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CVVH疗法对全身炎症反应综合征及脓毒血症患者内皮功能损伤标志物的影响 总被引:4,自引:0,他引:4
目的初步探讨连续血液净化疗法CBP(continuous blood purification)对全身炎症反应综合症(SIRS)及脓毒血症(SepsiS)患者内皮功能损伤标志物的影响。方法选择复旦大学附属华山医院肾内科15例SIRS或伴Sepsis患者,分别留取CVVH(continuous venous—venous homofiitrtion,连续静脉静脉血液滤过)治疗前后的血浆,直接检测血栓调节蛋白(sTM,soluble thrombomodulin)、E-选择素、细胞间黏附分子-1(SICAM-1,soluble intercellul aradhesion molecule-1)浓度。APACHⅡ评分评价临床疗效。结果临床转归:8名SIRS组患者,CVVH治疗后第4天APACHⅡ评分较治疗前显著改善(P〈0.01),而7名Sepsis组患者的APACHII评分更加恶化。SIRS组患者血浆sTM、SICAM-1、sE-选择素浓度显著高于正常对照组(P〈0.01);SepsiS组患者血浆sTM、SICAM-1、sE-选择素浓度显著高于正常对照和SIRS组(P〈0.01);CVVH治疗后1周,SIRS组患者sTM、sE-选择素较治疗前明显降低(P〈0.05),而Sepsis组患者无明显降低(P〉0.05)。结论SIRS/Sepsis患者内皮细胞存在明显的激活和损伤,CVVH治疗能部分改善SIRS患者内皮细胞功能,而对Sepsis患者效果不佳。 相似文献
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Objective To establish a citrate pharmacokinetics model which is applied to evaluate the risk of citrate accumulation in patients with liver dysfunction in the continuous renal replacement treatment (CRRT) with regional citrate anticoagulation (RCA). Methods The source of citrate for extracorporeal anticoagulation, the body clearance and filter elimination of citrate, which were the three major citrate fluxes of systemic citrate level, were combined into a single-pool, first order kinetic equation. The data from a published clinical study of systemic citrate kinetics in the intensive care unit patients with or without liver cirrhosis were adapted and the citrate kinetic equation was applied to predict the risk of systemic citrate accumulation in patients with normal, impaired and absent liver clearance while different RCA-CRRT protocols were carried out. Results The single pool, first order citrate kinetic modeling equation was as follows:Csys=C(0)·e-[(clb+clf)·t/V]+G/CLb+CLf×(1-e-[(clb+clf)·t/V])There was excellent agreement between published citrate measurements and our predictions. Kinetic modeling showed that the plasma citrate concentration of patients with normal citrate body clearance was no more than 1 mmol/L during common RCA-CRRT. The model predicted that when the single pass fractional extraction of citrate on the artificial kidney was above 66%, systemic steady citrate concentration would be among the safe range even in patients of impaired body metabolism of citrate.Conclusions The citrate kinetic model of RCA-CRRT can predict the risk of systemic citrate accumulation and provide the basis for designing the safe RCA-protocols for the patients with impaired body clearance of citrate. 相似文献
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Objective To assess the influences of low-protein diet on the renal function and nutritional status in patients with stage 3/4 chronic kidney diseases (CKD).Methods Totally 34 patients with stage 3/4 CKD were randomly divided into group A (protein intake:0.6 g·kg~(-1)·d~(-1);n=14) and B (protein intake:0.8 g·kg~(-1)·d~(-1);n=20).Anthropometric measurement and blood biochemical tests were performed,nutri-tional status was assessed,and 24-hour dietary recall survey was conducted before and after the treatment.Patients were followed up for 6 months.Results In group A,the creatinine level significantly decreased (P=0.010),while albumin level (P=0.042) and the intake of energy (P=0.018) and carbohydrate (P<0.001) signifi-cantly increased after the treatment In all the 34 patients,in group A and group B,the malnutrition rates were de-creased by 14.7%,7.2%,and 21.1% after nutritional intervention.Conclusion The low-protein diet (protein intake 0.6 g·kg~(-1)·d~(-1)),in which part of the staple food was replaced by wheat starch,can increase the in-takes of carbohydrate and energy and improve renal function and nutritional status in patients with stage 3/4 CKD. 相似文献
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