血液透析机超滤控制装置临床使用故障特点调研分析

目的:调研血液透析机内部超滤控制装置故障发生情况及特点,分析原因规范其维护保养.方法:对上海市82家血液净化中心(室)的3664台透析设备超滤故障进行调研,分析故障发生特点,找出超滤故障和超滤偏差发生原因.从执行透析设备自检程序、制定透析设备维护管理制度、掌握超滤控制装置结构部件误差和其他人为因素4个方面制定血液透析机...     

High hemoglobin fluctuation was a protective factor for cardiovascular‐related death in peritoneal dialysis (PD) patients: A retrospective analysis of 232 patients with PD

ObjectivesThis study aimed to investigate the effect of hemoglobin (Hb) fluctuation after dialysis on the prognosis of cardiovascular‐related and all‐cause deaths in peritoneal dialysis (PD).MethodsAccording to the Hb fluctuation, patients were divided into low fluctuation group, moderate fluctuation group, and high fluctuation group, and then, the effects of Hb fluctuation after dialysis on the prognosis of cardiovascular‐related and all‐cause death in PD were analyzed by regression analysis.ResultsA total of 232 patients were selected in this study. Compared with the low Hb fluctuation group, the moderate and high fluctuation groups had lower body mass index (BMI), estimated glomerular filtration rate (eGFR), and baseline Hb, and the moderate fluctuation group had less erythropoietin (EPO) and dialysis dose. Compared with survivors, patients with cardiovascular‐related and all‐cause deaths had lower mean Hb and Hb fluctuation (all p < 0.05). Cox regression analysis showed that before and after adjusting for confounding factors, Hb fluctuation was still independently correlated with cardiovascular prognosis, and higher Hb fluctuation was still a protective factor for cardiovascular‐related death in the Hb‐substandard group, but there was no significant correlation between Hb fluctuation and all‐cause death. Multivariate linear regression analysis revealed that Hb fluctuation was positively correlated with Kt/V and EPO dosage, but negatively correlated with the baseline Hb.ConclusionHigh Hb fluctuation was a protective factor for cardiovascular‐related death in PD with substandard Hb. Compared with Hb fluctuation, correction of anemia timely and making Hb reaches the standard level had a greater impact on reducing cardiovascular‐related death in PD.     

基于微信平台的健康教育对中青年居家腹膜透析患者负性情绪和自我管理能力的影响

目的 探讨基于微信平台的健康教育对中青年居家腹膜透析患者负性情绪和自我管理能力的影响.方法 选取2018年9月至2020年7月我院收治的中青年居家腹膜透析患者74例,随机分为实验组和对照组各37例.对照组采用常规健康教育,实验组采用基于微信平台的健康教育.比较两组患者干预前后的负性情绪和自我管理能力.结果 干预前,两组...     

阿托伐他汀对慢性肾衰并贫血患者微炎性反应的影响

目的 分析阿托伐他汀在慢性肾衰并贫血患者维持性血液透析期间对微炎性因子的影响.方法 慢性肾衰并贫血患者按随机数字表法分为两组,对照组60例进行维持性血液透析,观察组60例患者在透析期间联合应用阿托伐他汀治疗,比较两组患者治疗3个月后炎性因子及贫血状况的变化.结果 治疗3个月,观察组患者TC、TG、LDL-C以及HDL-C获得显著改善(P＜0.05),分别是(3.41±1.24) mmol/L、(1.35±0.58) mmol/L、(1.63±0.83) mmol/L、(2.61±0.69) mmol/L,且上述指标与同期对照组比较差异有统计学意义(P＜0.05).观察组患者hs-CRP、IL-6、TNF-α均较治疗前显著降低(P＜0.05),改善明显优于对照组.观察组应用促红细胞生成素剂量显著低于对照组(P＜0.05).结论 阿托伐他汀通过改善高脂血症,降低患者体内的微炎性状态,提高其对贫血治疗的敏感性.     

青藤碱抑制类风湿关节炎骨破坏的研究进展

类风湿关节炎(RA)骨破坏伴随其整个病程,一旦骨破坏发生,则意味着其病理改变进入不可逆期。因此延缓甚至阻断骨破坏成为治疗RA的主要策略之一,具有十分重要的意义。青藤碱(SIN)是青风藤中提取的生物碱单体,具有良好的抗炎、镇痛、免疫抑制等药理作用,临床用于治疗类风湿关节炎取得良好疗效。该文主要将近年来有关SIN在RA骨破坏方面的研究作一详细阐述,以期为后续的临床研究提供理论依据。     

头孢噻吩在腹膜透析和血液透析病人中的药物动力学

本实验测定了4例腹膜透析和3例血液透析病人,在静注头孢噻吩后的药物动力学过程,并观察了7例腹膜透析病人,从腹腔途径给药后的吸收情况.资料提示;腹膜约能吸收50-60％的头孢噻吩;血液透析可有效地清除之,透析半衰期约2h,但腹膜透析对该药从血浆中的清除并无显著影响,8h透析仅排出给药量的10％左右.     

两种腹腔灌洗引流方法在急性重症胰腺炎中的应用比较

目的比较两种腹腔灌洗引流方法在急性重症胰腺炎的应用。方法对43例ICU重症胰腺炎患者分别行腹膜透析管置入灌洗引流或双套管引流管置入并负压吸引引流,统计分析比较两组效果及并发症发生率。结果腹透管灌洗引流组患者的手术时间、术中出血量少于双套管负压吸引组(P<0.05);双套管负压吸引组血淀粉酶恢复情况、腹胀发生率明显低于腹透管灌洗引流组(P<0.05)。住院时间、死亡率及腹腔脓肿、胰瘘/假性囊肿发生率两组无明显差别(P>0.05)。结论两种引流方法操作简单、方便、安全,双套管负压吸引组有更好的引流效果。     

骨化三醇对腹透患者钙磷代谢及T淋巴细胞亚群的影响

目的 :了解骨化三醇 (1 ,2 5 (OH) 2 D3 ,罗钙全 )对腹膜透析患者钙磷代谢及免疫功能的影晌。方法 :观察 3 7例腹膜透析 (PD)患者服用骨化三醇前后血清T细胞亚群、IL 8以及血免疫反应甲状旁腺激素 (iPTH)、钙、磷水平变化。结果 :用药前PD组血清T淋巴亚群的CD4/CD8低于正常对照组 (P<0 .0 5 ) ,服用骨化三醇 4wk后 ,CD4/CD8从 0 .5 6±0 .1 0升至 0 .79± 0 .1 2 ;而iPTH显著降低 ,血钙显著升高 ,血磷明显下降。结论 :骨化三醇能改善PD患者钙磷代谢 ,进而改善其免疫功能     

MINOCYCLINE EXCRETION AND DISTRIBUTION IN RELATION TO RENAL FUNCTION IN MAN

SUMMARY 1. The biological half-life of minocycline in serum has been studied in twenty-one patients and shown to have no relationship to renal function. There is very little excretion of minocycline by the kidney, and practically none is removed by dialysis.
2. In normal subjects, minocycline therapy is not accompanied by a significant rise in blood urea concentration or urinary urea excretion. However, high doses may produce a marked increase in urea excretion.
3. Of eight patients with impaired renal function who were treated with a normal therapeutic dose of minocycline (200 mg/day), one showed a significant increase in urea excretion and a rise in plasma urea concentration. Two patients with severe unstable renal failure required dialysis following therapy.
4. Minocycline is unlikely to accumulate in patients with renal failure due to its predominantly gastrointestinal excretion and is therefore safe to use. However, its protein catabolic effect is dose dependent and if renal function is impaired, even a small increase in urea production may be sufficient to aggravate uraemia. In such patients the normal therapeutic dose (200 mg/day) should not be exceeded and monitoring of renal function is advisable.     

序贯透析治疗肾功能衰竭合并急性左心力衰竭的临床应用

目的观察序贯透析对肾功能衰竭合并心力衰竭、肺水肿患者的治疗效果。方法对13例肾功能衰竭合并急性心力衰竭、肺水肿的患者行序贯透析疗法,观察其临床症状、体征,分析其疗效。结果痊愈7例,显效5例,有效1例,总有效率为100.0%。结论序贯透析能迅速缓解肾功能衰竭合并急性左心力衰竭患者的临床症状,改善患者的心功能状况,是抢救肾功能衰竭合并急性左心力衰竭的有效方法 。