毒症肺,予抗感染及血液透析治疗,肺部症状改善。结论临床应重视尿毒症所致肺损害,胸部X线检查对诊断有一定帮助,充分的血液透析可改善病情。     

血液透析联合血液灌流对血液透析患者难治性高血压的影响

目的探讨血液透析联合血液灌流对尿毒症难治性高血压患者的疗效和可行性。方法将26例维持性血液透析患者随机分为两组：血液灌流串联血液透析（HD4-HP）组13例,每例患者在2周5次常规血液透析的同时,每周1次HD＋HP治疗;常规血液透析（HD）组13例,每周3次HD治疗。观察两组治疗前及治疗后血压、肾素（PRA）、血管紧张素Ⅱ（ATⅡ）、同型半胱氨酸（Hcy）的变化。结果HD4-HP组治疗后血压明显下降,治疗前后比较差异有统计学意义（P〈0．01）;HD＋HP组治疗前后比较,PRA、ATⅡ、Hcy明显下降,差异有统计学意义（P〈0．05）;HD组治疗前后PRA、ATⅡ、Hcy无明显变化（P〉0．05）。治疗后HD＋HP组PRA、ATⅡ、Hcy较HD组明显下降,差异有统计学意义（P〈0．05）。结论血液灌流串联血液透析对尿毒症难治性高血压患者有明显的治疗效果。     

实时三平面自动功能成像评价尿毒症患者血液透析前后左心室长轴收缩功能

目的 探讨实时三平面自动功能成像（AFI）评价尿毒症患者透析前后左心室长轴收缩功能的价值。方法 收集接受血液透析的尿毒症患者30例（尿毒症组）和健康志愿者（对照组）32名,患者均于初次透析前、透析后1个月和3个月接受超声心动图检查;应用实时三平面AFI测量左心室各节段纵向收缩峰值应变（RLS）和整体纵向收缩峰值应变（GLS）,比较尿毒症组与对照组AFI各指标差异,分析GLS与左心室心肌质量指数（LVMI）和左心室射血分数（LVEF）的相关性。结果 尿毒症组透析前、透析后1个月GLS和所有节段RLS,透析后3个月GLS及部分节段RLS明显低于对照组（P均<0.05）。尿毒症组透析后1个月和3个月GLS增高,部分节段RLS增高（P均<0.05）;与透析后1个月比较,透析后3个月GLS进一步增高,部分节段RLS进一步增高（P均<0.05）。GLS与LVMI呈负相关（r=-0.547,P<0.01）,与LVEF呈正相关（r=0.252,P<0.01）。结论 实时三平面AFI可早期定量评价尿毒症患者左心室长轴收缩能力。     

腹膜透析患者C反应蛋白水平与营养不良及心血管疾病的相关性

目的探讨腹膜透析（continuous ambulatory peritoneal dialysis,CAPD）患者C反应蛋白水平的改变及炎症反应与营养不良及心血管疾病的关系。方法检测健康对照者、尿毒症非透析患者和持续性非卧床腹膜透析（CAPD）患者C反应蛋白（CRP）,血清白蛋白（Alb）,血红蛋白（Hb）,血清铁蛋白（SF）,血清前白蛋白（PA）等指标。并根据CAPD患者CRP水平将其分为正常组（CRP〈10mg/L）,异常组（CRP〉10mg/L）,观察2组之间的差别。结果尿毒症非透析组和CAPD组CRP水平均高于对照组[（12.14±5.92）mg/L与（13.92±4.67）mg/L比（5.37±2.15）mg/L,t=8.16,t=12.95,P〈0.001],CAPD组CRP水平高于尿毒症非透析组[（13.92±4.67）mg/L比（12.14±5.92）mg/L,t=2.70,P〈0.01]。CAPD患者CRP水平与营养不良指标Alb,Hb,PA成负相关,有统计学意义（r=-0.44,P=0.007;r=-0.57,P=0.002;r=-0.36,P=0.010）,CRP水平与改良定量的整体营养评估（MQSGA）呈正相关,有统计学意义（r=0.26,P=0.048）。CAPD患者CRP水平升高组的心血管疾病发生率高于CRP正常组（？2=3.86,P〈0.05）,CRP水平与心脏超声检查指标左房内径（LAD）、左室舒张末内径（LVDd）、室间隔厚度（IVST）、左室后壁后度（LVPWT）呈正相关（r=0.315,P=0.028;r=0.252,P=0.049;r=0.297,P=0.035;r=0.349,P=0.020）有统计学意义,与左室射血分数（LVEF）呈负相关（r=-0.281,P=0.041）,有统计学意义。结论 CAPD患者存在CRP水平升高的炎症反应,且高于尿毒症非透析患者,CAPD患者营养不良及心血管疾病与慢性炎症状态相关。     

尿毒症患者尿红细胞形态、MCV及血红细胞MCV联合检测的临床意义

目的：探讨尿毒症患者尿红细胞形态、MCV及血红细胞MCV联合检验的临床价值。方法：用AVE-763尿沉渣分析仪观察尿毒症组、肾小球肾炎血尿组和非肾小球血尿组患者的尿红细胞形态并计算畸形率,再用XT-2000i全自动血细胞分析仪检测尿红细胞及外周血红细胞MCV。结果：尿毒症组尿红细胞畸形率、MCV及血MCV／尿MCV与肾小球肾炎血尿组比较差异有统计学意义（P〈0．01）,与非肾小球血尿组比较差异无统计学意义（P〉0．05）。结论：尿毒症患者尿红细胞形态、MCV与非肾小球性血尿接近,临床医生诊断和观察病情变化时必须重视。     

The use of multi-detector computed tomography venography and three dimensional reconstruction image in evaluating the central venous occlusive disease of hemodialysis patients

Objective To evaluate the feasibility and value of multi-detector computed tomography venography (MDCTV) and three dimensional reconstruction image in the assessment of central venous occlusive disease in hemodialysis patients, and in the value of guiding interventional treatments. Methods Sixty hemodialysis patients with swelling of upper limbs were scanned by Toshiba 128-multislice spiral computed tomography (128-MSCT) and totally 80-100 ml non-ionic contrast media was injected into each of the patients via the peripheral veins of the contralateral limb with the rate of 4 ml/s. MSCT scanning was taken by the technique of intelligent triggering after setting scanning triggering threshold, with the monitoring?point?set in the development of the lumen of inferior vena cava, to detect the position and degree of vascular stenosis. The images were reformed as maximum intensity projection (MIP), volume rendering (VR), curved planar reformation and three-dimensional image reconstruction technique. Results MDCTV clearly demonstrated the lesion location in all cases enrolled. Seventy-five occlusive lesions were detected in the total of 60 hemodialysis patients with swelling of upper limbs by MDCTV, of which the lesions of brachiocephalic vein was 47, superior vena cava 15 and subclavian vein 13. Among the 75 stenosis lesions, the number of complete occlusive, severe, moderate and mild stenosis was 31, 24, 19 and only 1, respectively. MDCTV provided information coincident with that of digital?subtraction?angiography (DSA), which the correlation index was 0.401, while DSA showed that number of complete occlusive, severe, moderate and mild stenosis was 49, 7, 14 and 5, respectively. Percutaneous transluminal angioplasty was performed in 53 patients, and stent placement was done in 40 patients. After interventional treatments, swelling of upper limbs were obviously relieved and vascular accesses got functional recovery to?the?extent?that?they could meet the requirement of hemodialysis. Conclusions MDCTV is the first choice to evaluate the condition of central?venous?occlusive diseases of hemodialysis patients with advantages of non-invasion, high definition and three-dimensional?reconstruction. It can provide accurate evaluations of the conditions of occlusive lesions, which can be of great clinical significance to subsequent interventional therapy.     

尿毒症继发甲状旁腺功能亢进的手术治疗进展

继发性甲状旁腺功能亢进是尿毒症患者常见的严重并发症之一.手术治疗是有效的治疗方法.甲状旁腺全切除加前臂移植术因其疗效确切,易于监测,较为常用.术前应进行充分的准备,特别是术前甲状旁腺定位至关重要.各种手术方法均有一定的复发率.     

血液透析配合血液灌流治疗尿毒症顽固性高血压疗效观察

目的：探讨血液透析配合血液灌流治疗尿毒症顽固性高血压的疗效。方法64例尿毒症顽固性高血压患者根据治疗方法不同分成观察组和对照组两组。对照组采用单纯血液透析治疗,每周3次,观察组采用血液透析联合血液灌流治疗,每周1次。比较两组治疗后的降压效果。结果观察组的总有效率显著高于对照组（90.6% vs 71.9%,P ＜0.05）。观察组和对照组患者治疗后的 SBP、DBP 均较治疗前明显降低,且观察组患者的 SBP、DBP 较对照组降低更显著（P ＜0.05）。结论血液透析配合血液灌流治疗尿毒症顽固性高血压疗效确切,值得推广和应用。