透析液钙离子浓度对肾功能衰竭血液透析患者血清钙离子水平及血压的影响

目的 观察不同钙离子浓度的透析液对血液透析患者透析后血清钙离子水平及血压变化的影响，为肾功能衰竭血液透析患者的高钙血症及高血压的防治提供依据。方法 选择不同钙离子浓度的透析液，将维持性血液透析患者分为高钙组（1．75mmol／L）和低钙组（1．25mmol／L），比较患者每次透析前后脉搏、血压，同时抽查患者透析前后血钙及血肌酐浓度的变化。结果透析后两组患者血肌酐浓度均显著下降，透析前后差异均具有统计学意义（P〈0．01）；高钙组患者透析后血钙较透析前升高，差异具有统计学意义（P〈0．01），而低钙组患者血钙比透析前略降低，差异无统计学意义（P〉0．05）。高钙组患者透析后较透析前收缩压、舒张压及平均动脉压都升高，差异均具有统计学意义（P〈0．05），而低钙组患者透析后较透析前收缩压、舒张压及平均动脉压都降低，差异均具有统计学意义（P〈0．05）。透析后两组血钙比较差异具有统计学意义（P〈0．01）；透析后低钙组较高钙组患者的收缩压、舒张压及平均动脉压都降低，三者差异均具有统计学意义（P〈0．01）。结论透析液钙离子浓度与血液透析患者血清钙离子水平及血压呈正相关，低钙透析液透析有助于维持性血液透析患者高血压的控制。     

Pancreatic Panniculitis Associated with Allograft Pancreatitis and Rejection in a Simultaneous Pancreas–Kidney Transplant Recipient

Pancreatic panniculitis is an uncommon condition that can occur in association with pancreatic disease. We present a case of pancreatic panniculitis in a female pancreas-kidney transplant recipient 5 months post-transplant. The patient was on standard immunosuppressive medications and had acute rejection of her renal allograft. The diagnosis of allograft pancreatitis and rejection presenting with pancreatic panniculitis was supported clinically, histopathologically and by laboratory and imaging data. This is the fourth case of pancreatic panniculitis occurring in a transplant recipient and the first in a simultaneous pancreas-kidney transplant recipient. It is also the first case associated with allograft rejection. Clinicians should be aware that pancreatic panniculitis may be a manifestation of underlying allograft pancreatic disease.     

补肾排毒合剂治疗慢性肾衰竭营养不良60例临床观察

目的:观察补肾排毒合剂治疗慢性肾衰竭营养不良的疗效.方法:90例慢性肾衰竭营养不良患者随机分为治疗组60例和对照组30例,并设健康对照组30例.治疗组和对照组在综合治疗的基础上,治疗组加用补肾排毒合剂,对照组加用爱西特和百令胶囊.比较两组肾功能、营养状态和血浆瘦素、神经肽Y的变化.结果:治疗组治疗后BUN、Scr明显降低,与治疗前及对照组相比均有统计学差异(P<0.05).治疗组营养状态好转,与治疗前及对照组相比均有统计学差异(P<0.05).两组慢性肾衰竭营养不良患者治疗前Leptin、NPY水平均高于健康组(P<0.05),治疗后治疗组Leptin、NPY较治疗前下降,有统计学意义(P<0.05),但与对照组相比无统计学差异(P＞0.05).结论:补肾排毒合剂治疗慢性肾衰竭营养不良疗效明显,可降低BUN、Scr,改善营养不良状态.     

Cerebral autoregulation is preserved in multiple system atrophy: A transcranial Doppler study.

Patients with multiple system atrophy (MSA) present large changes in blood pressure (BP) due to autonomic disturbances. We analyzed how this change may influence dynamic cerebral autoregulation (DCA). Simultaneous recordings of arterial BP (Finapres) and middle cerebral artery (MCA) blood flow velocity (BFV) (transcranial Doppler) were performed in 10 patients with MSA (61 +/- 12 yr of age) and 12 healthy volunteers (61 +/- 11 yr of age): cerebral BFV response to oscillations in mean BP was studied in the supine position by cross-spectral analysis of mean BP and mean MCA BFV. The DCA was also studied during the decrease in BP the first seconds when standing up from a sitting position by the assessment of the cerebrovascular resistance index (CR; mean BP/mean MCA BFV ratio). The MCA BFV/BP cross-spectral analysis showed a phase for the mid-frequency band (0.07-0.2 Hz) significantly larger in MSA, suggesting more active autoregulation in response to larger changes in BP. Changes in CR reflecting the rate of autoregulation, when standing did not differ between the two groups. These data suggest that dynamic cerebral autoregulation is preserved in MSA.     

伊贝沙坦与雷米普利对充血性心力衰竭疗效比较

目的比较伊贝沙坦与雷米普利对充血性心力衰竭(CHF)的临床疗效及安全性。方法72例CHF患者在常规治疗基础上随机分为2组。伊贝沙坦组(36例)口服伊贝沙坦150 mg.d-1;雷米普利组(36例)口服雷米普利2.5 mg.d-1。治疗前与治疗6 mo后分别用超声心动图测量左室射血分数(LVEF)、左室短轴缩短分数(LVFS)、每搏输出量(SV)、心排量(CO)、心脏指数(CI)评估心功能。结果治疗6 mo后,2组心功能较治疗前非常明显改善(P<0.01),2组之间比较差异无统计学意义(P>0.05)。结论伊贝沙坦与雷米普利治疗CHF均有效,且疗效相当。     

血管内皮生长因子及炎性因子在油酸性犬急性呼吸窘迫综合征中的变化

目的探讨油酸性急性呼吸窘迫综合征（ARDS）beagle犬血浆及肺泡灌洗液血管内皮生长因子（VEGF）、可溶性细胞间黏附分子-1（ICAM-1）、白细胞介素-8（IL-8）、肿瘤坏死因子-α（TNF—α）水平的改变。方法12只英国纯种beagle犬，静脉注射油酸0．15mL／kg，在注射油酸前、后1h，出现ARDS的典型表现时，抽血测VEGF、sICAM-1、IL-8、TNF—α，并对此时相作肺泡灌洗液VEGF、sICAM—1、IL-8、TNF-α的测定。结果beagle犬静脉注射油酸后1h血浆TNF—α升高（P〈0．05），血浆反肺泡灌洗液IL8、sICAM-1和VEGF在1h较油酸前没有明显变化（P〉0．05），beagle犬油酸型ARDS模型建立后血浆及肺泡灌洗液VECF、sICAM-1、IL-8、TNF—α均显著高于建模前（P〈0．05）。结论VEGF、sICAM-1、IL-8、TNF～α在beagle犬油酸型ARDS发生发展过程中可能均起重要作用，其水平的高低可能与ARDS严重程度及预后有关。     

天文潮汐对心脏病患者心力衰竭发生率影响的研究

目的　研究天文潮汐对心脏病患者发生心衰的影响。方法　分析 118例心脏病患者发生心衰在各潮汐期的分布。结果　在强天文潮汐期内心脏病患者发生心衰显著多于其余时期 ,而且在朔、望期发生的人数多于上、下弦期。结论　护理人员要了解天文潮汐的变化规律 ,教育心脏病患者在强天文潮汐期内要保持情绪稳定 ,必要时在强天文潮汐期内可给予心脏病患者适量的镇静剂和安眠药。     

慢性肾衰竭急性加重的临床特征及相关因素分析

目的：探讨慢性肾衰竭（CRF）急性加重因素及其治疗措施对预后的影响。方法：对2001年1月～2005年6月住院治疗的CRF急性加重患者42例，按其加重原因、基础疾病、治疗方式和疗效进行回顾性总结。结果：CRF急性加重因素依次为各种感染（45．2％）、原发病加重（19．0％）、高血压未控制（14．3％）、水电解质紊乱（11．9％）、肾毒性药物（11．9％）、心功能不全（9．5％）、尿路梗阻（4．8％）、血高粘滞状态（2．4%），7例同时存在≥2种上述病因（16．7％）。CRF急性加重原发病以慢性肾小球肾炎（52．4％）和糖尿病肾病（11．9％）为主。积极治疗后肾功能恢复达到或接近原来水平者40例，死亡2例，死亡2例的年龄均在60岁以上。结论：对于CRF肾功能急剧恶化的患者，应积极寻找其加重因素，并采取非透析和透析相结合治疗，改善肾功能，降低病死率，延长患者生命。     

Postinfectious gastroparesis related to autonomic failure: a case report

BACKGROUND AND AIM: Severe dysautonomia may be secondary to viral infections, resulting in impaired autoimmune, cardiovascular, urinary and digestive dysfunction. Herein, we present a case of a 31-year-old white female patient who had severe gastroparesis related to autonomic failure following an episode of acute gastroenteritis. This seems to be the first report providing thorough assessment of the enteric and autonomic nervous system by analysis of full-thickness small intestinal biopsies, cardiovagal testing and autopsy. HOSPITAL COURSE: This patient affected by a severe gastroparesis was treated with antiemetics, prokinetics, analgesics and gastric electrical stimulation to control symptoms. Nutritional support was made using jejunal feeding tube and, in the final stage of disease, with total parenteral nutrition. Autonomic studies revealed minimal heart rate variability and a disordered Valsalva manoeuvre although the enteric nervous system and the smooth muscle layer showed a normal appearance. Hospital courses were complicated by episodes of bacteraemia and fungemia. Serum antiphospholipid antibodies were noted but despite anticoagulation, she developed a pulmonary embolism and shortly thereafter the patient died. Autopsy revealed acute haemorrhagic Candida pneumonia with left main pulmonary artery thrombus. Sympathetic chain analysis revealed decreased myelinated axons with vacuolar degeneration and patchy inflammation consistent with Guillain-Barre syndrome. The evaluation of the enteric nervous system in the stomach and small bowel revealed no evidence of enteric neuropathy or myopathy. CONCLUSION: A Guillain-Barre-like disease with gastroparesis following acute gastroenteritis is supported by physiological and autonomic studies with histological findings.