持续肾脏替代治疗时间对终末期肾衰竭伴急性心肌梗死患者预后和费用的影响

目的探讨不同时间的连续性肾脏替代治疗（continuous renal replacement therapy,CRRT）对终末期。肾衰竭合并血流动力学不稳定的危重症患者预后和费用的影响。方法回顾性分析我院诊断为终末期肾衰竭合并急性心肌梗死，并存在血流动力学不稳定的患者23例，其中日间组（A组）17例，每日治疗时间为8～12h；24h组（B组）6例，每日治疗时间为20-24h。结果2组患者在日均脱水量、白蛋白（Alb）、血红蛋白（Hb）水平及低血压发生率、病死率、住院时间上无统计学差异（P〉0．05）。在出血事件发生率和治疗费用上A组均低于B组，2组比较有统计学差异（P〈0．05）。结论日间CRRT可能在救治此类危重患者中以较低的成本获得与治疗24h相同的效果，但并发症和病死率无明显增多。     

急性肾衰竭三种治疗方法的疗效对比观察

目的 :回顾性探讨治疗急性肾衰竭较理想的透析方法。方法 :对 2 3例HD患者和 2 0例PD患者及 17例CRRT患者进行比较 ,观察其治愈率、死亡率及透析后的主要并发症。结果 :HD组、PD组、CRRT组的治愈率分别为 82 .6 %、85 %、76 .5 % ;死亡率分别为 8.7%、0、17.6 %。腹膜透析并发症少。结论 :急性肾衰竭在缺少CRRT条件 ,病情允许情况下可首选腹膜透析治疗 ,严重病例、多器官衰竭还是选择CRRT为宜     

急性心肌梗死并发急性肺水肿联合CRRT治疗的临床疗效观察

目的：探讨连续性肾脏替代治疗（continuous renal replacement treatment,CRRT）治疗急性心肌梗死后并发急性肺水肿患者的疗效和安全性。方法：回顾性分析我院2010年8月～2011年7月期间,12例因急性心肌梗死后并发急性肺水肿经心内科常规治疗无效者联合CRRT治疗患者,观察其治疗前后临床症状、体征等变化和治疗的疗效和安全性。结果：9例患者显效,2例有效,1例无效,总有效率91.67%,未见严重的并发症。结论：CRRT治疗急性心肌梗死后肺水肿的疗效显著,值得临床应用推广。     

CRRT治疗59例危重病患者临床资料分析

从1960年最初提出连续性血液净化治疗的概念及1977年Kramer等率先报道使用连续性动静脉血液滤过（CAVH）抢救急性肾衰竭至今,连续性肾替代治疗（CRRT）近年来更是得到跨学科的广泛应用和发展。CRRT也在重症急性。肾衰竭、多器官功能障碍综合征（MODS）、重症胰腺炎、系统性炎症反应综合征（SIRS）等危重病救治中起着重要作用,减少了此类危重患者的病死率。尽管如此,其病死率仍高达19％～70％。为了解各种与其病死率及预后相关临床特点及因素,本文分析2005年3月-2009年12月期间我院ICU内予CRRT治疗的59例危重患者资料。     

日间CVVH治疗体外循环心脏术后急性肾衰竭患者的护理

目的 探讨日间连续性静脉一静脉血液滤过(CVVH)治疗体外循环心脏术后并发急性肾衰竭患者的护理方法.方法 对10例体外循环心脏术后合并急性肾衰竭的患者采用日间CVVH治疗,治疗中对患者进行监护,保持血管通路通畅,液体平衡的管理,监测抗凝的效果与出凝血的预防与观察,记录治疗前后水电解质和酸碱平衡、心脏、肾功能变化及不良反...     

连续性肾脏替代治疗重症急性肾衰竭进展

连续性肾脏替代治疗（continuous renal replacement thera-py,CRRT）已广泛用于急性肾衰竭（ARF）,特别是重危患者的救治,提高了患者生存率及肾功能恢复率。但在治疗模式、时机及治疗剂量等方面还存在争议。本文主要是对连续性肾脏替代治疗重症ARF的进展进行综述。     

急性心梗绿色通道在急诊科应用的护理体会

目的:探讨急性心梗绿色通道在急诊科的应用价值。方法:收集病例分析2010年9月以来我科开放急性心肌梗死患者绿色通道后206例的诊断治疗与护理情况,观察是否在有效时间内得到及时救治。结果:206例急性心肌梗死患者成功抢救并安全送入导管室194例,占94.17%。结论:急性心肌梗死绿色通道可以减少患者的诊断、转运、治疗时间,使患者得到及时的救治,为后期的进一步治疗赢得了宝贵的时间。     

连续性肾脏替代治疗应用于重症急性胰腺炎的临床疗效分析

目的 研究连续性肾脏替代治疗(CRRT)应用于重症急性胰腺炎(SAP)的临床疗效.方法 2010年3月至2012年12月收治的58例SAP患者,分为2组,CRRT组(40例)患者入院后即在常规治疗的同时给予CRRT;常规治疗组(18例)患者则给予常规抗胰腺炎治疗.结果 治疗3 d后,APACHEⅡ评分CRRT组优于常规治疗组(P＜0.01);血生化指标中CRRT组氧合指数、血钙水平高于常规治疗组,而血肌酐水平、白细胞计数低于常规治疗组,差异有统计学意义(P＜0.05或P＜0.01).CRRT组并发症发生率(6.2%)低于常规治疗组(13.7%),而治愈率(88.3%)高于常规治疗组(67.1%),差异有统计学意义(P＜0.05或P＜0.01).结论 SAP发病早期,无急诊手术指征的患者在常规治疗的基础上实施CRRT可有效缓解病情,减少并发症发生率,提高治愈率.     

基于患者安全系统工程模型的急性心肌梗死患者直接PCI流程优化

目的 探讨基于患者安全系统工程模型的急性心肌梗死患者直接经皮冠状动脉介入治疗流程优化实施与效果.方法 按住院时间先后将急诊行直接经皮冠状动脉介入治疗的急性ST段抬高型心肌梗死患者分为对照组和观察组各80例,对照组实施常规救治,观察组应用患者安全系统工程模型对工作系统进行优化并实施.比较两组重要救治节点时间、住院时间和费...     

CRRT在脓毒血症急性肾损伤患者救治中的临床研究

目的 观察连续性肾脏替代治疗(CRRT)在脓毒血症急性肾损伤患者治疗中的临床效果,为临床治疗提供参考.方法 收集从2013年7月至2015年4月来本院就诊的临床诊断为脓毒血症并急性肾损伤的患者76例,将其随机分为两组,分别为CRRT治疗组与常规治疗组,每组各38例,对两组患者治疗前后生命体征(体温、心率、收缩压、舒张压和平均动脉压),生化指标包括(PH)、血红蛋白(HB)、血肌酐(SCr)、尿素氮(BUN)、白细胞计数(WBC)、血小板计数(PLT)、白蛋白(ALB)和超敏C反应蛋白(hsCRP)进行比较,再对两组患者治疗前后A-PACHEⅡ评分及生存率进行比较.结果 治疗后CRRT治疗组的体温和心律均低于常规治疗组,两组患者治疗前后的体温、心律方面的差异具有统计学意义,CRRT治疗组患者治疗后的收缩压高于治疗前,差异具有统计学意义(P＜0.05);治疗后两组患者在PH、SCr、BUN、WBC及PLT方面的差异有统计学意义(P＜0.05),CRRT治疗组患者在治疗前后的PH、SCr、BUN、WBC、PLT、ALB及hsCRP方面的差异有统计学意义(P＜0.05);治疗后CRRT治疗组的A-PACHEⅡ评分低于常规治疗组,治疗后CRRT治疗组的生存率高于常规治疗组,差异具有统计学意义(P＜0.05).结论 CRRT治疗脓毒血症急性肾损伤能有效清除代谢废物,维持内环境稳定,提高患者的短期生存率,推荐在临床上应用.     

Urologist-Acquired Renal Access for Percutaneous Renal Surgery

Objectives. In most endourology programs an interventional radiologist is employed to acquire renal access for percutaneous renal surgery. Over the last 13 years the senior endourologist at Oregon Health Sciences University has acquired access without employing a radiologist. We report our experience with urologist-acquired renal access for percutaneous renal surgery in 522 cases.Methods. We reviewed the records of all patients at our hospital who underwent percutaneous renal surgery between August 1983 and December 1996 with renal access being obtained in the operating room by a urologist.Results. Four hundred fifty-six patients underwent 522 procedures. Indications for percutaneous renal surgery were renal and proximal ureteral calculi (n = 516), retained ureteral stent (n = 3), and intrarenal collecting system tumor (n = 3). We were successful in gaining access to 513 of 522 kidneys (98.3%). Access was obtained via a subcostal approach in 344 procedures, over the 12th rib in 152 procedures, over the 11th rib in 15 procedures, and transabdominally in 2 procedures. Sixty-five patients (12.7%) required a second or multiple sites to facilitate complete removal of calculi. Our overall complication rate was 15.3%. Blood transfusion was required in 5.4% of the cases, ileus developed in 1.9%, pneumothorax in 1.1%, intraoperative hydrothorax in 1.1%, postoperative pleural effusion requiring aspiration in 0.9%, and septic shock in 0.9%. Our overall success rate for stone removal was 94.5%.Conclusions. In our experience, the urologist is able to safely and effectively obtain percutaneous access to the collecting system for percutaneous renal surgery as a one-stage procedure without the aid of interventional radiologists.     

Renal Adenoma Associated with Renal Cyst Formation

We report a renal adenoma associated with renal cyst formation in a 49-year-old male. A small renal mass inside a right renal cyst was discovered incidentally by ultrasonography. A right nephrectomy was performed. A pathologic examination revealed a well-differentiated, benign papillary tumor which was composed of slightly eosinophilic cells. We therefore diagnosed this patient as having a renal adenoma with hemorrhage.     

Renal Imaging in Patients with Renal Impairment

In patients with renal impairment, the incremental benefits from administration of contrast media for imaging studies need to be carefully assessed relative to the potential increased risks of worsening renal dysfunction and systemic adverse effects. This review provides an overview of risk and benefits of iodinated and gadolinium-based contrast agents; examines their relationships to contrast-induced nephropathy (CIN) and nephrogenic systemic fibrosis (NSF), respectively; and discusses various clinical strategies to minimize the risk of CIN and NSF. Specifically, renal imaging strategies aimed to minimize the adverse effects of contrast media as well as alternatives to iodinated and gadolinium-based contrast-enhanced renal imaging are proposed with emphasis on non–contrast-enhanced magnetic resonance imaging.     

Early Assessment of Renal Resistance Index and Long-Term Renal Function in Renal Transplant Recipients

Background. The effect of the intrarenal arterial resistance index (RI) on long-term renal functions is not well known. We examined the predictive value of intrarenal RI on long-term allograft outcomes. Methods. We retrospectively investigated 121 stable renal transplant recipients, followed for a mean of 63.21?±?19.9 months after renal transplant. Patients with complications during the first six months after transplant were not included. Color Doppler ultrasonography was done to calculate the intrarenal RI within the first four weeks after transplant. Results. Older recipient age, high pulse pressure, active smoking, and proteinuria were associated with a higher intrarenal RI. Multivariate analyses revealed that renal RI and donor age were independent predictors of allograft outcome. Kaplan-Meier estimates of cumulative graft survival were significantly worse in patients who had an RI of 0.7 or more than they were in patients who had an RI of less than 0.7 (p?=?.005). Development of chronic allograft nephropathy (CAN) was significantly higher in patients who had an RI of 0.7 or more (p?=?.02). Conclusions. Renal RI determined within the first month after renal transplant predicts long-term allograft function and development of CAN in renal transplant recipients.     

Obesity Affects Short-Term Renal Function After Renal Transplantation

BackgroundThe literature has shown a significant association between body mass index (BMI) and patient and graft outcomes after renal transplantation. The purpose of this study was to reveal the effect of obesity on graft function in a Taiwanese kidney transplant cohort.MethodsTwo hundred consecutive patients who received kidney transplantation were enrolled in our study. Eight pediatric cases were excluded due to differing definitions of BMI among children. According to the national obesity criteria, these patients were divided into underweight, normal, overweight, and obese groups. Their estimated glomerular filtration rate (eGFR) was compared accordingly using t tests. Cumulative graft and patient survivals were calculated using Kaplan-Meier analysis. A P value of ≤ .05 was considered significant.ResultsThe mean age of our cohort (105 men and 87 women) was 45.3 years. There was no significant difference comparing biopsy-proven acute rejection, acute tubular necrosis, and delayed graft function between the obese and nonobese groups (P values: .293, .787, and .304, respectively). Short-term eGFR was inferior in the overweight group, but this effect was insignificant beyond 1 month. The 1-month and 3-month eGFR were found to be correlated with BMI groups (P = .012 and P = .008, respectively) but not significant after 6 months post–kidney transplantation.ConclusionsOur study found that short-term renal function was affected by obesity and being overweight, possibly due to the higher prevalence of diabetes and dyslipidemia in obese patients and the increased surgical difficulty.     

Coexisting Renal Cell Carcinoma and Renal Artery Aneurysm

We report a rare case of a patient with a renal artery aneurysm (RAA) and an ipsilateral renal cell carcinoma (RCC). This patient was treated with simultaneous aneurysmectomy and radical nephrectomy. The indications for surgical intervention for RAA remain controversial. We present a review of the literature on the clinical presentation, classification, etiology, and management of RAA and associated RCC.