多巴胺、速尿、酚妥拉明治疗链球菌感染后肾炎并急性肾功能衰竭

目的 :观察联合使用肾剂量多巴胺、大剂量速尿、酚妥拉明联合治疗链球菌感染后肾小球肾炎并急性肾功能衰竭的临床疗效。方法 :将病例随机分为治疗组和对照组 ,观察两组患儿血尿素氮 (或血清肌酐 )恢复至正常值时间 ,尿蛋白消失时间及住院天数。结果 :两组血尿素氮恢复至正常时间 ,尿蛋白消失时间及住院天数分别为 1 0± 4(日 )与 1 3± 4(日 ) ,1 3± 5(日 )与 1 7± 5(日 ) ,2 0± 7(日 )与 2 5± 8(日 ) ;治疗组总有效率为 91 .89% ,对照组总有效率为 70 .2 7% ,两组比较有显著性差异 (P <0 .0 5)。结论 :多巴胺、速尿、酚妥拉明联合治疗链球菌感染后肾小球肾炎并急性肾功能衰竭效果满意。     

前列地尔联合厄贝沙坦治疗慢性肾小球肾炎的临床疗效观察

目的 探讨前列地尔联合厄贝沙坦应用于慢性肾小球肾炎治疗中的临床疗效.方法 随机选取我院收治的60例慢性肾小球肾炎患者,将患者分为观察组与对照组,每组30例.观察组采用前列地尔联合厄贝沙坦治疗,对照组单独采用厄贝沙坦治疗,对比两组患者的治疗效果.结果 观察组血尿素氮为(10.1±2.4)mmol/L,血肌酐为(117.6±10.2)μmol/L,尿蛋白定量为(0.95±1.4)g/24 h,治疗总有效率为93.3%;对照组血尿素氮为(12.3±3.9)mmol/L,血肌酐为(124.3±9.6)μmol/L,尿蛋白定量为(0.98±0.7)g/24 h,治疗总有效为73.3%.两组患者血尿素氮、血肌酐及治疗总有效率对比差异有统计学意义(P<0.05),尿蛋白定量对比差异无统计学意义.结论 采用前列地尔联合厄贝沙坦治疗慢性肾小球肾炎,可有效改善患者的临床症状,提高患者的疗效.     

新型冠状病毒肺炎患者肾损伤的临床分析

目的探讨新型冠状病毒肺炎（COVID-19）患者肾损伤的临床特征。方法选取2020年1月20日至2月20日杭州市西溪医院收治的COVID-19确诊患者73例,其中轻型6例、普通型57例、重型10例、危重型0例。患者入院第1天留取清晨第一次尿标本检测尿蛋白水平,抽取同日清晨空腹静脉血检测血肌酐水平,并计算内生肌酐清除率（Ccr）。分析患者肾损伤情况。结果73例患者尿蛋白阳性率为54.8%,Ccr异常率为10.96%。轻型、普通型、重型COVID-19患者尿蛋白阳性率分别为33.33%（2/6）、54.39%（31/57）、70.00%（7/10）,Ccr异常率分别为0.00%（0/6）、8.77%（5/57）、30.00%（3/10）。不同疾病严重程度COVID-19患者尿蛋白阳性率、Ccr异常率比较差异均无统计学意义（均P＞0.05）。结论COVID-19患者易出现肾损伤,但不同疾病严重程度的患者尿蛋白阳性率和Ccr异常率无统计学差异。     

贝那普利联合百令胶囊治疗慢性肾炎的疗效评价

目的 探讨对慢性肾炎患者给予百令胶囊、贝那普利联合治疗的临床疗效.方法 方便选取该院2016年2月—2017年2月收治的160例慢性肾炎患者进行观察,所有患者均给予饮食指导、血压控制等对症治疗.采用随机分组法分为研究组、对照组,每组中80例.研究组给予百令胶囊、贝那普利联合治疗,对照组给予贝那普利治疗.治疗3个疗程,记录两组患者的肾功能指标变化情况及总有效率.结果 治疗后,研究组24 h尿蛋白定量(0.6±0.5)g明显低于对照组(1.2±0.6)g,差异有统计学意义(P<0.05);研究组血肌酐(Scr)、血尿素氮(BUN)水平分别为(96.9±24.6)μmol/L、(5.5±0.8)mmol/L,对照组血肌酐(Scr)、血尿素氮(BUN)水平分别为(94.1±23.1)μmol/L、(5.3±1.0)mmol/L,差异无统计学意义(P>0.05);研究组总有效率(92.50%)明显优于对照组(80.00%),差异有统计学意义(P<0.05).结论 对慢性肾炎患者给予百令胶囊、贝那普利联合治疗可以迅速降低尿蛋白水平,治疗效果显著,具有较高的临床应用价值.     

科素亚降低糖尿病肾病尿蛋白排泄的临床研究

探讨科素亚降低糖尿病肾病尿蛋白排泄率的作用。方法 :40例 2型糖尿病肾病患者随机分为两组 ,2 0例常规接受口服降糖药或胰岛素治疗作为对照组 ,2 0例在常规治疗基础上给予科素亚 5 0 m g,每天一次 ,共 8周作为治疗组。结果 :科素亚能显著降低糖尿病肾病 2 4h尿白蛋白排泄率 (mg/2 4h) (12 5 .6± 43.2降至 87.5± 30 .4,t=3.2 2 5 6 ,P <0 .0 1) ,尿微球蛋白 (mg/L) (0 .134± 0 .0 34降至 0 .10 6± 0 .0 2 5 ,t=2 .96 72 ,P <0 .0 1) ,动脉收缩压 (k Pa) (18.71± 2 .6 2降至 17.45± 2 .0 6 ,t=0 .30 46 ,P <0 .0 5 )及平均动脉压 (k Pa) (14.2 0± 2 .33降至 12 .5 6± 2 .0 3,t=2 .385 6 ,P <0 .0 5 )。而内生肌酐清除率(Ccr)、血尿素氮 (BU N)及肌酐 (Cr)无显著变化。科素亚降低 2 4h尿蛋白排泄率及其对动脉收缩压及平均动脉压的降压作用无显著相关 (r=0 .311,P>0 .0 5及 r=0 .2 2 7,P>0 .0 5 )。结论 :科素亚能显著降低糖尿病肾病的尿白蛋白及 β2 -微球蛋白排泄率 ,对延缓糖尿病肾病发展 ,可能具有重要价值。     

联合检测尿微量蛋白在糖尿病肾病早期诊断中的意义

目的 :探讨尿微量蛋白对早期诊断糖尿病肾病的价值。方法 :采用速率散射免疫比浊法检测尿微量白蛋白 (MA)、转铁蛋白 (TRF)、IgG和α1 微球蛋白 (α1 MG) ,Jaffe速率法测定尿肌酐。结果 :糖尿病尿蛋白定性阴性组和阳性组的尿微量蛋白均显著高于正常对照组 (P <0 .0 1,分别为 (1.65± 0 .78)mg/mmol、(0 .2 2± 0 .19)mg/mmol、(1.2 1± 0 .62 )mg/mmol、(0 .98± 0 .45 )mg/mmol) ,且尿蛋白定性阳性组的尿微量蛋白较阴性组显著增高 (P <0 .0 1)。单项检测尿微量蛋白诊断糖尿病早期肾病阳性率较低 ,联合检测可提高检测阳性率 ,四联检测阳性率可达 92 .8%。结论 :联合检测尿MA、TRF、IgG和α1 MG是诊断糖尿病患者肾脏早期损伤灵敏、可靠的实验室指标     

观察缬沙坦胶囊联合前列地尔脂微球载体制剂对糖尿病肾病的疗效

目的:观察代文(缬沙坦胶囊)联合益康宁(前列地尔脂微球载体制剂)对糖尿病肾病的疗效。方法:将糖尿病肾病患者43例,随机分为治疗组23例与对照组20例,治疗组应用代文160 mg,1次/d口服,益康宁10μg,1次/d静脉滴注,联合用药30 d为1个疗程。对照组不予上述治疗,其他治疗方法相同。治疗前后测定尿素氮(BUN)、血肌酐(Scr)、内生肌酐清除率(Ccr)、24 h尿蛋白排出量。结果:应用代文联合前列腺治疗1个疗程后24 h尿蛋白排出量由(3.67±1.42)g/24 h降至(2.31±1.22)g/24 h,差异有统计学意义(P<0.01),Scr由(81±10)μmol/L降至(76±10)μmol/L,Ccr由(69±9)ml/min升至(76±8)ml/min,以上均P<0.05。治疗过程未发生明显不良反应。结论:代文(缬沙坦胶囊)联合益康宁(前列地尔脂微球载体制剂),可以明显减少糖尿病肾病尿蛋白的漏出,并能保护肾功能,是治疗糖尿病肾病有效而安全的药物。     

第179例腰骶部疼痛-蛋白尿-双肾积水-急性肾损伤

病历摘要 患者男,43岁,因腰骶部疼痛伴蛋白尿1年,发现双肾积水并血肌酐升高3个月人院.1年前患者无诱因出现腰骶部疼痛伴尿中泡沫增多,无肉眼血尿,测血压110/70 mm Hg(1mm Hg=0.133 kPa),查尿蛋白(+++),尿红细胞10个/HP,未予重视.半年前自觉夜尿增多,3～4次/夜.入院前3个月单位体检发现双肾积水并右肾包膜下积液,血肌酐升高193 μmol/L,尿素氮10.8 mmol/L,尿蛋白(++),潜血微量,诊断为"慢性肾功能不全".入院前2个月复查血肌酐230 μmoL/L,尿素氮11.5 mmol/L,肌酐清除率33.5 ml/min,血白蛋白30.2 g/L,球蛋白67 g/L,总胆固醇3.1 mmol/L,24 h尿蛋白定量0.32 g/d,血红蛋白139 g/L,血小板225×109/L,白细胞8.63×109/L,嗜酸性粒细胞比率7%,B超示"双肾弥漫病变及双.肾积水",以对症治疗.     

随机尿蛋白与肌酐比值测定的临床价值

为探讨随机尿的尿蛋白与肌酐的比值测定是否可代替24h尿蛋白定量用于监测尿蛋白的排出情况,利用美国Beckman公司生产的全自动血生化分析仪(CX9),采用双缩脲比色法测定尿蛋白,采用Jaffle动力学法测定肌酐。结果,当肌酐清除率(Ccr)>10、20~、50~80、≥80 mL/min时随机尿蛋白/肌酐比值和24h尿蛋白测定的相关系数分别为r=0.88、0.92、0.94、0.87,呈正相关(P<0.01),认为在肌酐清除率(Ccr)>10 mL/min时,随机尿蛋白/肌酐比值可取代24h尿蛋白用于临床尿蛋白程度的监测。     

他克莫司治疗儿童紫癜性肾炎疗效观察

目的探讨他克莫司(TAC)治疗儿童紫癜性肾炎的疗效和安全性。方法选择2013年1月至2016年6月于苏州大学附属儿童医院接受治疗且病理分级Ⅲ~Ⅵ级的40例紫癜性肾炎患儿,分为TAC组19例和环磷酰胺(CTX)组21例,TAC组患儿给予TAC口服治疗,CTX组患儿给予静脉CTX冲击治疗,观察比较2组患儿治疗前与治疗6个月后的24 h尿蛋白定量、尿红细胞计数、血清白蛋白、血肌酐、血尿素氮,并观察比较2组患儿的治疗效果及不良反应情况。结果治疗前2组患儿的24 h尿蛋白量、尿红细胞计数、血清白蛋白、血肌酐、血尿素氮水平比较差异均无统计学意义(P>0.05)。治疗6个月后,2组患儿的24 h尿蛋白量、尿红细胞计数较治疗前均显著减少(P<0.05);2组患儿的血清白蛋白有所升高,血肌酐、血尿素氮有所降低,但与治疗前比较差异均无统计学意义(P>0.05)。治疗6个月后,TAC组患儿的24 h尿蛋白量、尿红细胞计数较CTX组显著下降(P<0.05);2组患儿的血清白蛋白、血肌酐、血尿素氮比较差异均无统计学意义(P>0.05)。治疗6个月后,TAC组患儿的有效率显著高于CTX组(χ2=4.607,P<0.05)。TAC组患儿的不良反应发生率显著低于CTX组(χ2=4.043,P<0.05)。结论 TAC治疗儿童紫癜性肾炎有效率高,且服用方便,不良反应小。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

Development on Adjustable Calibration Marker for Shock Wave Focus

Shock wave lithotripsy （SWL） is a treatment of choice for upper urinary stones. However, this procedure is inappropriate for obese patients because the focus is often unable to reach the target owing to the limited focal distance in shock wave source. Although treating such patients in a blast path may increase the application length of shock wave source, it＇s difficult to find this path on the lithotripter monitor. For this reason, we invented an adjustable calibration marker in order to set an effective focus in the shock wave hath.     

Study on the TCM Pathogenesis of Angiopathic Complications of Type II Diabetes

Excess production of reactive oxygen species(ROS)of mitochondrion mediated by hyperglycemia is the common pathogenesis of angiopathic complications of diabetes.TCM holds that the damp from the dysfunction of spleen.kidney and liver is the causative factor of complications of diabetes.This is similar to the mechanism of Ros resulting in angiopathic complications of diabetes.When the angiopathic complications of type II diabetes mellitus(T2DM)are difierentiated as caused by turbid damp in TCM can be explained as ROS.Since the obstruction of pathogenic damp in channels and collaterals is said to be the main pathogenesis,the treating principle should be dissolving the damp to remove the obstruction.     

Leptin, Ghrelin and TNF-α before and after Hypo-caloric Traditional Chinese Diet and Auricular Acupuncture

INTRODUCTION Obesity is a complex emergent problem, which can be possibly solved not only by the diet but also by the life style and promotion of a constant physical exercise. 1, 2 No doubt careful attentions must be given to the nutritional condition of obese people, the dietary habits, the somatic build (i.e. distribution of fat mass) and the organic functions linked to formation of the fat mass. All the parameters should be constantly monitored before, during and after a diet treatment. 3, 4, 5     

Relationship between Dysglycemia and Carotid Atherosclerosis in Tibetan Population

People with dysglycemia are at high risk for atherosclerotic diseases. This study aims at investigating the atherosclerotic vascular damage in dysglycemia and its metabolic origin in Tibetan population.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Dr.Zhang Ren's Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.