低浓度钙透析液对维持性血液透析患者继发性甲状旁腺功能亢进及颈动脉粥样硬化的影响

目的:分析低浓度钙透析液对维持性血液透析患者继发性甲状旁腺功能亢进及颈动脉粥样硬化的影响.方法:收集2013年12月至2015年12月间本院收治的接受维持性血液透析治疗的尿毒症患者76例,按照随机数表法分为对照组(n=38):高浓度钙透析液(DCa1.75),3次/周,持续6月;观察组(n=38):低浓度钙透析液(DCa1.25),3次/周,持续6月.检测两组患者的治疗前及治疗6月后外周血甲状旁腺激素(PTH)及钙磷代谢指标、脂质代谢指标、氧化应激指标含量,超声下颈动脉粥样硬化参数.结果:透析6月后,观察组患者的外周血总钙(tCa)、离子钙(iCa)、甲状旁腺激素(PTH)含量低于对照组患者,磷(P)含量高于对照组患者(P<0.05);外周血脂质代谢指标总胆固醇(TC)、三酰甘油(TG)、载脂蛋白B(ApoB)、低密度脂蛋白胆固醇(LDL-C)含量低于对照组患者,高密度脂蛋白胆固醇(HDL-C)含量高于对照组患者(P<0.05);血清超氧化物歧化酶(SOD)含量高于对照组患者,丙二醛(MDA)、活性氧物质(ROS)含量低于对照组患者(P<0.05);超声下颈动脉参数颈动脉内膜中层厚度(IMT)、颈动脉阻力指数(CA-RI)水平低于对照组患者,收缩期血流峰值流速(Vmax)、舒张期血流峰值流速(Vmin)水平高于对照组患者(P<0.05).结论:对于钙浓度在正常范围的尿毒症患者,低浓度钙透析液的应用有助于维持钙磷及P TH含量的稳定,进一步抑制颈动脉粥样硬化的进展,个体化钙浓度透析液的选择是确保尿毒症患者透析效果、减少严重并发症发生的重要环节.     

Gambro AK 96血液透析装置维修案列分析与解决

本文通过对Gambro AK 96血液透析装置出现的两例故障进行描述分析,提供具体的解决方案,同时通过这两例维修案列探讨改进Gambro AK 96血液透析装置的日常维护。故障一主要由静脉压传感器发生故障引起,故障二主要由消毒液阀膜老化引起。我们通过查找此机型的机器报错代码,结合透析液液路图,快速准确的找到故障点,进行针对性维修。工程师需要熟悉报错代码,精通透析液液路图,快速解决故障,为医院节省维修成本。     

Cooling dialysate during in-center hemodialysis: Beneficial and deleterious effects

The use of cooled dialysate temperatures first came about in the early 1980s as a way to curb the incidence of intradialytic hypotension (IDH). IDH was then, and it remains today, the most common complication affecting chronic hemodialysis patients. It decreases quality of life on dialysis and is an independent risk factor for mortality. Cooling dialysate was first employed as a technique to incite peripheral vasoconstriction on dialysis and in turn reduce the incidence of intradialytic hypotension. Although it has become a common practice amongst in-center hemodialysis units, cooled dialysate results in up to 70% of patients feeling cold while on dialysis and some even experience shivering. Over the years, various studies have been performed to evaluate the safety and efficacy of cooled dialysate in comparison to a standard, more thermoneutral dialysate temperature of 37 °C. Although these studies are limited by small sample size, they are promising in many aspects. They demonstrated that cooled dialysis is safe and equally efficacious as thermoneutral dialysis. Although patients report feeling cold on dialysis, they also report increased energy and an improvement in their overall health following cooled dialysis. They established that cooling dialysate temperatures improves hemodynamic tolerability during and after hemodialysis, even in patients prone to IDH, and does so without adversely affecting dialysis adequacy. Cooled dialysis also reduces the incidence of IDH and has a protective effect over major organs including the heart and brain. Finally, it is an inexpensive measure that decreases economic burden by reducing necessary nursing intervention for issues that arise on hemodialysis such as IDH. Before cooled dialysate becomes standard of care for patients on chronic hemodialysis, larger studies with longer follow-up periods will need to take place to confirm the encouraging outcomes mentioned here.     

不同血液透析液对U937细胞凋亡和PKCδ表达的影响

目的 研究不同血液透析液对U937细胞蛋白激酶C-δ(PKCδ)表达及细胞凋亡的影响.方法 在对数生长期人单核细胞株U937细胞培养液中添加不同血液透析液进行干预,分为A液+B液组(血液透析液A液+B液组合)、A液+B液+PKCδ特异性抑制剂(rottlerin)组、A液+B粉组(血液透析液A液+B粉组合)、A液+B粉+ rottlerin组,同时设立空白对照和正常对照组.分组干预后24 h和48 h分别收集细胞,Hoechst33258染色后荧光显微镜观察细胞形态学改变;Annexin V-FITC/PI双标记流式细胞术检测细胞凋亡;RT-PCR和Western blotting 检测PKCδ mRNA和蛋白表达.结果 A液+B粉组凋亡细胞明显增多,呈凋亡典型形态学改变,分组干预24 h和48 h的细胞凋亡率明显高于相应时间点空白对照组、正常对照组和A液+B粉+rottlerin组(P<0.05);同时与两对照组和A液+B粉+rottlerin组比较,A液+B粉组U937细胞PKCδ mRNA和蛋白表达均明显上调(P<0.05).A液+B液组细胞凋亡率及PKCδ mRNA和蛋白表达与两对照组和A液+B液+rottlerin组比较,差异均无统计学意义(P＞0.05).结论 血液透析液A液+B粉组合对U937细胞有明显促凋亡作用,其机制可能与上调细胞PKCδ表达有关;与A液+B粉组合比较,选择A液+B液组合作为血液透析液可降低患者外周血单核细胞的细胞凋亡率.     

不同血液透析液对U937细胞凋亡和PKCδ表达的影响

目的 研究不同血液透析液对U937细胞蛋白激酶C-δ(PKCδ)表达及细胞凋亡的影响.方法 在对数生长期人单核细胞株U937细胞培养液中添加不同血液透析液进行干预,分为A液+B液组(血液透析液A液+B液组合)、A液+B液+PKCδ特异性抑制剂(rottlerin)组、A液+B粉组(血液透析液A液+B粉组合)、A液+B粉+ rottlerin组,同时设立空白对照和正常对照组.分组干预后24 h和48 h分别收集细胞,Hoechst33258染色后荧光显微镜观察细胞形态学改变;Annexin V-FITC/PI双标记流式细胞术检测细胞凋亡;RT-PCR和Western blotting 检测PKCδ mRNA和蛋白表达.结果 A液+B粉组凋亡细胞明显增多,呈凋亡典型形态学改变,分组干预24 h和48 h的细胞凋亡率明显高于相应时间点空白对照组、正常对照组和A液+B粉+rottlerin组(P<0.05);同时与两对照组和A液+B粉+rottlerin组比较,A液+B粉组U937细胞PKCδ mRNA和蛋白表达均明显上调(P<0.05).A液+B液组细胞凋亡率及PKCδ mRNA和蛋白表达与两对照组和A液+B液+rottlerin组比较,差异均无统计学意义(P＞0.05).结论 血液透析液A液+B粉组合对U937细胞有明显促凋亡作用,其机制可能与上调细胞PKCδ表达有关;与A液+B粉组合比较,选择A液+B液组合作为血液透析液可降低患者外周血单核细胞的细胞凋亡率.     

碳酸氢钠透析液的临床应用

对27例慢性肾功能衰竭患者进行了528次血液透析,其中446次施行碳酸氢钠透析。碳酸氢钠透析液是由CO_2通入透析液中配制而成,使其pH维持在7.0～7.4。结果表明此方法简便易行,并可避免透析中的钙镁沉淀。碳酸氢钠透析与醋酸钠相比,纠正酸中毒效果好,透析中并发症少,尤其适用于危重病人。     

Beeinflussung von Gasaustausch und Metabolismus durch unterschiedliche Hämodialyseverfahren

Summary We compared the effects of various dialysate composition on pulmonary and transdialyzer gas exchange in patients during hemodialysis. Under acetate hemodialysis there was a permanent loss of CO₂ (45–68 ml/min) into the dialysate resulting in a significant decrease of arterial pO₂, which can be explained by a reduced alveolar ventilation. The pulmonary oxygen uptake increased up to +20% during treatment, reflecting rising energy metabolism and possibly increased cardiopulmonary instability.Using different concentrates for bicarbonatehemodialysis we saw a moderate to clinical relevant uptake of CO₂ (40–60 ml/min) from the dialysate into the blood of the patients, cause the pCO₂ in the dialysate varied between 45 and 115 mmHg.Bicarbonate hemodialysis with high pCO₂-levels in the dialysate led to hyperventilation and markedly increased oxygen consumption. In critically ill hemodialysis patients the pathophysiologic effects on pulmonary gas exchange of either acetatehemodialysis and bicarbonatehemodialysis with high pCO₂ can explain the higher incidence of severe complications.

Herrn Professor Dr. F. Scheler zu seinem 65. Geburtstag gewidmet     

SD大鼠不同组织透析外液的抑瘤作用

用透析的方法从成年雄性免疫与非免疫ＳＤ大鼠的脑、肝、脾、肺、睾丸、心脏、肾组织中得到透析外液，以荷Ｌ５１７８Ｙ、Ｐ８１５肿瘤的小鼠做模型，观察不同透析外液对肿瘤生长的抑制作用。结果表明非免疫大鼠的心脏、肾脏提取物对Ｌ５１７８Ｙ有明显的抑制作用，脑、肾脏对Ｐ８１５抑制作用较明显。免疫脾的透析外液对两种肿瘤均有抑制作用，非免疫脾只对Ｐ８１５表现出抑制。通过体外抑瘤试验观察到，非免疫ＳＤ大鼠的不同组织透     

The peritoneal equilibration test variables in pediatric CAPD patients

The peritoneal equilibration test (PET) is generally accepted as a valuable tool in individualizing continuous ambulatory peritoneal dialysis (CAPD) treatment schedules in adults. However, the classification of peritoneal permeability as described by Twardowski is not available for children due to differences in peritoneal transport abilities. In this paper, we report the results of the PET for 20 patients aged from 1.5 to 24 years (mean 10.3 years), who started CAPD therapy at age 0–15 years, using Twardowski's standardized technique. D/P creatinine (dialysate to plasma ratio of creatinine at 4 h), D/D₀ glucose (the ratio of dialysate glucose at 4 h dwell time to dialysate glucose at 0 dwell time), and the residual volume (RV) in the abdominal cavity were calculated. The mean and standard deviation values for D/P creatinine and D/D₀ glucose were of a higher permeability level than those reported in Twardowski's data. Furthermore, a significant correlation of creatinine and glucose with fluid drainage ability of the peritoneum were observed. A large amount of RV (425±125 mL/m²) was detected in the patients' peritoneal cavity and this had a significant correlation with dialysate leak occurrences. The authors suggest that the RV would be an indicator for leaks and especially latent leaks. The cause of a large RV is unknown, but there is a probability that drainage volume and transport rates of metabolites decrease because the concentration of the instilled dialysate is immediately diluted by a large RV within the peritoneum.