非离子型造影剂对正常肾功能和肾功能不全患者肾功能的影响分析

目的探讨和分析非离子造影剂对正常肾功能和肾功能不全患者肾功能的影响。方法回顾性分析具有完整临床资料的2008年10月至2010年10月来我院使用造影剂检查和介入手术治疗的住院患者100例,其中正常肾功能患者50例,肾功能不全患者50例。两组比较采用非离子型造影剂进行冠脉造影,其中又按使用等渗造影剂与低渗造影剂分为二个治疗组．同时对其中进行单纯造影与造影后直接行PCI术的患者根据造影剂用量的不同,分为≤100mL组和〉100mL组,观察和比较对两组患者等渗造影剂与低渗造影剂以及不同剂量的造影剂对肾功能的影响。结果肾功能正常组患者在造影前和造影后血肌酐、血尿素氮、肌酐清除率以及尿B：微球蛋白的水平无显著性差异（P〉0．05）,≤100mL组和〉100mL组的血肌酐、血尿素氮、肌酐清除率以及尿p：微球蛋白的水平无显著性差异,（P〉0．05）;而肾功能不全组患者在造影前和造影后血肌酐和尿B：微球蛋白水平具有显著性差异,（P〈0．05）,≤l00mL组的血肌酐、血尿素氮、肌酐清除率以及尿B。微球蛋白的水平显著低于〉100mL组,差异具有显著性,P〈0．05。血尿素氮和肌酐清除率水平无显著性差异（P〉0．05）。肾功能不全组患者发生造影剂肾病患者有3例,发生率为6％;等渗组对肾功能的影响明显小于低渗组,组间比较差异具有统计学意义（P〈0．05）结论非离子型造影剂可对慢性肾功能不全患者的肾功能产生较大影响,并且低渗造影剂对于肾功能不全的患者的影响大于等渗造影剂,肾功能不全的患者应慎用非离子型造影剂。     

左卡尼汀对急性肾功能衰竭患者肾功能的影响

目的：观察左卡尼汀对急性肾功能衰竭患者肾功能的影响。方珐：选取急性肾功能衰竭患者82例,随机分为治疗组与对照组,其中治疗组42例,对照组40例。对照组给予常规治疗;治疗组在常规治疗基础上加用左卡尼汀,疗程7日。结果：两组的血肌酐、尿素氮、肾小球滤过率、24h尿量变化经治疗后均有好转,与治疗前比较有显著差异（P〈0．05）;治疗组治疗后又优于对照组（P〈0．05）;同时,治疗组治疗后在少尿总时间、少尿持续时间及尿蛋白恢复正常时间方面均较对照组明显缩短,有显著差异（P〈0．05）。结论：在常规治疗急性肾功能衰竭基础上加用左卡尼汀,可有效改善肾功能,促进肾功能恢复,对于治疗急性肾功能衰竭患者有重要的治疗价值。     

肾功能衰竭患者血液透析前后肾功能变化分析

临床资料1一般资料1998年7月至2003年6月,我科共收治39例尿毒症患者进行血液透析。本组病例39例,其中男24例,女15例,年龄13～78岁,平均41.2±8.3岁,39例中透析时间最短3月,最长12年。原发病:慢性肾小球肾炎23例,糖尿病肾病7例,高血压肾病9例。2仪器及方法本组病例均采取碳酸氢盐透析,透析器为聚砜膜透析器(F6)和血仿膜透析器。半透膜面积1.3～1.7m2。常规透析时血流量180～300ml/min,透析液流速为500ml/min。维持性透析每周2、3次。每次均为4h,给予促红细胞生成素辅助治疗。一般普通肝素抗凝,个别有出血倾向的患者用低分子肝素抗凝。用美国…     

肾功能分级在成人心脏术后肾功能衰竭的应用

Objective To evaluate the ability of the RIFLE classification to predict hospital mortality in adult patients who underwent cardiac surgery. Methods From October Ist 2006 to December 31st 2006, five hundred and nine adult patients who underwent coronary artery bypass grafting and/or valve operation were enrolled in this study. Renal function was assessed daily according to the RIFLE classification, meanwhile, APACHE Ⅱ score and SOFA score were also evaluated, as well as the maximum scores were recorded. Results Mean duration of ventilation support was 18(14 - 19) hours, the time of ICU stay was 1.4 ± 1.0 days, and the time of postoperative hospital stay was 12. 0(10.0- 15.0) days. 167 patients (32. 8%) incurred postoperative ARF according to the RIFLE classification. The overall mortality was 4. 3% (22/502). A significant increase (P < 0. 01) was observed for mortality based on RIFLE classification. By applying the area under the receiver operating characteristic curve, the RIFLE classification had more powerful discrimination power [0. 933, (95% CI 0. 872 -0. 995) ,P <0. 001]. Conclusions ARF is one of the major complications in postcardiotomy patients. Analytical data suggested the good discriminative power of the RIFLE classification for predicting inpatient mortality of adult postoperative patient with ARF, and the RIFLE classification is simple and practically performed. According to the RIFLE classification, patients with RIFLE class I or class F incur a significantly increased risk of in-hospital mortality compared with those who never develop ARF.     

肾功能分级在成人心脏术后肾功能衰竭的应用

Objective To evaluate the ability of the RIFLE classification to predict hospital mortality in adult patients who underwent cardiac surgery. Methods From October Ist 2006 to December 31st 2006, five hundred and nine adult patients who underwent coronary artery bypass grafting and/or valve operation were enrolled in this study. Renal function was assessed daily according to the RIFLE classification, meanwhile, APACHE Ⅱ score and SOFA score were also evaluated, as well as the maximum scores were recorded. Results Mean duration of ventilation support was 18(14 - 19) hours, the time of ICU stay was 1.4 ± 1.0 days, and the time of postoperative hospital stay was 12. 0(10.0- 15.0) days. 167 patients (32. 8%) incurred postoperative ARF according to the RIFLE classification. The overall mortality was 4. 3% (22/502). A significant increase (P < 0. 01) was observed for mortality based on RIFLE classification. By applying the area under the receiver operating characteristic curve, the RIFLE classification had more powerful discrimination power [0. 933, (95% CI 0. 872 -0. 995) ,P <0. 001]. Conclusions ARF is one of the major complications in postcardiotomy patients. Analytical data suggested the good discriminative power of the RIFLE classification for predicting inpatient mortality of adult postoperative patient with ARF, and the RIFLE classification is simple and practically performed. According to the RIFLE classification, patients with RIFLE class I or class F incur a significantly increased risk of in-hospital mortality compared with those who never develop ARF.     

肾功能分级在成人心脏术后肾功能衰竭的应用

Objective To evaluate the ability of the RIFLE classification to predict hospital mortality in adult patients who underwent cardiac surgery. Methods From October Ist 2006 to December 31st 2006, five hundred and nine adult patients who underwent coronary artery bypass grafting and/or valve operation were enrolled in this study. Renal function was assessed daily according to the RIFLE classification, meanwhile, APACHE Ⅱ score and SOFA score were also evaluated, as well as the maximum scores were recorded. Results Mean duration of ventilation support was 18(14 - 19) hours, the time of ICU stay was 1.4 ± 1.0 days, and the time of postoperative hospital stay was 12. 0(10.0- 15.0) days. 167 patients (32. 8%) incurred postoperative ARF according to the RIFLE classification. The overall mortality was 4. 3% (22/502). A significant increase (P < 0. 01) was observed for mortality based on RIFLE classification. By applying the area under the receiver operating characteristic curve, the RIFLE classification had more powerful discrimination power [0. 933, (95% CI 0. 872 -0. 995) ,P <0. 001]. Conclusions ARF is one of the major complications in postcardiotomy patients. Analytical data suggested the good discriminative power of the RIFLE classification for predicting inpatient mortality of adult postoperative patient with ARF, and the RIFLE classification is simple and practically performed. According to the RIFLE classification, patients with RIFLE class I or class F incur a significantly increased risk of in-hospital mortality compared with those who never develop ARF.     

普拉固对慢性肾功能衰竭脂质代谢及肾功能的影响

观察了３８例慢性肾功能衰竭（ＣＲＦ）患者非透析阶段脂质代谢改变，用３－羟－３－甲基辅酶Ａ（ＨＭＧ－ＣｏＡ）还原酶抑制剂普拉固对２０例ＣＲＦ患者进行治疗，观察其对ＣＲＦ脂质代谢及肾功能的影响，并与单纯饮食治疗１８例作对照。结果显示：ＣＲＦ患者具有以Ⅳ型高脂血症为特征的脂质代谢异常，主要表现为ＴＧ增高，并有Ｔｃｈ、ＬＤＬ－Ｃｈ、ＡｐｏＢ升高，ＨＤＬ－Ｃｈ、ＡｐｏＡ／ＡｐｏＢ降低。用普拉固治疗后，脂质代谢紊乱与肾功能都有改善，与治疗前比均有显著差异。对照组治疗后，血脂变化不大，肾功能虽有改善，但除Ｂｕｎ外，Ｓｃｒ、Ｃｃｒ与治疗前比，无显著差异。     

帕歌斯对慢性肾功能衰竭大鼠肾功能的影响

目的帕歌斯是一种用于风湿性疾病和各种疼痛治疗的天然止痛药物。文中探讨帕歌斯对慢性肾功能衰竭(chronic renal failure,CRF)大鼠肾功能的影响。方法将52只SD雄性大鼠随机分为正常组、模型组、帕歌斯低剂量组与高剂量组、双氯芬酸组。采用腺嘌呤法制作CRF大鼠模型,并给予相应的药物,造模后及给药30d后检测各组肾功能相关指标,包括24h尿量、24h尿蛋白定量、肾重/体重、血尿素氮(BUN)、肌肝(Scr)、血红蛋白(Hb)和电解质。HE、Masson染色观察肾脏病理改变与肾纤维化情况。免疫组化法检测转化生长因子-β1(TGF-β1)在肾组织中的表达。结果成功建立CRF大鼠模型。帕歌斯高、低剂量组治疗前后的肾功能相关指标及HE、Masson染色中无加重及升高,双氯芬酸组病变最重。TGF-β1在帕歌斯高、低剂量组表达较少,在双氯芬酸组表达最多。结论帕歌斯没有加重CRF大鼠肾小管-间质损害,没有造成肾功能的进一步恶化。其肾保护机制与帕歌斯减少TGF-β1在肾组织中的表达之间的关系有待进一步研究。     

肾功能分级在成人心脏术后肾功能衰竭的应用

Objective To evaluate the ability of the RIFLE classification to predict hospital mortality in adult patients who underwent cardiac surgery. Methods From October Ist 2006 to December 31st 2006, five hundred and nine adult patients who underwent coronary artery bypass grafting and/or valve operation were enrolled in this study. Renal function was assessed daily according to the RIFLE classification, meanwhile, APACHE Ⅱ score and SOFA score were also evaluated, as well as the maximum scores were recorded. Results Mean duration of ventilation support was 18(14 - 19) hours, the time of ICU stay was 1.4 ± 1.0 days, and the time of postoperative hospital stay was 12. 0(10.0- 15.0) days. 167 patients (32. 8%) incurred postoperative ARF according to the RIFLE classification. The overall mortality was 4. 3% (22/502). A significant increase (P < 0. 01) was observed for mortality based on RIFLE classification. By applying the area under the receiver operating characteristic curve, the RIFLE classification had more powerful discrimination power [0. 933, (95% CI 0. 872 -0. 995) ,P <0. 001]. Conclusions ARF is one of the major complications in postcardiotomy patients. Analytical data suggested the good discriminative power of the RIFLE classification for predicting inpatient mortality of adult postoperative patient with ARF, and the RIFLE classification is simple and practically performed. According to the RIFLE classification, patients with RIFLE class I or class F incur a significantly increased risk of in-hospital mortality compared with those who never develop ARF.     

肾功能分级在成人心脏术后肾功能衰竭的应用

Objective To evaluate the ability of the RIFLE classification to predict hospital mortality in adult patients who underwent cardiac surgery. Methods From October Ist 2006 to December 31st 2006, five hundred and nine adult patients who underwent coronary artery bypass grafting and/or valve operation were enrolled in this study. Renal function was assessed daily according to the RIFLE classification, meanwhile, APACHE Ⅱ score and SOFA score were also evaluated, as well as the maximum scores were recorded. Results Mean duration of ventilation support was 18(14 - 19) hours, the time of ICU stay was 1.4 ± 1.0 days, and the time of postoperative hospital stay was 12. 0(10.0- 15.0) days. 167 patients (32. 8%) incurred postoperative ARF according to the RIFLE classification. The overall mortality was 4. 3% (22/502). A significant increase (P < 0. 01) was observed for mortality based on RIFLE classification. By applying the area under the receiver operating characteristic curve, the RIFLE classification had more powerful discrimination power [0. 933, (95% CI 0. 872 -0. 995) ,P <0. 001]. Conclusions ARF is one of the major complications in postcardiotomy patients. Analytical data suggested the good discriminative power of the RIFLE classification for predicting inpatient mortality of adult postoperative patient with ARF, and the RIFLE classification is simple and practically performed. According to the RIFLE classification, patients with RIFLE class I or class F incur a significantly increased risk of in-hospital mortality compared with those who never develop ARF.     

肾功能分级在成人心脏术后肾功能衰竭的应用

Objective To evaluate the ability of the RIFLE classification to predict hospital mortality in adult patients who underwent cardiac surgery. Methods From October Ist 2006 to December 31st 2006, five hundred and nine adult patients who underwent coronary artery bypass grafting and/or valve operation were enrolled in this study. Renal function was assessed daily according to the RIFLE classification, meanwhile, APACHE Ⅱ score and SOFA score were also evaluated, as well as the maximum scores were recorded. Results Mean duration of ventilation support was 18(14 - 19) hours, the time of ICU stay was 1.4 ± 1.0 days, and the time of postoperative hospital stay was 12. 0(10.0- 15.0) days. 167 patients (32. 8%) incurred postoperative ARF according to the RIFLE classification. The overall mortality was 4. 3% (22/502). A significant increase (P < 0. 01) was observed for mortality based on RIFLE classification. By applying the area under the receiver operating characteristic curve, the RIFLE classification had more powerful discrimination power [0. 933, (95% CI 0. 872 -0. 995) ,P <0. 001]. Conclusions ARF is one of the major complications in postcardiotomy patients. Analytical data suggested the good discriminative power of the RIFLE classification for predicting inpatient mortality of adult postoperative patient with ARF, and the RIFLE classification is simple and practically performed. According to the RIFLE classification, patients with RIFLE class I or class F incur a significantly increased risk of in-hospital mortality compared with those who never develop ARF.     

肾功能分级在成人心脏术后肾功能衰竭的应用

Objective To evaluate the ability of the RIFLE classification to predict hospital mortality in adult patients who underwent cardiac surgery. Methods From October Ist 2006 to December 31st 2006, five hundred and nine adult patients who underwent coronary artery bypass grafting and/or valve operation were enrolled in this study. Renal function was assessed daily according to the RIFLE classification, meanwhile, APACHE Ⅱ score and SOFA score were also evaluated, as well as the maximum scores were recorded. Results Mean duration of ventilation support was 18(14 - 19) hours, the time of ICU stay was 1.4 ± 1.0 days, and the time of postoperative hospital stay was 12. 0(10.0- 15.0) days. 167 patients (32. 8%) incurred postoperative ARF according to the RIFLE classification. The overall mortality was 4. 3% (22/502). A significant increase (P < 0. 01) was observed for mortality based on RIFLE classification. By applying the area under the receiver operating characteristic curve, the RIFLE classification had more powerful discrimination power [0. 933, (95% CI 0. 872 -0. 995) ,P <0. 001]. Conclusions ARF is one of the major complications in postcardiotomy patients. Analytical data suggested the good discriminative power of the RIFLE classification for predicting inpatient mortality of adult postoperative patient with ARF, and the RIFLE classification is simple and practically performed. According to the RIFLE classification, patients with RIFLE class I or class F incur a significantly increased risk of in-hospital mortality compared with those who never develop ARF.     

肾功能分级在成人心脏术后肾功能衰竭的应用

Objective To evaluate the ability of the RIFLE classification to predict hospital mortality in adult patients who underwent cardiac surgery. Methods From October Ist 2006 to December 31st 2006, five hundred and nine adult patients who underwent coronary artery bypass grafting and/or valve operation were enrolled in this study. Renal function was assessed daily according to the RIFLE classification, meanwhile, APACHE Ⅱ score and SOFA score were also evaluated, as well as the maximum scores were recorded. Results Mean duration of ventilation support was 18(14 - 19) hours, the time of ICU stay was 1.4 ± 1.0 days, and the time of postoperative hospital stay was 12. 0(10.0- 15.0) days. 167 patients (32. 8%) incurred postoperative ARF according to the RIFLE classification. The overall mortality was 4. 3% (22/502). A significant increase (P < 0. 01) was observed for mortality based on RIFLE classification. By applying the area under the receiver operating characteristic curve, the RIFLE classification had more powerful discrimination power [0. 933, (95% CI 0. 872 -0. 995) ,P <0. 001]. Conclusions ARF is one of the major complications in postcardiotomy patients. Analytical data suggested the good discriminative power of the RIFLE classification for predicting inpatient mortality of adult postoperative patient with ARF, and the RIFLE classification is simple and practically performed. According to the RIFLE classification, patients with RIFLE class I or class F incur a significantly increased risk of in-hospital mortality compared with those who never develop ARF.     

肾功能分级在成人心脏术后肾功能衰竭的应用

Objective To evaluate the ability of the RIFLE classification to predict hospital mortality in adult patients who underwent cardiac surgery. Methods From October Ist 2006 to December 31st 2006, five hundred and nine adult patients who underwent coronary artery bypass grafting and/or valve operation were enrolled in this study. Renal function was assessed daily according to the RIFLE classification, meanwhile, APACHE Ⅱ score and SOFA score were also evaluated, as well as the maximum scores were recorded. Results Mean duration of ventilation support was 18(14 - 19) hours, the time of ICU stay was 1.4 ± 1.0 days, and the time of postoperative hospital stay was 12. 0(10.0- 15.0) days. 167 patients (32. 8%) incurred postoperative ARF according to the RIFLE classification. The overall mortality was 4. 3% (22/502). A significant increase (P < 0. 01) was observed for mortality based on RIFLE classification. By applying the area under the receiver operating characteristic curve, the RIFLE classification had more powerful discrimination power [0. 933, (95% CI 0. 872 -0. 995) ,P <0. 001]. Conclusions ARF is one of the major complications in postcardiotomy patients. Analytical data suggested the good discriminative power of the RIFLE classification for predicting inpatient mortality of adult postoperative patient with ARF, and the RIFLE classification is simple and practically performed. According to the RIFLE classification, patients with RIFLE class I or class F incur a significantly increased risk of in-hospital mortality compared with those who never develop ARF.     

洛汀新对老年慢性肾功能衰竭患者肾功能的保护作用

目的评价洛汀新对老年慢性肾功衰竭患者肾功能的保护作用。方法采集2002年3月~2006年3月住院治疗的慢性肾功能衰竭（慢性肾衰）患者87例,其中男64例,女23例。87例分成两组,洛汀新治疗组和美多心安对照组。结果应用洛汀新组与美多心安组对照GFR观察3年,洛汀新组达到终点的比例和GFR年平均下降速率显著低于美多心安组,表明洛汀新可以延缓肾功能减退的速度。结论洛汀新对轻中度高血压、轻度肾功能不全患者的疗效比中度以上肾功能不全及重度高血压患者的疗效较好,对血压偏低者则不适用。对肾小球性疾病肾功能的保护作用显著。     

肾功能分级在成人心脏术后肾功能衰竭的应用

Objective To evaluate the ability of the RIFLE classification to predict hospital mortality in adult patients who underwent cardiac surgery. Methods From October Ist 2006 to December 31st 2006, five hundred and nine adult patients who underwent coronary artery bypass grafting and/or valve operation were enrolled in this study. Renal function was assessed daily according to the RIFLE classification, meanwhile, APACHE Ⅱ score and SOFA score were also evaluated, as well as the maximum scores were recorded. Results Mean duration of ventilation support was 18(14 - 19) hours, the time of ICU stay was 1.4 ± 1.0 days, and the time of postoperative hospital stay was 12. 0(10.0- 15.0) days. 167 patients (32. 8%) incurred postoperative ARF according to the RIFLE classification. The overall mortality was 4. 3% (22/502). A significant increase (P < 0. 01) was observed for mortality based on RIFLE classification. By applying the area under the receiver operating characteristic curve, the RIFLE classification had more powerful discrimination power [0. 933, (95% CI 0. 872 -0. 995) ,P <0. 001]. Conclusions ARF is one of the major complications in postcardiotomy patients. Analytical data suggested the good discriminative power of the RIFLE classification for predicting inpatient mortality of adult postoperative patient with ARF, and the RIFLE classification is simple and practically performed. According to the RIFLE classification, patients with RIFLE class I or class F incur a significantly increased risk of in-hospital mortality compared with those who never develop ARF.     

辛伐他汀对冠心病合并肾功能不全患者肾功能的影响

目的 探讨辛伐他汀对冠心病合并肾功能不全患者肾功能的治疗效果.方法 128例冠心病合并肾功能不全患者,随机分为治疗组和对照组,治疗组66例,男性39例,女性27例;对照组62例,男性33例,女性29例.对照组治疗,抗血小板药+血管紧张素转换酶抑制剂(angiotension converting enzyme inhibitors,ACEI)或+血管紧张素Ⅱ受体阻滞剂(angiotensinⅡ receptor blockers,ARB)+β受体阻断剂,治疗组在对照组治疗基础上+辛伐他汀40 mg/d.治疗后3、6、12个月各查肾功能1次,以此对肾功能进行评价.结果 治疗组血清尿素氮由(11.5±3.5) mmol/L降到(7.2±2.5) mmol/L(P＜0.01);血清肌酐由(168±28)μmol/L降到(120±25)μmol/L(P＜0.01),尿蛋白由(652±28)mg/24 h降到(548±25)mg/24 h(P<0.01),65%患者血清肌酐恢复正常,心血管事件显著减少,差异有统计学意义;对照组血清尿素氮由(11.1±3.0)mmol/L降到(10.5±2.0)mmol/L(P＞0.05),血清肌酐由(162±23)μmol/L降到(145±20)μmol/L(P＞0.05),尿蛋白由(661±26)mg/24 h降到(632±23)mg/24 h(P>0.05),对照组治疗前后差异无统计学意义.结论 辛伐他汀40 mg/d能改善冠心病合并肾功能不全患者的肾功能,且价格低,值得应用与推广.     

MRI与肾功能

临床上检测肾功能的方法有很多,但这些方法各有不足之处。理论上MRI在检测肾功能方面有明显的优势,但尚未得到临床应用。作者就MRI检测肾功能的优势、可行性、方法及其应用情况进行了综述。     

放射性核素肾功能显像对IVP不显影肾功能的评价

肾脏是人体的重要器官,患者的分肾功能状态及患肾有无 功能的判定,在临床上具有重要的意义。本研究对38例静脉 肾盂造影(Intravenous pyelography,IVP)单侧肾不显影患者进行 了放射性核索肾功能显像,现报告如下。     

糖尿病肾功能衰竭患者血糖水平与肾功能的关系

在许多国家,糖尿病所致的肾病已成为慢性肾功能衰竭(chronic renal failure,CRF)的首位病因[1],在我国这一趋势也逐渐明显.CRF已成为糖尿病的主要致死因素之一.本文通过观察糖尿病肾功能衰竭患者的空腹血糖、尿素氮、肌酐水平的变化,及其相关性.以了解二者的相互关系及其临床意义.