医用腹膜透析管路护理腰带的改良设计与应用

目的对传统护理腰带进行改良设计,解决长期腹膜透析患者透析管路的护理问题。方法本着方便、安全、可靠的原则,对传统的腹膜透析腰带进行改进。选择2013年5月-2015年5月在西安某院肾病内科长期行腹膜透析治疗的终末期肾脏病患者90例为研究对象。将其中2013年5月-2014年4月接受治疗的45例患者设为对照组,采用传统护理腰带进行护理;将2014年5月-2015年5月接受治疗的45例患者设为观察组,采用改良的腹膜透析护理腰带进行护理。观察比较两组患者腹膜透析期间的透析管出口处感染、导管脱落及隧道炎的发生情况。结果经改良的腹膜透析护理腰带设计合理,能妥善固定腹膜透析管路,安全方便。观察组患者的出口处感染和导管脱落明显低于对照组,差异有统计学意义(P0.05);观察组无隧道炎发生,也明显低于对照组,差异有统计学意义(P0.05)。结论经过改良的腹膜透析管路护理腰带使长期腹膜透析患者的护理更方便、安全、有效,它能减少腹膜透析相关性腹膜炎的发生率,值得临床推广应用。     

Indwelling hemodialysis catheterization by transthoracic way

Abstract

Chronic kidney failure can be described as a chronic and progressive disfunction in metabolic-endocrine function and in adjustment of fluid-electrolyte balance of kidney, as a result of reducing of glomerular filtration value. Besides being a medical issue, chronic kidney failure affects social, economic, and psychological conditions of patients. Indwelling catheters can be placed in the right atrium by right mini thoracotomy in kidney patients who depend on dialysis and all central veins are used. In the patients whose central veins were used, were able to do catheterization by this technique, and this is a procedure that must be retentioned.     

Early Start of Dialysis Has No Survival Benefit in End-Stage Renal Disease Patients

The timing for dialysis initiationis still debated. The aim of this study was to compare mortality rates, using a propensity-score approach, in dialysis patients with early or late starts. From January 2000 to June 2009, incident adult patients (n = 836) starting dialysis for end-stage renal disease (ESRD) were enrolled. The patients were assigned to either an early- or late-start group depending on the initiation time of the dialysis. After propensity-score-basedmatching, 450 patients remained. At the initiation of dialysis, the mean estimated glomerular filtration rate (eGFR) was 11.1 mL/min/1.73 m² in the early-start group compared with 6.1 mL/min/1.73 m² in the late-start group. There were no significant differences in survival between the patients in the early- and late-start groups (Log rank tests P = 0.172). A higher overall mortality risk was observed in the early-start group than in the late-start group for the patients aged ≥ 70 yr (hazard ratio [HR]: 3.29; P = 0.048) and/or who had albumin levels ≥ 3.5 g/dL (HR: 2.53; P = 0.046). The survival of the ESRD patients was comparable between the patients in the early and late-start groups. The time to initiate dialysis should be determined based on clinical findings as well as the eGFR.     

不同容量连续性肾脏替代治疗严重腹腔感染对比研究

目的:探讨治疗严重腹腔感染的最佳连续性肾脏替代治疗(CRRT)血液滤过容量。方法:56例严重腹腔感染患者分别进行常规容量、大容量持续CRRT治疗,CRRT治疗前、治疗后4h、12h、24h、36h、48h、72h检测血浆肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)水平及降钙素原(PCT)水平、统计ICU入住时间、机械通气时间及日均医疗费用,评价卫生经济学。结果:大容量组持续CRRT治疗后4hTNFα-、IL-6水平开始下降直至48h,其后下降水平不大,降钙素原在持续CRRT治疗后4h下降,维持至72h,大容量组入住ICU时间4.3±0.6d,机械通气时间36.3±0.8h,短于常规容量组,日均医疗费用无差异。结论:大容量CRRT能有效清除炎症介质,控制感染较常规容量好,效益/费用比更好。     

腹膜透析患者长期生存及相关因素分析——单中心登记系统数据分析

目的：分析南京军区南京总医院全军肾脏病研究所腹膜透析(PD)中心长期PD患者临床数据，探讨当前PD患者临床特点、远期预后及影响因素。方法：分析2002年2月至2010年11月登记的681例PD患者的临床资料。采用Kaplan-Meier方法计算患者生存率及技术存活率，并以多因素COX回归模型计算风险比值(hazard ratios，HR)，进一步明确影响预后的独立因素。结果：男性398例(58.5％)，女性283例(41.5％)，平均年龄(45.68±15.69)岁。原发病以慢性肾小球肾炎(77.1％)和糖尿病肾病(11.8％)为主。患者平均透程(13.94±16.40)月，其中日间不卧床腹膜透析(DAPD)604例(88.7％)，持续不卧床腹膜透析(CAPD)77例(11.3％)。1年、3年、5年及8年的技术存活率为87％、74.4％、61.85％及53％，患者生存率为94.2％、80.8％、75.3％及64.5％。除因经济因素放弃治疗及肾移植外，近三年导致患者退出PD的主要因素分别是透析超滤失败(35.2％)、心血管系统并发症(33.8％)和腹膜炎(12.6％)。此外，少数患者因导管(8.5％)及胸腔积液(4.2％)等因素退出。导致患者死亡的主要因素为心血管事件(37.7％)、感染(10.4％)和脑血管事件(7.8％)。通过单因素COX回归分析显示低血浆白蛋白血症、严重贫血等与营养不良相关的并发症以及透析不充分是导致PD患者掉队的独立风险因素。结论：本中心PD患者有较好的生存率和技术存活率，影响PD患者预后的主要因素为心、脑血管并发症及透析不充分。     

己糖激酶在原代培养腹膜间皮细胞的表达

目的 :探讨大鼠腹膜间皮细胞 (peritonealmesothelialcell,PMC)的原代培养方法及其己糖激酶 (hexoki nase ,HK)的表达。方法 :胰蛋白酶 EDTA消化法进行PMC的分离、培养 ,6 磷酸葡萄糖脱氢酶 (G6PDH)偶联比色法检测其HK总活性。结果 :PMC的原代及传代细胞 5～ 8d即可达到融合 ,其HK的基础活性为 (4.80± 0 .39)U/g蛋白。结论 :改良的胰蛋白酶消化法是进行PMC原代培养的一种可靠的实验方法。PMC有较强的HK活性 ,参与了腹膜透析时对葡萄糖吸收和利用方面的调节 ,可能对透析超滤有较大的影响     

1-Hydroxyethylidene-1,1-bisphosphonate decreases the postovariectomy enhanced interleukin 1 secretion from peritoneal macrophages in adult rats

Summary Bisphosphonates are potent inhibitors of bone resorption. In previous studies, we have shown that ovariectomy accelerated bone resorption and 1-hydroxyethylidene-1,1-bisphosphonate (HEBP) inhibits ovariectomy-accelerated bone resorption in female Wistar adult rats. As interleukin 1 (IL-1) stimulates bone resorptionin vitro andin vivo, we have investigated the effects of ovariectomy and HEBP administeredin vivo on IL-1 secretion from peritoneal macrophages in adult rats. Ovariectomy or sham surgery were performed in female Wistar rats at 40 weeks of age. Overiectomized and sham-operated rats were administered with HEBP (10 mg) or saline, 10 times in total, from 43 to 46 weeks of age. Paraffin oil-induced peritoneal macrophages at 46 weeks of age were cultured for 24 hours. Lipopolysaccharide (LPS)-stimulated peritoneal macrophages from ovariectomized rats secreted more IL-1 than sham-operated rats. HEBP decreased LPS-stimulated IL-1 secretion from peritoneal macrophages in ovariectomized rats, but not in sham-operated rats.In vivo administration of HEBP decreased IL-1 secretion only in postovariectomy hyperresorptive states. These results suggest that alterations in LPS-stimulated IL-1 secretion from oil-induced peritoneal macrophages may be responsible, at least in part, for the postovariectomy acceleration in bone resorption and its inhibition by HEBP.     

复用对高通透性透析安全性的影响及其机制--体内及体外研究

目的 通过体内及体外试验研究复用对高通透性透析安全性的影响及其机制。方法 体内试验：20例慢性肾功能衰竭患者随机分为普通和高通透性透析组，经透析器初用及复用后，记录透析中出现的急性并发症，测定透析前、后血浆中白介素(IL)-1β、肿瘤坏死因子(TNF)-α、IL-6水平，同时测定透析后血浆内毒素水平。体外试验：选择初用和复用后不同透析器建立体外循环闭合环路以模拟血液透析过程，分别在透析液室加入嗜麦芽假单胞菌细菌滤液前、后从血液室采集样本，采用人全血孵育法孵育样本检测上清液中IL-1受体拮抗剂(IL—1ra)浓度。结果 高通透性透析复用组低血压、寒战发生率较普通透析复用组明显升高(P＜0．05)，高通透性透析复用组透析后血浆IL-6水平较透析前显著升高(P＜0．05)，两组透析后血浆内毒素水平的差异无显著性。高通透性透析膜F60聚砜膜与低通透性透析膜铜仿膜及F6聚砜膜相比，初用时在透析液室加入细菌滤液并循环1h后，三者血液室样本诱导人全血产生的IL-1ra浓度均较加入细菌滤液前明显升高，但三者间的差异无显著性；复用时F60聚砜膜与初用时比较，该指标的升高显著高于铜仿膜及F6聚砜膜。结论 高通透性透析在初用时是安全的，但在复用时其急性并发症发生率明显升高。其机制与复用损伤高通透性透析膜，使其在发生反超滤时引起内毒素等细胞因子诱导物质转运入血有关。     

Genotyping: a new application for the spent dialysate in peritoneal dialysis.

BACKGROUND: The dialysate of patients on peritoneal dialysis (PD) is used to determine the concentration of growth factors and cytokines, and as a source of resident peritoneal cells for subsequent culture experiments. We hypothesized that the cells contained in spent dialysate samples obtained at the time of the peritoneal equilibration test (PET) and subsequently stored may represent a source of DNA from a given PD patient. METHODS: We characterized a protocol of DNA extraction from dialysates obtained in PD patients after a long dwell during the initial PET and kept frozen up to several years. After amplification of the source DNA by strand displacement using the bacteriophage phi 29 DNA polymerase, we performed polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP) analysis for the Glu298Asp polymorphism of ENOS to demonstrate the suitability of the extracted DNA for genotyping. RESULTS: A significant amount of DNA (mean yield 12 microg/ml dialysate) was extracted from frozen dialysate samples. The extraction yield was not influenced by the duration of storage at -20 degrees C. Following amplification, the DNA extracted from the dialysate was used successfully for genotyping the Glu298Asp polymorphism of ENOS, as demonstrated by parallel analyses using DNA extracted from the peripheral blood and sequencing. CONCLUSIONS: These results demonstrate that the dialysis effluent obtained at the time of the initial PET and stored at -20 degrees C is a reliable source of DNA that can be used subsequently for PCR amplification, RFLP analysis and sequencing.