树脂灌血液灌流在顽固性高血压患者血液透析中的应用

目的:探讨树脂灌血液灌流对血液透析顽固性高血压患者血压及肾素-血管紧张素-醛固酮系统的影响。方法:选择我院82例,均分为Ⅰ组和Ⅱ组各41例,Ⅰ组患者采用金宝8LR聚酰胺膜透析器进行常规透析,Ⅱ组患者在常规透析的基础上串联树脂血液灌流,检测两组患者治疗前和治疗后3个月血清肌酐、尿素氮变化情况,和患者体内肾素活性、血管紧张素Ⅱ和醛固酮变化情况,并对血压变化值进行比较。结果:两组患者治疗后3个月血肌酐、血尿素氮均明显较治疗前降低,Ⅰ组患者治疗后3个月收缩压和舒张压较治疗前均无明显变化,Ⅱ组治疗后3个月收缩压和舒张压均较治疗前明显降低,Ⅰ组治疗后3个月肾素、血管紧张素Ⅱ和醛固酮较治疗前无明显差异,Ⅱ组治疗后3个月肾素、血管紧张素Ⅱ和醛固酮较治疗前均明显降低。结论:血液透析联合树脂吸附灌在保证有效清除患者体内代谢物质的同时,能较好的控制患者血压。     

树脂灌血液灌流在顽固性高血压患者血液透析中的应用

目的：探讨树脂灌血液灌流对血液透析顽固性高血压患者血压及肾素-血管紧张素．醛固酮系统的影响。方法：选择我院82例,均分为I组和II组各41例,I组患者采用金宝8LR聚酰胺膜透析器进行常规透析,II组患者在常规透析的基础上串联树脂血液灌流,检测两组患者治疗前和治疗后3个月血清肌酐、尿素氮变化情况,和患者体内肾素活性、血管紧张素II和醛固酮变化情况,并对血压变化值进行比较。结果：两组患者治疗后3个月血肌酐、血尿素氮均明显较治疗前降低,I组患者治疗后3个月收缩压和舒张压较治疗前均无明显变化,II组治疗后3个月收缩压和舒张压均较治疗前明显降低,I组治疗后3个月肾素、血管紧张素II和醛固酮较治疗前无明显差异,II组治疗后3个月肾素、血管紧张素II和醛固酮较治疗前均明显降低。结论：血液透析联合树脂吸附灌在保证有效清除患者体内代谢物质的同时角色较好的控制患者血压。     

低钠透析联合血液透析滤过对终末期肾脏病合并顽固性高血压患者血压节律、钙磷代谢的影响

目的:探讨低钠血液透析(hemodialysis,HD)联合血液透析滤过(Hemodiafiltration,HDF)对终末期肾脏病合并顽固性高血压的透析患者血压节律、钙磷代谢的影响。方法:将62例终末期肾脏病合并顽固性高血压患者随机分为治疗组和对照组,对照组应用常规HD治疗,每周3次,每次4 h,治疗组低钠联合HDF治疗,每周1次,3个月后进行效果评价。比较两组治疗前后血压昼夜节律、钙磷代谢变化及不良反应的发生情况。结果:治疗后,治疗组24 h收缩压(systolic blood pressure,24h SBP)、24 h舒张压(diastolic blood pressure,24h DBP)、日间收缩压(day systolic blood pressure,dSBP)、日间舒张压(day diastolic blood pressure,dSBP)、夜间收缩压(night systolic blood pressure,nSBP)、夜间舒张压(night diastolic blood pressure,nSBP)均较治疗前明显下降,且明显低于对照组(P0.05);对照组除nSBP外,其余血压指标治疗前后比较差异均无统计学意义(P0.05)。治疗后,治疗组血Ca水平较治疗前明显升高,且显著高于对照组,而血P、PTH水平较治疗前明显降低,且均明显低于对照组(P0.05)。治疗组和对照组不良反应发生率分别为16.1%、12.9%,两组比较差异无统计学意义(P0.05)。结论:低钠HD联合HDF治疗终末期肾脏病合并顽固性高血压患者可有效改善钙磷代谢并促进血压节律恢复。     

维持性血液透析患者营养状况的探讨与治疗

由于血液透析技术的广泛开展,慢性肾脏病(chronic kidney disease;CKD)血液透析患者的生活质量得到了明显改善,而血液透析患者的营养不良却仍然是临床医生棘手的问题,并越来越引起人们的重视,它可直接影响血透病人的临床症状、体征、并发症以及存活率等一系列问题.维持性血液透析(Maintenance hemodialysis;MHD)病人发生营养不良时,一般均可出现免疫功能降低,贫血加重,容易感染,心、脑、肺等脏器功能减退,易发生各种严重并发症,导致病人的生活质量下降,长期生存率降低,死亡率增高.营养不良不但影响维持性血液透析患者的生存期和生活质量,同时亦是并发症和死亡率增加的一个重要原因之一,探讨其原因,维持性血液透析病人营养不良的发生,既有血液透析本身的原因,也有血液透析以外的原因,本文从不同角度探讨了MHD患者营养不良的原因、影响因素以及临床上在维持性血液透析(MHD)患者营养不良方面采取的治疗对策.     

营养支持小组对临床维持性血液透析患者营养状况的影响

目的：研究营养支持小组对临床维持性血液透析患者一般营养状况的影响及应用价值。方法：选择武汉大学中南医院收治的进行维持性血液透析患者共180例纳入研究,随机分为观察组和对照组,对照组患者给予常规营养支持,观察组在此基础上由专业的营养支持小组为患者提供专业化营养支持;分析两组患者的营养状况。结果：两组干预前相关指标无统计学差异,干预后观察组患者营养指标明显优于干预前和对照组干预后,差异显著（P＜0.05）。SGA评价结果显示观察组营养状况良好者比例明显高于对照组,差异有统计学意义（P＜0.05）。结论：临床应用专业的营养支持为维持性血液透析患者提供营养支持,可改善患者营养不良情况,促进患者营养全面提升,具有积极临床意义。     

耳穴贴压法辅助治疗慢性肾脏病维持性血液透析患者营养不良的效果

目的 探讨耳穴贴压法对血液透析患者营养不良的临床疗效.方法 选择维持性血液透析患者120例,采用随机数字表法分为对照组和治疗组各60例.对照组给予常规治疗及血液透析,治疗组在常规治疗及血液透析基础上进行耳穴贴压疗法.治疗2个月后,采用综合性营养评估法(GNA)评价两组患者的营养状况.结果 治疗后,治疗组的营养不良发生率...     

血液透析联合血液透析滤过对患者营养及微炎症指标的影响

目的:探讨血液透析(HD)联合血液透析滤过(HDF)对维持性血液透析(MHD)患者营养及微炎症指标的影响。方法:选择2005年12月到2014年12月在我院接受治疗的140例MHD患者,随机分为HD组(n=70)和HD+HDF组(n=70)。比较两组患者治疗前后营养不良-炎症评分(MIS)、C反应蛋白(CRP)、白细胞介素6(IL-6)、白蛋白(ALB)、前白蛋白(PA)、血红蛋白(Hb)、握力(HS)、肱三头肌皮褶厚度(TSF)的变化。结果:治疗后,HD+HDF组患者MIS明显降低,ALB、PA、Hb、HS、TSF明显升高(均P0.05),且各指标改善程度均优于HD组(均P0.05);治疗后,HD+HDF组患者相比于治疗前和HD组治疗后,CRP、IL-6明显降低(均P0.05)。结论:HD联合HDF较单纯HD能更好的改善患者营养状态,减轻微炎症反应。     

简易血液透析滤过的临床应用

本文介绍了用普通血液透析机、恒温箱、床称(Patient Weighing monitor)及血泵进行的简易血液透析滤过方法(simplified hemodiafiltration,SHDF)。对比了不同的透析膜、不同血液净化方法对BUN、Cr、中分子物质(middle molecule substances,MMS)及β_(2m)的清除结果。发现用聚砜(polysulfone,ps)膜进行的SHDF对小分子毒物清除效果与HD相似,优于HF:对MMS及β_(2m)清除率与HF相似,优于HD及HDF(high flux dialysis)。SFDF是一种简便、有效的血液净化方法,且一机多用特点,可以在一般血液净化单位开展。     

维持性血液透析患者心理状态及相关因素调查

目的:探讨维持性血液透析患者心理状态及其相关因素。方法:对60例维持性血液透析患者应用焦虑自评量表(SAS)和抑郁自评量表(SDS)评定其心理状态,并对其影响因素:包括患者的年龄、性别、婚姻状况、学历、透析时间及家庭支持情况进行调查。结果:60例维持性血液透析患者焦虑、抑郁的发生率分别为63.33%、55.00%。年龄大小、透析时间、家庭支持水平与其焦虑、抑郁发生率之间有明显差别,存在统计学意义(p0.05)。结论:维持性血液透析患者焦虑、抑郁检出率较高,与患者的年龄(呈正相关r=0.629 p0.01;r=0.567 p0.01)、透析时间(呈负相关r=-0.496 p0.01;r=-0.474 p0.01)及家庭支持水平(呈负相关r=-0.584 p0.01;r=-0.498 p0.01)有关,在今后护理工作中应对透析年龄大,透析时间短及家庭支持水平差的患者高度重视其心理护理。     

126例维持性血液透析患者膳食调查

目的：通过膳食调查了解维持性血液透析患者饮食结构和膳食摄入量,评估各膳食营养素摄入量对血液透析患者营养需求的满足程度,为合理营养干预提供依据。方法：本课题以我国慢性肾脏病蛋白营养治疗共识（2005）及欧洲肠外肠内营养学会（ESPEN）的膳食指南为推荐量,采用24h膳食回顾法调查血透患者连续3d膳食摄入情况,分析食物来源和饮食结构,评价每日食物及每日营养素摄入量,比较各营养素摄入量与推荐量的差异性。结果：根据食物分类,血透患者日均摄入量排在前三位分别是蔬菜类（247.5g,占34%）、谷类（209g,占28.7%）和水果类（71.5g,占9.8%）,排在末三位分别是鱼类、豆类、蛋类（13.7g,占1.9%;22.2g,占3.0%;27.6g,占3.9%）;动物性食物是蛋白质摄入的主要食物来源（占62%）,植物性食物是钙、铁摄入的主要食物来源（占53%和69%）;与推荐量相比,血透患者除了维生素E和钠的摄入量大于推荐量外,日均总热卡和三大产热营养素（蛋白质、脂肪、碳水化合物）摄入量低于推荐量;部分维生素（维生素C、维生素B1、B2、B6）和部分矿物质（锌、硒、铁等）摄入量低于推荐量（P＜0.05）。结论：血透患者普遍存在膳食摄入不足的问题,大部分膳食营养素摄入量不能满足血透患者营养需求,建议加强饮食指导和营养支持。     

不同护理模式对维持性血液透析患者透析依从性与生活质量的影响

目的探讨不同护理模式对维持性血液透析患者透析治疗依从性与生活质量的影响。方法将行维持性血液透析的患者80例,根据护理模式的不同分为对照组与研究组各40例,对照组采用常规护理模式,研究组采用协同护理模式,两组均干预4个月,并对两组患者干预前后进行透析依从性量表、简明健康调查表(SF-36)、护理满意度进行问卷调查,分析干预前后两组患者透析依从性、生活质量变化及对护理满意度情况。结果与干预前比较,干预后研究组患者在透析依从性评分、SF-36评分及护理满意度方面均明显升高,差异有统计学意义(均P0.01);而且与对照组比较差异亦有显著统计学意义(均P0.01)。结论协同护理模式可显著提高维持性血液透析患者的血透治疗依从性及生活质量,提高了护理满意度,值得临床推广应用。     

维持性血液透析终末期肾病患者肠道优势菌群多样性变化研究

目的探讨维持性血液透析终末期肾病患者肠道优势菌群多样性及其与炎症因子的相关性。方法采集维持性血液透析的稳定终末期肾病患者和健康对照受试者的血液和粪便样本,采用荧光实时定量PCR(real-time quantitative PCR,QPCR)检测肠道优势菌群的变化情况,应用酶联免疫吸附技术(enzymelinked immunosorbent assay,ELISA)检测患者血液中的白介素1β(interleukin 1β,IL-1β)、白介素6(interleukin 6,IL-6)、肿瘤坏死因子α(tumor necrosis factor-α,TNF-α)和内毒素(lipoposaccharide,LPS)。结果维持性血液透析终末期肾病患者肠道菌群总菌量差异无统计学意义,但肠道内有益菌群如双歧杆菌属细菌、乳酸杆菌属细菌和粪杆菌属细菌显著降低,而肠道内有害菌如肠杆菌科细菌和肠球菌属细菌均显著升高(P0.05)。维持性血液透析终末期肾病患者血液中IL-6、TNF-α和LPS显著升高,均与双歧杆菌属细菌有显著负相关,与肠杆菌科细菌有显著正相关。肠道内乳酸杆菌属细菌和粪杆菌属细菌与IL-6呈显著负相关,肠球菌属细菌与其呈显著正相关。此外,乳杆菌属细菌与TNF-α呈显著负相关,肠球菌属细菌和LPS呈显著正相关。结论维持性血液透析终末期肾病患者肠道优势菌群多样性发生了显著变化,且与患者炎症因子有密切的相关性。     

益生菌对维持性血液透析慢性肾脏病患者肠道菌群失调的影响

目的 探究益生菌对维持性血液透析慢性肾脏病患者肠道菌群失调的影响,为此类患者的治疗提供参考。 方法 选取2017年4月到2019年4月我院收治的78例维持性血液透析慢性肾病患者,按照随机数字法分为观察组和对照组各39例。对照组患者给予常规治疗,观察组患者给予常规治疗联合益生菌。检测两组患者肠道菌群变化,同时检测血清炎性因子(IL6、TNFα、CRP)、肠道屏障功能(D乳酸、内毒素)及肾功能指标[肌酐(serum creatinine,Scr)、尿素氮(blood urea nitrogen,BUN)]水平。 结果 治疗后两组患者Scr、BUN水平均下降(均P0.05)。治疗后两组患者肠道双歧杆菌、乳杆菌数量均增加,大肠埃希菌、肠球菌数量均下降,且观察组患者改善情况优于对照组,差异有统计学意义(t=4.226、9.634、6.157、2.739,P结论 益生菌对维持性血液透析慢性肾脏病患者肠道菌群失衡、肠道屏障功能和微炎症状态均具有改善作用,可为该类患者临床治疗提供一定参考。     

Resting metabolic rate and its adjustments as predictors of risk protein-energy wasting in hemodialysis patients

Background: The purpose of the present study was to explore the association between resting metabolic rate (RMR) and protein-energy wasting (PEW) risk in Chinese hemodialysis patients by age and gender subgroup.Methods: RMR and body composition (body cell mass (BCM) and fat mass) of 774 patients undergoing hemodialysis were estimated by bio-electrical impedance analysis (BIA). Anthropometric data were collected by a standard measurement protocol, and the upper arm muscle circumference (AMC) was calculated. Biochemical nutritional and dialysis parameters were obtained. Linear regression analysis was used to analyze the relationship among RMR, body composition and nutritional factors.Results: The mean age was 54.96 ± 15.78 years. RMR level in patients was 1463.0 (1240.5, 1669.0) kcal/d. In multiple linear regression models, BCM, left calf circumference (LCC), fat mass were the determinants association with RMR (P<0.001). Among the patients in the sample, 133 (17.2%) had been diagnosed with PEW per International Society of Renal Nutrition and Metabolism (ISRNM) criteria and 363 (46.9%) were being at risk PEW. The area under the receiver-operating characteristic curve (AUC) of RMR for predicting risk PEW was greater than RMR/BCM and RMR/body surface area (BSA). When the cutoff of RMR was 1481 kcal/d it had the higher sensitivity and specificity (82 and 42%), and the AUC was 0.68 in elderly maintenance hemodialysis (MHD) patients (P<0.001). After adjustment for potential confounders, lowest RMR quartile level (<1239) increased the risk of PEW (OR = 4.71, 95% CI: 1.33–16.64, P=0.016) in all patients.Conclusions: Older patients with PEW have a lower RMR reduction. RMR and RMR/BCM may play the role in objective screening to detect risk PEW in MHD patients, especially in males.     

Thyroid function and plasma selenium in chronic uremic patients on hemodialysis treatment

It has been shown recently that Selenium (Se), an essential trace element for humans, is involved in the regulation of thyroid function, since the enzyme that catalyzes the liver conversion of the thyroid hormone T4 to the more active form T3 is a selenoenzyme. In chronic uremic patients, low blood Se levels as well as thyroid function abnormalities are often found. The present study was carried out to verify whether any correlation exists between Se levels and thyroid function, and to evaluate possible changes in hormonal pattern during Se supplementation in 10 chronic uremic patients on hemodialysis (HD) treatment. Se was supplemented orally as sodium selenite over six consecutive months. Basic plasma Se levels were significantly lower in patients than in normal controls. Right from the start of Se supplementation, plasma Se concentration promptly normalized and leveled off in the normal range throughout the study. Significant increase of FT3 and reduction of TSH levels were detected during Se supplementation. In Se-supplemented patients, a significant direct correlation was also found between reverse T3 (rT3) and TSH, and a significant inverse correlation was found between Se and TSH. Our results suggest that Se deficiency in chronic uremic patients represents a factor influencing the thyroid function and that the Se status should be determined in the evaluation of thyroid metabolism in these patients.     

Base excision repair capacity in chronic renal failure patients undergoing hemodialysis treatment

The aim of this study was to determine if the differences observed in the levels of DNA damage in a group of patients suffering from chronic renal failure are due to differences in the repair capability. DNA damage was initially measured with the comet assay in 106 hemodialysis patients. A selected group of 21 patients representing high (ten patients) and low (11 patients) levels of DNA damage were obtained for determination of base excision repair capacity. This was measured in an in vitro assay where protein extracts from lymphocytes were incubated with a substrate of DNA containing 8‐oxoguanine, and the rate of incision was measured with the comet assay. Patients with high levels of genomic damage showed, as an average, significantly lower repair capacity (12·73 ± 1·84) in comparison with patients with low levels of genomic damage (18·13 ± 1·13). Nevertheless, the correlation coefficient between repair ability and levels of genomic damage was found to be only close to the significance value (r:?0·423, p: 0·056). Although DNA damage was clearly related to time on hemodialysis, base excision repair capacity was not. This is one of the few studies providing information on the repair capacity of chronic renal failure patients undergoing hemodialysis. As a summary, our results would indicate that DNA damage levels are in part associated to the repair capacity of the patients, and this repair capacity is not associated with the duration of hemodialysis treatment. Copyright © 2013 John Wiley & Sons, Ltd.     

Serum zinc concentrations in the maintenance hemodialysis patients

Zinc is necessary for growth and cells' division. Its deficiency may seriously affect antioxidant defense system and is usually related to renal failure, gastrointestinal diseases and alcoholism. It is very important to know zinc status in dialyzed patients and to prevent hypo- or hyperzincemia. Serum samples from 89 patients with chronic terminal renal failure on regular hemodialysis were withdrawn for the estimation of zinc concentrations immediately before and after dialysis. Serum zinc concentrations showed to be highly dependent on hemodialysis. In 57 (64%) patients, serum zinc concentrations decreased, sometimes from very high to normal values. In remaining 32 (36%) patients serum zinc concentrations tended to increase, but remained within normal range. Zinc supplementation may be recommended only in the patients with proven zinc deficiency, but for all chronic renal failure patients it is questionable.     

缬沙坦联合苯磺酸左旋氨氯地平治疗201例高危高血压患者的疗效评价

目的探讨缬沙坦联合苯磺酸左旋氨氯地平治疗高危高血压患者的临床疗效。方法选择常州市新北区春江人民医院2014年6月至2016年6月收治的201例高危高血压患者,随机分为治疗组(n=101)和对照组(n=100)。对照组采用苯磺酸左旋氨氯地平治疗,治疗组在对照组的基础上联合缬沙坦治疗。观察比较两组收缩压和舒张压水平、血钾和血肌酐浓度、SF-36评分及不良反应发生情况。结果治疗后,两组收缩压和舒张压水平均显著降低(P0.05),且观察组低于对照组(P0.05);治疗后4周,观察组收缩压和舒张压水平亦均显著低于对照组(P0.05)。治疗后,两组血K+浓度、血肌酐浓度均显著降低(P0.05),且观察组低于对照组(P0.05);治疗后4周,观察组血K+浓度和对照组无差异(P0.05),血肌酐浓度亦低于对照组(P0.05)。两组SF-36评分均显著升高(P0.05),且观察组显著高于对照组(P0.05)。观察组不良反应率为5.94%,对照组为8.00%,两组比较无统计学意义(χ~2=1.612,P=0.880)。结论缬沙坦联合苯磺酸左旋氨氯地平治疗高危高血压临床疗效显著,安全性高,可以有效改善患者生活质量,值得推广应用。     

阿托伐他汀治疗高血压并颈动脉粥样硬化的临床疗效观察

目的:观察阿托伐他汀治疗高血压并颈动脉粥样硬化的临床疗效。方法:选择高血压并颈动脉粥样硬化患者64例,按照自愿的原则分为对照组和观察组,对照组给予常规治疗,观察组在常规治疗的基础上给以阿托伐他汀治疗。治疗6个月后,比较两组患者血压、血脂及颈动脉斑块分级情况。结果:治疗6周后,两组患者在上述方面比较,差异均具有统计学意义,观察组优于对照组。结论:在高血压并颈动脉粥样硬化患者药物治疗过程中,应加行阿托伐他汀治疗,可提高临床疗效。     

Creatol,an oxidative product of creatinine in hemodialysis patients

Creatol (CTL) is a product resulting from the reaction of creatinine (Cr) with the hydroxyl radical and is identified as a precursor of methylguanidine (MG), a uremic toxin. In this study, we investigated serum CTL levels together with those of Cr and MG in 66 patients who were on maintenance hemodialysis (HD). Prior to dialysis, the mean serum levels of Cr, CTL and MG were 967 (=11.1 mg/dl) ±267 μM, 11.1 ± 4.8μM and 5.8±2.9 μM, respectively. The mean CTL level was about 1.1% that of Cr, and the CTL plus MG level was about 1.4% that of the Cr level. The reduction rates of Cr, CTL and MG by a single HD were 62.6±6.1%, 71.0±10.3% and 51.9±11.6%, respectively. The CTL level at 0.5, 1 and 6h after HD increased rapidly by 20.7±8.7%, 31.7±14.7% and 80.1±27.3%, respectively. There was a significant correlation between CTL or CTL/Cr and parathyroid hormone in patients who had just undergone parathyroidectomy. No significant correlation was found between CTL or CTL/Cr and those factors which seems to be related to the predialysis levels of reactive oxygen. Therefore, because of the good clearance of CTL and its rapid conversion to MG, its usefulness for the estimation of hydroxyl radical generation in HD patients is limited.