Hemodialysis in schizophrenia

Summary Therapeutic trials with hemodialysis have been performed in three cases of chronic schizophrenia. The severely ill patients had been hospitalized for more than ten years and had not responded to different types of conventional somatic treatment. Psychopathology was evaluated by use of the IMPS, BPRS, and NOSIE scales. No improvement could be observed as a consequence of 12 (11 in one case) hemodialysis treatments. Rather, some deterioration occurred in two of the patients. This result is not in accord with the markedly positive findings of Wagemaker and Cade (1977). However, further studies appear necessary to render final conclusions.Supported by a Stipendium of the Fritz-Thyssen-Foundation, Cologne     

血液透析治疗海洛因依赖80例分析

目的:总结、分析血液透析治疗海洛因依赖的效果及原理。方法:对80例海洛因依赖者进行血液透析治疗1周。1周内透析2～3次,每次4 h;同时辅以抗焦虑、抗抑郁剂治疗;用美沙酮治疗80例作为对照组。结果:血液透析组80例患者均脱毒成功,未出现明显的戒断症状,效果优于美沙酮组(P<0.01)。结论:血液透析可能是较好的脱毒方法,脱毒快,成功率高,副作用小。     

Hemodialysis in elderly patients

International Urology and Nephrology -     

Trace Metals' abnormalities in hemodialysis patients: relationship with medications

A multicenter collaborative study was performed to investigate the prevalence of abnormal blood contents of 6 trace metals, copper (Cu), zinc (Zn), aluminum (Al), lead (Pb), cadmium (Cd), and mercury (Hg), in hemodialysis (HD) patients and to analyze their relationship with the medications, such as CaCO3, Ca acetate, Al containing phosphate-binding agents, 1,25-dihydroxy vitD3, 1-hydroxy vitD3, and erythropoietin (EPO), as well as hematocrit level, by chi-square statistics. From 6 medical centers in Taiwan, we included 456 patients in maintenance HD for more than 4 months for this study, and they had continued the previously mentioned medications for at least 3 months. Blood samples were collected before initiating HD, and atomic absorption spectrophotometry was used to measure plasma levels of Cu, Zn, and Al as well as whole blood levels of Pb, Cd, and Hg. Three hundred seventy-five (78%) of the HD patients had low plasma Zn levels, that is, <800 microg/L, and the mean (+/-SD) concentration was 705.8 (+/-128.23) microg/L in all subjects. One hundred forty-one (31%) of the HD patients had high plasma Al, that is, >50 microg/L, and the mean (+/-SD) was 44.30 (+/-28.28) microg/L in all subjects. Three hundred thirty-three (73%) of the dialysis patients had high Cd levels, that is, >2.5 microg/L, and the mean (+/-SD) was 3.32 (+/-1.49) microg/L in all subjects. The majority of HD patients had normal blood levels of Cu, PB, and Hg. Only 21 (4. 6%), 5 (1.1%), and 3 (0.06%) patients had elevated blood levels of Cu, Pb, and Hg, respectively. Their mean (+/-SD) blood concentration of Cu, Pb, and Hg were 1,049.78 (+/-233.25) microg/L, 7.45 (+/-3.95) microg/dL, and 3.17 (+/-25.56) microg/L, respectively. Three patients had elevated plasma Hg concentrations, that is, 546, 12.6, and 24.0 microg/L, respectively. In the 152 normal healthy age and sex matched control group, the blood levels of Al, Cd, and Pb were all significantly lower than the HD patients. However, the levels of Cu and Zn were higher in the control group. The Hg level was not significantly different in both groups. There was no statistical difference between patients with normal and abnormal blood levels of trace metals in various medications except Al containing phosphate binder. The Al containing phosphate binder users had significantly higher plasma Al levels (54.71 +/- 26.70 versus 41.15 +/- 28.03 microg/L, p < 0.001) and hematocrit levels (29.61 +/- 4.61 versus 27. 81 +/- 3.91, p < 0.0005). There was no statistical correlation between erythropoietin (EPO) dose and hematocrit level in these patients. In conclusion, the blood level of trace metals of these HD patients except Al was not related to their medications. However, caution must be exercised in interpreting this result as dose and duration of medication; efficiency of HD and water treatment may play an important role. Otherwise, environmental factors, diet, and the aging process may contribute to the trace metal burden in uremia. Thus, Zn and Cu are abundant in seafood, and Cd is abundant in contaminated plants such as rice.     

Is Erythrocyte Damage Prevented by Gardos Effect in Hemodialyzed Uremic Patients?

The purpose of this study was to determine the changes of calcium and potassium content in red blood cells (RBC) from uremic patients during a hemodialysis (HD) session. In 17 uremic patients on HD, the calcium and potassium content of RBC was determined in 3 blood samples collected at 0 min-HD (pre-HD), 45 min-HD, and 240 min-HD (end-HD) during a 4 h HD session. The calcium and potassium content of RBC also was determined in 20 normal subjects (controls). The mean values (+/-SD) of RBC calcium content in patients at 0 min-HD, 45 min-HD, and 240 min-HD were 1.95 +/- 0.34, 2.82 +/- 0.50, and 2. 05 +/- 0.4 microg/ml, respectively, and in controls 0.61 +/- 0.14 microg/ml. These values show that the RBC calcium in patients was generally significantly higher (p < 0.0001) in comparison to that of controls. The RBC calcium at 45 min-HD was significantly higher as compared to that at 0 min-HD and at 240 min-HD (p < 0.0001). The mean values (+/-SD) of RBCs' potassium in uremic patients at the previously mentioned measurements were 95.9 +/- 3.34, 92.5 +/- 4.32, and 93.85 +/- 3.89 mEq/L, respectively, and in controls 98.46 +/- 2. 30 mEq/L. These values show that RBC potassium of patients was generally significantly lower in comparison to controls (0 min-HD: p < 0.01, 45 min-HD and 240 min-HD: p < 0.001). Potassium decrease also was significantly lower at 240 min-HD (p < 0.01) and even lower at 45 min-HD (p < 0.001) compared to that at 0 min-HD. In conclusion, uremic patients during an HD session present a high calcium and a low potassium content of erythrocytes. These changes may prevent swelling of the cells (Gardos effect).     

复方氨基酸胶囊纠正慢性肾功能衰竭血液透析伴低蛋白血症的疗效观察

目的:观察复方氨基酸胶囊纠正慢性肾功能衰竭血液透析伴低蛋白血症的疗效。方法:30例慢性肾功能衰竭血液透析伴低蛋白血症患者口服复方氨基酸胶囊(0. 35g/粒)2粒,2次/d ,连用12wk ,比较治疗前和治疗后肝、肾功能及血浆白蛋白、血浆前白蛋白的变化。结果:治疗前、后血浆白蛋白分别为(30. 5±4. 6)、(35 .9±7. 1)g/L(P<0. 05) ;治疗前、后血浆前白蛋白分别为(213. 0±46. 9)、(275. 8±52 .3)mg/L(P<0. 05)。治疗前、后患者肝、肾功能无显著变化,且服药过程中无1例发生任何不良反应。结论:复方氨基酸胶囊用于纠正慢性肾功能衰竭血液透析患者的低蛋白血症安全、有效。     

急慢性肾衰竭并高钾血症542例次抢救体会

目的分析急慢性肾衰竭并高钾血症的临床表现和抢救体会。方法回顾性分析5年来用血液透析等抢救一组肾衰竭并高钾血症病人186例,共并发高钾血症542次的临床过程。结果540例次的临床症状改善,血清钾浓度降至正常范围,心电图的高血钾图象消失,2病例抢救无效死亡。抢救成功率99.6%。结论血液透析疗法是治疗高钾血症最有效的方法,使用含钾3.0~3.5mmol/L浓度的碳酸氢盐透析液进行透析,对降低高钾血症效果确切,可靠安全。血液透析治疗早期,不应作单纯超滤脱水治疗。透析早期仍有因高钾而致心跳骤停等危险,应随时准备心脏复苏等抢救。     

水处理各环节对血液透析用水质量的影响分析

目的 研究水处理各环节对血液透析用水质量的影响。方法 2003年对湖南地区99家透析中心水处理方式、各部件更换消毒情况以及反渗水生物学及理化特征进行卫生学调查和测定。结果 前处理填料及反渗膜更换时间、消毒间隔时间以及反渗水输送模式对反渗水生物学特性及理化特性均有影响。结论 定期做好水处理消毒及填料更换以及采用闭路循环输送反渗水是保证透析用水水质合格的关键所在。     

血液透析间期急性左心功能衰竭112例临床分析

目的 探讨尿毒症患者在血液透析间期发生急性左心衰的原因和提高防治效果。方法 选择112例慢性肾功能衰竭尿毒症期维持性血液透析治疗间期发生急性左心衰的患者。对其临床表现和治疗情况进行回顾性分析。结果 全组病例都有急性左心衰的临床表现，出现急性肺水肿13例，心电图提示ST段下降、T波倒置78例，左心室扩大31例，发生高血压95例，比上次超滤脱水后的体重(或干体重)增加超过3kg 71例，血清肌酐950～1200μmol／L 69例，超过1200μmol／L 43例；经过紧急血液透析。结合强心、扩血管药物对症治疗．本组病例均抢救成功。结论 认识尿毒症血液透析间期急性左心衰常见的临床表现有利于及早对其诊断；采取紧急血液透析和超滤脱水是提高疗效的关键，应该注意单纯超虑脱水的时间和数量；充分透析和透析间期控制体重、血压稳定是预防急性左心衰的重要措施。     

关于血液透析机维护和管理中需要注重的问题

随着医疗卫生事业的飞速发展，大量高科技电子设备不断涌现，是技术密集．知识密集、资金密集的产品，而血液透析机无论是国产还是进口的设备，（进口占比侧大），均属高科技机电一体化医电产品，并且采用微机技术．自检报警功能多，操作相对复杂，而不同产地（不同型号其操作方法和日常维护方法也不同着重阐述了透析机供电和透析掖的配制和血液透析机的维护与保养和维修。