传统尸体供肾与心脏死亡器官捐献供肾肾移植效果的比较

比较心脏死亡器官捐献(donation after cardiac death,DCD)供肾与传统尸体供肾肾移植的临床效果.方法 回顾性分析2012年1月至2013年2月在郑州人民医院实施肾移植的70例患者的临床资料.根据供肾来源分为DCD供肾组(DCD组,22例)和传统尸体供肾组(传统组,48例).患者均签署知情同意书,符合医学伦理学规定.比较两组患者术后7、14、28 d肾功能指标血尿素氮(BUN)和血清肌酐(Scr)水平差异.比较两组患者术后1个月内并发症发生情况及预后情况.结果 DCD组术后7、14 d的BUN和Scr水平均明显高于传统组(均为P<0.01);DCD组术后28 d的Scr水平亦明显高于传统组(P<0.05),两组BUN水平差异无统计学意义(P>0.05).与传统组比较,DCD组的移植物功能延迟恢复(DGF)、急性排斥反应(AR)、感染、移植肾切除的发生率及死亡率明显增高,差异有统计学意义(均为P<0.01).结论 DCD供肾肾移植术后早期肾功能恢复情况不如传统尸体供肾,且围手术期内各种并发症的发生率及死亡率也明显高于传统尸体供肾肾移植.     

老年心脏外科术后患者早期康复实践

目的 促进老年心脏外科术后患者康复。方法 将79例心脏及大血管疾病择期行心脏外科手术的老年患者分为对照组（42例）与干预组（37例）。对照组行常规康复护理,干预组制订和实施低强度床上早期康复方案。结果 干预组术后第7天Barthel指数、出院时Rivermead运动指数显著优于对照组（均P＜0.05）;两组均未发生康复相关不良事件;干预组康复依从性好者（35.14%）,较依从性一般患者（64.86%）体质量更轻、术前内生肌酐清除率更低、有医保率更低（均P＜0.05）。结论 低强度床上早期康复可提高心脏外科术后老年患者近期运动功能水平,应加强针对性教康教育,提高患者早期康复锻炼依从性。     

ECD kidney transplantation outcomes are improved when matching donors to recipients using a novel creatinine clearance match ratio (CCMR)

Improved outcomes have been associated with various methods of size matching between expanded criteria (ECD) donors and recipients. A novel method for improved functional based matching was developed utilizing manipulation of Cockcroft‐Gault estimated creatinine clearances for donor and recipient. We hypothesized that optimal clearance‐based matches would have superior outcomes for both immediate graft function and long‐term graft survival. For the analysis, recipients of ECD kidneys in the Scientific Registry of Transplant Recipients (SRTR) transplanted between October 1, 1987 and August 31, 2011 were included. Univariate and multivariate analyses predicted the hazard ratio of graft failure and the odds ratio of requiring dialysis within the first week. A total of 25,640 ECD kidney transplants were analyzed. On multivariate analysis, higher creatinine clearance match ratio (CCMR) was associated with increased graft failure and odds of requiring dialysis within the first week (comparing highest ratio quintile versus lowest ratio quintile: HR 1.43, p < 0.001; OR 2.08, p < 0.001). This study suggests that ECD kidneys have improved outcomes when the recipient/donor CCMR is optimized.     

体重指数与早期移植肾功能的关系

目的  探讨体重指数(BMI)与早期移植肾功能的关系。方法  回顾性研究2003年11月至2014年11月在新疆医科大学第一附属医院肾病科接受同种异体活体肾移植的133例受者的临床资料。根据移植前的BMI将受者分为3组, 消瘦组(BMI < 18.5 kg/m²)、正常体重组(BMI 18.5~23.9 kg/m²)、超重肥胖组(BMI>23.9 kg/m²)。比较3组受者术后1周的实验室指标[血尿素氮(BUN)、血清肌酐(Scr)、血红蛋白、血清白蛋白、总胆固醇和甘油三酯]、移植肾功能延迟恢复发生率, 并对肾移植受者Scr与BMI进行相关分析。结果  3组受者的Scr水平比较差异有统计学意义(P < 0.05);两两比较, 超重肥胖组Scr水平高于正常体重组, 差异有统计学意义(Z=-3.408, P=0.01)。3组肾移植受者血红蛋白、血清白蛋白、总胆固醇水平差异均无统计学意义(均为P>0.05)。肾移植受者Scr水平与BMI呈正相关(r=0.187, P=0.031), Scr水平随BMI增加而升高。结论  BMI影响早期移植肾功能恢复, 肾移植术前控制体重, 有助于改善移植肾功能。     

肠内和肠外营养对重度颅脑外伤患者营养状况与胃肠激素的影响

目的：探究肠内营养（EN）或肠外营养（PN）对重度颅脑外伤患者营养状况和胃肠激素的影响。方法：97例重度颅脑外伤患者随机分为EN组48例,PN组49例。入院后分别给予EN或PN支持治疗,于入院后2、4和8d清晨分别测定患者24h尿尿素氮、尿肌酐及空腹血清白蛋白、血浆胃动素（MTL）和缩胆囊素（CCK）水平。结果：①EN组患者的氮平衡在入院后第8天稍优于PN组,但两组数据相比较差异无统计学意义,两组患者的肌酐身高指数和血清白蛋白水平无差别;②EN组患者入院后第4、8天血浆MTL水平明显高于PN组（P〈0．05）;③EN组患者入院后第8天血浆CCK水平明显高于PN组（P〈0．05）。结论：①重度颅脑外伤患者入院后应用本文方式的EN、PN支持可以维持患者2d的正氮平衡,两组患者的营养指标在入院后短期内无明显差异;②入院后应用EN能增加血浆MTL水平,促进胃肠功能的恢复;③入院后应用EN能增加血浆CCK水平,促进胆囊收缩,预防胆汁淤积等胆囊疾病的发生。     

皮肤电导率在早期糖尿病肾病筛查中的应用价值

目的 探讨皮肤电导率（ESC）在早期糖尿病肾病筛查中的应用价值。方法 选取2022年10月至2023年2月于安徽医科大学第二附属医院分泌科住院的176例2型糖尿病患者,根据尿白蛋白/肌酐比值（UACR）和肾小球滤过率（eGFR）将其分为两组,糖尿病肾病组（DKD组,n=68）和糖尿病非肾病组（non-DKD组,n=108）,所有患者均完善SUDOSCAN仪检测,获得双手、双足ESC(HESC、FESC),肾病风险分数（SUDOSCAN-DN）,采用Spearman相关性分析UACR与SUDOSCAN各指标的关系。采用受试者工作特征（ROC）曲线判断SUDOSCAN各指标对糖尿病肾病的诊断效能。结果 与non-DKD组相比,DKD组年龄较大,病程较长,收缩压较高,三酰甘油（TG）、血尿酸及肌酐、促甲状腺激素（TSH）水平较高,HbA1c水平偏低,HESC、FESC、SUDOSCAN-DN值均较低,差异有统计学意义（P<0.05）;Spearman相关分析显示,UACR与TC、LDL-C、血肌酐、TSH呈正相关（r值分别为0.202、0.207、0.378、0.174,P<0....     

A case series of LMWH use in pregnancy: Should trough anti-Xa levels guide dosing?

Introduction

Pregnancy is a thrombogenic state, increasing the risk for venous thromboembolism (VTE), and the risk of valve thrombosis amongst women with mechanical heart valves (MHV). While low molecular weight heparins (LMWH) are generally dosed based on weight (i.e., enoxaparin 1 mg/kg every 12 hours), data in pregnant women have shown that weight-based dosing does not consistently achieve target anti-Xa levels. In women with MHV, our practice includes titrating LMWH doses to target both trough and peak anti-Xa levels, while for those with VTE peak anti-Xa levels guide dosing.

Materials/Methods

This retrospective case series included pregnant women requiring LMWH treatment doses with at least 3 peak (+/− trough) anti-Xa levels. Our primary objective was to describe the actual LMWH dose required to achieve targeted anti-Xa levels relative to weight-based dosing in patients with MHV. Secondarily, we compared the same for VTE patients; compared actual dosing between those with MHV and VTE; and examined maternal and fetal outcomes.

Results/Conclusion

Women with MHV (N = 4) required greater than weight-based dosing of enoxaparin (1.35 mg/kg Q12H) to achieve targeted anti-Xa levels. Importantly, achieving target peak anti-Xa levels did not always ensure maintenance of minimum trough levels. VTE patients (N = 12) did not require more enoxaparin (0.96 mg/kg Q12H) than weight based dosing. MHV patients received more enoxaparin compared to VTE patients (P < 0.001). No bleeding or clotting complications were associated with LMWH administration. In pregnant women with MHV at high risk of thromboembolism, LMWH dosing guided by trough and peak anti-Xa levels should be considered.     

益气养阴方治疗骨髓抑制期气阴两虚型急性白血病临床研究

目的:探讨益气养阴方治疗处于骨髓抑制期气阴两虚型急性白血病的临床疗效、安全性.方法:收集300例骨髓抑制期气阴两虚型急性白血病患者,按随机数字表法分为两组,对照组150例予以常规西药治疗,观察组150例通过益气养阴方治疗,比较两组的中医症状评分、疗效、血常规指标、安全性.结果:观察组治疗后面色苍白、乏力气短、腰膝酸软、...