药用活性炭有效降低顽固性高磷血症透析患者血磷水平与钙磷乘积

目的 研究口服药用活性炭对未能控制的高磷血症透析患者血磷与钙磷乘积的作用.方法 采用单中心、前瞻性、自身前后对照研究.经含钙的磷结合剂治疗后仍存在高磷血症的血液透析或腹膜透析患者,餐中加服药用活性炭4.5～7.2 g/d治疗3个月.检测治疗前后血磷、钙、钙磷乘积、全段甲状旁腺激素( iPTH)、白蛋白、血红蛋白水平.用配对t检验进行统计学分析.结果 与治疗前比较,治疗3个月后患者血磷水平显著下降[(1.85±0.30)mmol/L比(2.16±0.34) mmol/L,P＜0.01];血钙磷乘积也相应显著下降[(54.12±8.37) mg2/dl2比(63.93±8.83) mg2/dl2,P＜0.01];有更多并发继发性甲状旁腺功能亢进症的患者可以接受维生素D治疗(83.3％比50％);血钙与iPTH水平无显著性变化(P=0.734,0.665).活性碳治疗期间血白蛋白水平较前下降[(40.1±2.2)g/L比(41.7±2.9) g/L,P=0.001].结论 顽固性高磷血症透析患者在继续原有磷结合剂治疗基础上,口服药用活性炭可以有效地降低血磷水平与钙磷乘积,对血钙及iPTH水平没有显著性影响.活性炭治疗可使患者血白蛋白水平轻度下降.     

肾衰宁联合药用炭治疗慢性肾功能衰竭的136例疗效观察

目的:通过中药肾衰宁胶囊与药用发胶囊联合口服用于慢性肾功能衰竭病人的治疗,探讨该方案对慢性肾功能衰竭的疗效.方法:慢性肾功能衰竭病人136例,随机分为对照组和治疗组,对照组给予饮食治疗,对症支持,治疗原发病等,治疗组在对照组治疗的基础上加服肾衰宁胶囊和药用炭胶囊.结果:治疗组对慢性肾功能衰竭疗效总有效率73.5%,血清肌酐、尿素氮、尿酸等均明显降低,较对照组有显著性差异(P<0.05).结论:肾衰宁具有益气健脾、活血化癖、通腑泄浊的功效,药用炭胶囊直接吸附毒素,两者联合应用具有良好的协同作用,改善症状,明显降低血清肌酐、尿素氮、尿酸等,并且相互抵消两药的不良反应,值得推广应用.     

慢性肾衰竭血液透析并发高磷血症患者的生活质量状况及其影响因素

目的 调查慢性肾衰竭(CRF)血液透析(MHD)并发高磷血症患者的生活质量,分析影响高磷血症的相关因素.方法 将本院2017年1月至2020年1月收治的93例行MHD治疗的CRF患者纳为研究对象,根据是否并发高磷血症,将其分为高磷血症组(71例)与血磷正常组(22例),采用EQ-5D-3L量表评估两组生活质量,并分析两...     

慢性肾功能衰竭腹膜透析患者的出凝血紊乱

为了阐明慢履肾功能衰竭患者腹膜透析治疗中出血倾向和血栓形成倾向并存的矛盾状态，对２６例慢性肾功能衰竭行ＰＤ治疗患者，１７例慢性肾功能衰竭保守治疗患者，３６例慢性肾功能衰竭行血液透析治疗患者与２０例正常对照者的凝血，抗凝血，纤维蛋白溶解及血小板功能进行了综合研究。     

氧化应激与慢性肾功能衰竭透析患者动脉粥样硬化的发生

慢性肾功能衰竭(肾衰)和血液透析患者心血管病是终末期肾病患者死亡的主要原因,而氧化应激可能是心血管病高发生率重要的原因之一。 氧化应激是指机体活性氧的生成增加或/和清除活性氧的能力降低,由此导致活性氧的生成和清除失衡,过量的活性氧引起分子、细胞和机体的损伤。有关慢性肾衰患者活性氧生成增加的原因目     

慢性肾功能衰竭的发病机理和对策

慢性肾功能衰竭的发病机理和对策蒋季杰，范亚平慢性肾功能衰竭（ＣＲＦ）是多种原发或继发肾脏病变持续进展的共同后果，通常系一进行性不可逆的临床综合征，目前缺乏有效的治疗方法，积极探讨ＣＲＦ发病机理并设法延缓其发展是临床急待解决的重要课题。ＣＲＦ的发病机理...     

一氧化氮与慢性肾功能衰竭

一氧化氮（ＮＯ）在细胞信息传递、细胞防御和细胞损伤中起着重要作用，对ＮＯ的深入了解改变了心血管、神经及免疫系统生理和病理生理的观点。本文综述了ＮＯ的来源，代谢、作用机制；ＮＯ对肾脏血液动力学的影响及ＮＯ在慢性肾功能衰竭中的作用     

慢性肾功能衰竭患者机体成分研究的进展

本文综述了近年来慢性肾功能衰竭者机体成分分析研究情况，指出了各种方法的优缺点。     

肾衰宁联合药用炭片治疗血液透析患者高磷血症的疗效观察

目的观察肾衰宁胶囊联合药用炭片治疗血液透析患者高磷血症的疗效。方法采用前瞻性随机对照研究方法,将我院106例存在高磷血症的血液透析患者随机分为肾衰宁组和对照组。肾衰宁组:给予肾衰宁胶囊6粒,口服,3次/日;药用炭片1.5 g,口服,3次/日。对照组:给予醋酸钙片口服,每日6片,分为早餐1片,午餐2片,晚餐3片。分别于治疗前及治疗2、4、8周后观察2组患者血磷、血钙、钙磷乘积变化和治疗8周后全段甲状旁腺素(immunoreactive parathyroid hormone iPTH)水平的变化。结果与治疗前相比,2组的血磷、钙磷乘积在治疗2、4、8周后均明显下降(P0.05),iPTH水平在治疗8周后也明显下降(P0.05),但组间比较差异无统计学意义(P0.05)。肾衰宁组血钙水平无明显变化,对照组血钙水平略有上升,但与治疗前比较差异无统计学意义(P0.05)。2组患者不良反应发生率相比(7.5%比9.4%),差异无统计学意义(P0.05)。结论肾衰宁胶囊联合药用炭片能有效治疗血液透析患者的高磷血症,并有效降低钙磷乘积、iPTH水平,且无明显不良反应。     

腹腔镜引导下腹膜透析管置放术

目的　探讨腹腔镜引导下放置腹膜透析管的方法。　方法　选择 9例慢性肾功能衰竭患者 ,在腹腔镜引导将Tenckhoff腹膜透析管置入腹腔并经皮下隧道引出。　结果　所有病例腹膜透析管均放置成功。手术时间 10min～ 2 0min。均成功的进行了腹膜透析。患者术后 2～ 7天出院。　结论　腹腔镜引导放置腹膜透析管技术具有透析管定位准确 ,手术切口小 ,术后疼痛轻。优于常规开腹技术     

非布司他与别嘌醇治疗慢性肾脏病合并高尿酸血症的疗效比较

目的探讨非布司他与别嘌醇在治疗慢性肾脏患者合并高尿酸血症的临床疗效分析比较。方法回顾性分析2013年1月至2015年2月中国人民解放军第174医院收治的78例慢性肾脏病合并高尿酸血症患者,并根据治疗方法将其分为对照组和治疗组。2组患者均采用优质低蛋白饮食、降压[钙通道阻滞剂和(或)β受体阻滞剂]、纠正贫血(促红细胞生长素)、补充α酮酸(开同)及纠正水、电解质酸碱平衡(碳酸氢钠)等综合治疗;观察组加用非布司他20 mg/d,对照组加用别嘌醇100 mg/d;2组均治疗观察24周。分析治疗前后2组患者血肌酐、血尿酸及临床疗效,并进行统计学分析。结果 2组治疗前后实验室相关指标比较结果表明2组治疗后血尿酸与治疗前比较,均有显著改善(均P0.05),且治疗组患者治疗后尿酸与对照组行组间比较有统计学差异(P0.05)。治疗组治疗后血肌酐与治疗前比较明显降低,有统计学差异(P0.05);而对照组治疗前后血肌酐无明显变化(P0.05)。治疗组临床总有效率高于对照组(P0.05)。2组均未发现明显的不良反应。结论非布司他相对于别嘌醇降低血尿酸水平的作用更强,且可改善肾功能,药物不良反应较小,因此在治疗慢性肾脏合并高尿酸血症患者上具有良好的应用前景。     

Abdominal wall hernia repair in patients with chronic renal failure and a dialysis catheter

This paper describes the incisional hernia repair technique carried out on 50 patients with chronic renal insufficiency requiring continuous ambulatory peritoneal dialysis. The technique involved fixing a polypropylene mesh prosthesis to the deep face of lateral incisions into the aponeurosis of the rectus abdominis muscle. Under general or epidural anaesthesia the old scar was resected and the hernial sac dissected, care being taken not to open the peritoneum. At 5 cm from either side of the hernia margin, the aponeurosis was incised longitudinally and the adjacent muscle separated. The mesh was sutured to the deep face of the aponeurosis, covering the hernial defect. A Tenckhoff catheter was left in the abdominal cavity. Peritoneal dialysis was given to all 50 patients in the immediate postoperative period, with no leaking of the dialysis fluid. One year later there has been no recurrence. Prosthetic mesh fixed to the deep face of the abdominal aponeurosis at incisions lateral to the hernia margins, without opening the peritoneum, is an effective treatment of incisional hernia repair for patients on peritoneal dialysis and allows early institution of dialysis.     

Growth hormone for children with chronic renal failure and on dialysis

We studied all children with CRF who received recombinant human growth hormone (rhGH) for more than a year (mean±SD duration of therapy 3.7±2.5 years) over an 11-year period. There were 32 children. Twenty-one children were conservatively managed, with a mean glomerular filtration rate (GFR) of 24±12 mL min^–1/1.73 m² at the start of rhGH. Their height standard deviation score improved from –2.5±1.4 to –2.1±0.7 at 1 year (P=0.3), –2.0±0.7 at 2 years (P=0.01), and –1.6±0.6 at 3 years (P=0.001). After that there was no improvement. Eleven children were on dialysis, six on haemodialysis (HD) and five on peritoneal (PD). Ht SDS improved from –2.7±0.5 to –2.3±0.5 at 1 year (P=0.02). Thereafter there was no further improvement. RhGH was stopped because of transplantation in 29 patients at a mean±SD age of 12.1±4.0 years. Mean Ht SDS was –1.8±0.8 at transplant and there was no change over the following 5 years. In conclusion, treatment with rhGH resulted in improvement in Ht SDS in conservatively managed CRF for up to 3.0 years and for 1 year in children on dialysis. Discontinuation of rhGH after transplantation resulted in little change in Ht SDS.     

Peritoneal dialysis for chronic renal failure in a patient with methylmalonic acidaemia

Chronic renal failure is a common complication of methylmalonic acidaemia (MMA). It is usually managed with haemodialysis and renal transplantation. We report the use of continuous cycling peritoneal dialysis (CCPD) for 20 months in a paediatric patient with chronic renal failure due to MMA. This procedure resulted in the elimination of 950 μmol methylmalonate (MM) per day and a fall in the plasma MM concentration from 3.9 to 0.74 mmol/l. As a result of this treatment, the frequency at which this patient was hospitalised was markedly reduced prior to a successful renal transplantation.     

维持性血液透析患者皮肤瘙痒情况的调查

目的 分析维持性血液透析患者皮肤瘙痒的部位、程度及治疗情况.方法 对我院血液净化中心63例维持性血液透析患者的皮肤瘙痒发生部位、以视觉模拟评分法评估瘙痒程度并调查其治疗情况.结果 63例维持性血液透析患者常见的瘙痒部位依次为背部、下肢、胸部、上肢、头颈部;轻度、中度、重度瘙痒分别为22例(34.9%)、25例(39.6%)、16例(25.4%);合并皮肤感染5例.63例患者中有40例患者接受血液灌流和(或)血液透析滤过治疗,经规律血液灌流和(或)血液透析滤过治疗后症状缓解.单纯行血液透析治疗的23例瘙痒患者中有14例去皮肤科就诊,经局部对症治疗效果不明显.结论 维持性血液透析患者皮肤瘙痒多为中、重度并可能发生皮肤感染.规律血液灌流和(或)血液透析滤过治疗能有效地缓解维持性血液透析患者皮肤瘙痒,而单纯局部对症治疗无效.     

慢性肾衰患者血红蛋白浓度变化对血清细胞因子活性的影响作用

目的为了探讨贫血与慢性肾衰（ＣＲＦ）免疫功能状态的关系。方法检测了ＣＲＦ患者单纯输血及用红细胞生成素（ＥＰＯ）治疗前后细胞因子白细胞介素２（ＩＬ２）、可溶性白细胞介素２受体（ｓＩＬ２Ｒ）、肿瘤坏死因子（ＴＮＦ）及γ干扰素（γＩＦＮ）水平，并与肾功能正常肾小球肾炎患者（ＧＮ）组及对照组（Ｃ）进行比较分析。结果ＣＲＦ组血清ＩＬ２，ＴＮＦ和γＩＦＮ水平均显著低于ＧＮ组及Ｃ组（Ｐ＜００１），ｓＩＬ２Ｒ水平则较ＧＮ组及Ｃ组明显升高（Ｐ＜００１）。ＣＲＦ组血清ＩＬ２，ＴＮＦ和γＩＦＮ水平与血红蛋白浓度存在直线正相关，而ｓＩＬ２Ｒ水平与血红蛋白浓度呈负相关性，单纯输血或应用ＥＰＯ治疗能改变这些细胞因子活性水平。结论ＣＲＦ免疫功能低下与贫血有关，及时治疗和改善贫血状态可部分纠正这种免疫异常。     

慢性肾功能衰竭患者结核感染预防治疗的指征探讨

观察了８３０例慢性肾功能衰竭患者长期随访过程中结核感染的发生情况，以探讨这类患者预防性抗结核治疗的指征。由此提示，具有前三项中一项或一项以上因素的慢性肾衰患者应视为结核感染的高危人群而给予预防性抗结核治疗。     

Gastric emptying in patients with chronic renal failure on continuous ambulatory peritoneal dialysis

Radionuclide gastric emptying studies were carried out on 20patients with end-stage renal failure (ESRF) undergoing continuousambulatory peritoneal dialysis (CAPD). Nine of the patientshad diabetes mellitus. Eight normal volunteers were also studiedto establish normal ranges. Solid and liquid emptying patternswere investigated simultaneously using a meal made up of a solidphase labelled with ^99mTechnetium and a liquid phase labelledwith ¹¹¹Indium. The solid emptying fitted a model with a lagphase followed by a linear emptying phase and the liquid emptyingfitted a single exponential. Nine of the 20 patients (four diabetic,five non-diabetic) were found to have delayed solid emptying,and four of these (two diabetic, two non-diabetic) also haddelayed liquid emptying. No correlation was found between anyof the parameters studied and the clinical symptoms of the patients.It is concluded that almost half of the patients studied hadabnormal gastric emptying, but that many of these did not sufferfrom severe symptoms.