小剂量肝素微量泵持续定时静脉注射治疗小儿原发性肾病综合征的临床研究

目的 探讨小剂量肝素微量泵持续定时静脉注射对小儿原发性肾病综合征(PNS)的疗效及安全性.方法 对PNS合并高凝状态88例患儿采取开放性对照研究的方法进行临床研究.肝素治疗组在常规应用糖皮质激素治疗的基础上加用小剂量肝素微量泵持续定时静脉注射治疗,并与常规糖皮质激素组进行对照.结果 肝素治疗组治疗后血清白蛋白、APTT均高于治疗前,差异有显著性(P＜0.01),而血Fib低于治疗前,差异有显著性(P＜0.01).常规治疗组治疗后血清白蛋白高于治疗前,差异有显著性(P＜0.01),而血APTT、血Fib与治疗前比较差异均无显著性(P＞0.05).肝素治疗组治疗后血清白蛋白、APTT均高于常规治疗组,差异有显著性(P＜0.01),而血Fib低于常规治疗组,差异有显著性(P＜0.01).肝素治疗组治疗后尿蛋白转阴率82/88例(93.2%),高于常规治疗组[63/80例(78.8%)],差异有显著性(P＜0.01).尿蛋白转阴病例中,肝素治疗组尿蛋白转阴时间、水肿消退时间均短于常规治疗组,差异有显著性(P＜0.01).肝素浓度为峰值时,肝素治疗组血APTT(61.72±10.23)s,高于治疗前的血APTT[(25.92±9.54)s],差异有显著性(P＜0.01),且两者均数比值为2.38;肝素浓度为谷值时,血APTT(28.08±7.69)s,与治疗前比较差异无显著性(P＞0.05).结论 小剂量肝素微量泵持续定时静脉注射治疗小儿PNS的抗凝作用明显,能提高尿蛋白转阴率,且能缩短尿蛋白转阴及水肿消退时间;同时该疗法安全,不需要实验室监测,药物不良反应少,值得临床推广.     

丙种球蛋白治疗儿童原发性肾病综合征的疗效及免疫功能变化

我们采用静脉滴注丙种球蛋白（IVIG）治疗儿童原发性肾病综合征（PNS），观察其疗效及患儿免疫功能的变化。     

小剂量肝素微量泵持续定时静脉注射治疗小儿原发性肾病综合征的临床研究

Objective To explore the efficacy and safety of low-dose heparin in the treament of children with primary nephrotic syndrome (PNS). Methods It was an open and comparative trial. Eightyeight children with PNS in the hypercoagulable state,on the basis of administrating with glucocorticosteroid,were administrated with low-dose heparin that infused by micro pump oriented to time ( group A). Eighty patients only treated with glucocorticosteroid were chosen as control (group B). Results Serum-albumin and activated partial thromboplastin time (APTT) increased,but fibrinogen (Fib) decreased after therapy in the group A,and they all showed significant differences (P ＜ 0. 01 ). Serum-albumin increased after therapy in the group B and there was significant difference (P＜0. 01 ). However,APTT and Fib in the group B showed no significant difference( P ＞ 0. 05 ) between post-treatment and pretherapy. Post-treatment serum-albumin and APTT in the group A were significantly higher than those in group B, and Fib was significantly lower than that in group B ( P ＜ 0. 01 ). The rate of urine protein remission in group A (82/88) was significantly higher than that in group B (63/80). Urine protein remission time and edema disappearance time were significantly shorter in group A than group B ( P ＜ 0. 01 ). APTT of group A at the peak concentration of heparin after therapy was significantly higher than that of pretherapy ( P ＜ 0. 01 ), and the ratio was 2. 38. However, there was no significant difference in APTT at the valley concentration of heparin between post-treatment and pretherapy ( P ＞ 0.05 ). Conclusion Low dose-heparin infused by micro pump oriented to time in the treatment of children with PNS has an obvious anticoagulative effect. It can improve the rate of urine protein remission and shorten edema disappearance time. Meanwhile it is safety ,requires no laboratory monitor and has few drug side effects,thus it deserves further clinical application.     

小剂量多巴胺联用酚妥拉明治疗原发性肾病综合征患儿水肿的临床研究

目的 探讨小剂量多巴胺联用等量酚妥拉明对原发性肾病综合征(PNS)患儿水肿的疗效及安全性.方法 采取回顾性对照研究的方法.在常规综合治疗的基础上,对155例PNS并发水肿患儿(联用治疗组)给予小剂量多巴胺联用等量酚妥拉明治疗,并与128例单用呋塞米患儿(呋塞米治疗组)对照.结果 联用治疗组治疗后尿量、尿钠均高于治疗前,差异有显著性(P＜0.01),而血钾、血钠及尿钾虽高于治疗前,但差异无显著性(P＞0.05).呋塞米治疗组治疗后尿量、尿钾、尿钠均高于治疗前,差异有显著性(P＜0.01),而血钾、血钠均低于治疗前,差异有显著性(P＜0.01).联用治疗组治疗后水肿减轻率、尿量、尿钠、血钾及血钠均高于呋塞米治疗组,差异有显著性(P＜0.01);而尿钾低于呋塞米治疗组,差异有显著性(P＜0.05).治疗后药物不良反应发生率方面,联用治疗组低于呋塞米治疗组,差异有显著性(P＜0.01).结论 小剂量多巴胺联用等量酚妥拉明治疗小儿PNS水肿安全、有效,适用于不同血容量状态的患儿,可替代呋塞米等利尿剂作为一线用药.

Abstract：

Objective To explore the efficacy and safety of low dose dopamine combined with phentolamine in the treatment of primary nephrotic syndrome (PNS) with edema. Methods Retrospective control studies were performed in 155 patients of PNS with edema, who received comprehensive treatment with small dose dopamine combined with phentolamine (group A). Patients treated with furosemide infusion were recruited as control (group B). Results The urinary output, urinary sodium increased after therapy in group A, showing significant differences (P ＜ 0. 01). But urinary potassium excretion, serum sodium and potassium showed no significant difference after therapy in group A. The urinary output, urinary sodium and potassium excretion increased and the serum sodium and potassium decreased after therapy in group B, all showing significant differences between before and after treatment (P ＜0. 01). The edema relief rate,urinary output, urinary sodium excretion, serum sodium and potassium in group A was significantly higher whereas urinary potassium excretion were significantly lower than those of group B(P ＜0. 01). The rate of drug adverse reaction in group A was significantly lower than that of group B. Conclusion Low dose dopamine combined with phentolamine in PNS with edema is safe and effective,which may be a substitute of diuretic like furosemide in the treatment of edema of patients with different blood volume.     

小儿原发性肾病综合征合并特发性急性肾功能衰竭的临床分析

目的 探讨小儿原发性肾病综合征(PNS)合并特发性急性肾功能衰竭(IARF)的临床病理特点、疗效及预后.方法 回顾性分析1997年1月至2007年11月入院的12例PNS合并IARF患儿的临床资料.结果 476例PNS患儿中,合并IARF12例(占2.52%),其中男9例,学龄儿童9例.全部病例均发生在PNS活动期,均为少尿型肾功能衰竭,且有较严重的低白蛋白血症[(20.13±5.35)g/L]、蛋白尿[(9.45±3.55)g/d]及明显水肿.合并胸腔、腹腔等浆膜腔积液及血压增高者7例,且均有外周血小板、纤维蛋白、纤维蛋白降解产物、D-二聚体增高,凝血酶原时间缩短等指标中一项或多项的异常.B超示双肾肿大10例.5例接受肾活检,其中微小病变3例,轻度系膜增生性肾炎2例,其共同病理变化示小管间质病变广泛.经甲泼尼龙、小剂量多巴胺联用等量甲磺酸酚妥拉明、必要时间断输注血浆或加用呋塞米及抗凝等综合治疗,肾功能均恢复正常.随访0.5～2年,IARF未见再发.结论 小儿PNS合并IARF以男性学龄儿童多见,临床表现为少尿型肾功能衰竭、严重的蛋白尿、低白蛋白血症及明显水肿,常合并浆膜腔积液、高血压及血液高凝状态;B超示肾肿大多见;肾病理诊断以肾小球轻微病变为主,且小管间质病变广泛;通过早期积极综合治疗,其预后良好.     

两种皮下注射胰岛素方法的研究

目的 通过对胰岛素两种皮下注射方法在局部的疼痛程度和不良反应发生情况的比较,找出更适合糖尿病患儿的皮下注射方法.方法 选取注射胰岛素的糖尿病患儿,采用自身对照的方法,实验组采用垂直皮下注射法,对照组采用传统的斜刺皮下注射法.结果 实验组的局部疼痛程度和局部不良反应的发生率明显低于对照组,差别有显著性意义(P＜0.05).结论 垂直皮下注射法能减轻局部疼痛程度和减少局部不良反应的发生率,是更适合糖尿病患儿的皮下注射方法.     

新生儿围手术期静脉营养支持的应用与护理

我科1998年10月至2000年10月对32例新生儿在围手术期应用全营养混合液(Total.nutrient admixture,TNA)经围静脉营养支持效果良好.现将护理体会报告如下: 1 临床资料     

改良胸骨抬举术治疗漏斗胸32例手术前后护理

漏斗胸是一种先天性胸廓发育畸形,会改变正常胸廓形态,造成内脏受压,导致心肺功能障碍。同时,由于胸廓畸形,会给患儿造成心理负担,严重影响患儿身心健康。手术是唯一有效的矫治方法。2005年12月至2009年5月,我科采用改良胸骨抬举术治疗漏斗胸32例,由于加强了围手术期护理,取得较好的效果。现将护理过程和体会报告如下。