三草汤在蛇伤患者中抗肾损害的临床研究

目的观察三草汤在蛇伤患者中抗肾损害的疗效。方法选择186例毒蛇咬伤患者,给予早期口服三草汤,观察患者治疗前,治疗后2、24、72 h及72 h后的尿微白蛋白、尿转铁蛋白、血尿素氮、血肌酐等临床指标变化。结果三草汤对毒蛇咬伤早期肾损害的疗效显著,临床生化指标明显改善。结论蛇伤后早期口服三草汤能有效预防和治疗肾损害,并能有效降低急性肾功能衰竭的发生。     

毒蛇咬伤患者院前程序化急救与护理

毒蛇咬伤是临床常见急症之一,病情变化迅速,致残致死率高,因此做好蛇伤病人早期救治显得十分必要。而院前急救是蛇伤治疗前期的一个关键性步骤,对毒蛇咬伤的预后影响较大。有资料表明,毒蛇咬伤患者的死亡原因之一是由     

毒蛇咬伤患者院前早期程序化急救处理方案的应用观察

目的探讨毒蛇咬伤患者院前早期程序化急救处理方案的应用价值。方法回顾性分析我院58例毒蛇咬伤患者应用院前早期程序化急救处理方案的临床资料。结果 58例毒蛇咬伤患者经院前早期程序化急救处理后,痊愈出院53例,好转3例,自动出院1例,院前死亡2例（眼镜王蛇咬伤1例,银环蛇咬伤1例）。结论院前急救是蛇伤治疗前期的一个关键性步骤,院前早期程序化急救处理方案应用于蛇伤患者,有利于提高抢救成功率。     

222例血循毒和混合毒毒蛇咬伤患者的凝血功能分析

目的探讨血循毒和混合毒毒蛇咬伤患者凝血功能与致伤蛇种及就诊时间的相关性。方法对我院2010年7月～2012年7月收治的222例毒蛇咬伤患者的凝血功能(凝血酶原时间、活化部分凝血活酶时间、纤维蛋白原)及致伤蛇种、就诊时间进行回顾性分析。结果 (1)我院蛇伤(血循毒和混合毒)患者以竹叶青蛇、烙铁头蛇、五步蛇、眼镜蛇为常见,少数为乡城烙铁头蛇、白头蝰蛇、眼镜王蛇,其它蛇伤罕见。(2)五步蛇伤早期(6h内)容易出现凝血功能障碍。(3)除五步蛇、蝰蛇外,其它血循毒和混合毒毒蛇咬伤6h后就诊者凝血功能障碍机率高。结论我院蛇伤以竹叶青蛇、烙铁头蛇、五步蛇、眼镜蛇咬伤常见,五步蛇咬伤早期(6h内)易出现凝血功能障碍,其它血循毒、混合毒毒蛇咬伤6h后凝血功能障碍率高;早期凝血功能障碍对五步蛇咬伤有诊断参考价值。     

毒蛇咬伤患者血尿α1一微球蛋白及尿蛋白测定及其临床意义（附54例结果分析）

毒蛇咬伤患者血尿α１一微球蛋白及尿蛋白测定及其临床意义（附５４例结果分析）陈月珍江苏常熟市白茆卫生院肾功能损害是毒蛇咬伤患者常见的器官中毒性损伤。常规的血液生化Ｃｒ、ＢＵＮ难以早期检出轻微的肾功能损害。近年来,α１－微球蛋白（α１－ｍ）及尿蛋白（Ａ／...     

萍乡地区毒蛇咬伤流行病学分析

目的分析萍乡地区毒蛇咬伤患者流行病学特点,为本地区的蛇伤防治提供依据和指导。方法通过1993~2012年萍乡地区毒蛇咬伤流行病学调查,并对蛇伤住院患者的年龄、性别、受伤部位、年份、季节、职业、蛇伤种类和治疗转归等进行分析。结果蛇伤的发病率逐渐上升,死亡率逐年下降;主要致伤蛇种为蝮蛇、五步蛇、银环蛇、眼镜蛇;蛇伤患者以中老年男性居多,职业以农民、市民、野外工作及蛇类作业者为多;咬伤部位以下肢多见。危重症与就诊时间及咬伤蛇种有关,治愈好转率为99%。结论了解本地区毒蛇咬伤的流行病学特点,加强宣教,提高广大人民群众的预防意识及急救知识,对降低本地区毒蛇咬伤的病死率及致残率具有重要意义。     

基层门诊处理毒蛇咬伤的注意事项

毒蛇咬伤在我国南方各省每年都较为常见,其中以7、8、9月份为高峰期。农民群众被毒蛇咬伤后常因缺乏蛇伤防治知识,思想认识表现不一,有的不能及时就医或盲目轻信民间草药偏方,以致耽误最佳救治时机,引起严重后果,而危及生命。因此,在基层门诊的处理恰当与否影响着蛇伤的疗效及预后。现就基层门诊处理蛇伤的注意事项与体会介绍如下。1精神安慰大多数毒蛇咬伤患者都存在紧张、恐惧心理,加上部分患者平素身体虚弱或有其他基础性疾病,而过度恐惧,可致精神性虚脱或休克,因此,对蛇伤患者的精神安慰和适当解释,显得尤为重要。消除患者紧张恐惧的心…     

血液透析治疗毒蛇咬伤致急性肾功能衰竭的护理

目的 探讨血液透析治疗毒蛇咬伤致急性肾功能衰竭(ARF)患者的护理.方法 根据对12例毒蛇咬伤致ARF患者的血液透析治疗的护理体会,探讨蛇伤患者血液透析的护理特点.结果 12例患者中11例治疗成功,1例男性患者因合并呼吸衰竭死亡.有效病例血液透析后血肌酐(Cr)、尿素氮(BUN)和尿酸(UA)均明显下降.结论 遵循血液透析的基本原则,注意毒蛇咬伤的特点,有针对性地进行护理,才能保证抢救成功.     

毒蛇咬伤治疗前后肝功能变化规律探讨

目的探讨毒蛇咬伤患者治疗前后肝功能的变化情况。方法对我院2012年9月~2014年9月收治住院治疗、且明确何种蛇伤诊断的毒蛇咬伤患者作为研究对象,对患者治疗前后各时段进行6项肝功能指标检测,并按蛇种、时段及病情对检测结果进行统计分析。结果 5种毒蛇咬伤患者的6项肝功能指标在治疗前和治疗后1天大多有升高趋势,治疗后2天和4天降低,肝酶指标的下降与治疗前和治疗后1天比较有显著性差异(P0.05或P0.01)。治疗前和治疗后1天所有指标的血清水平均是重症高于轻症,而且两者比较差异有显著统计学意义(P0.05或P0.01)。各种毒蛇咬伤患者治疗前后各时段比较肝功能变化无统计学意义。结论毒蛇咬伤特别是重症患者可引起肝功能异常,以肝酶变化比较明显,胆红素变化较小。     

湖南衡阳地区毒蛇咬伤流行病学分析及防治

目的分析湖南省衡阳市毒蛇咬伤的流行病学特征,为毒蛇咬伤的防治提供依据。方法采用回顾性分析方法收集衡阳市2018年1～12月份的1214例毒蛇咬伤患者的临床资料,分析致伤蛇种、患者的性别和年龄、月份、就诊时间、毒蛇辨认能力等资料的分布特点。结果衡阳市主要致伤蛇种为蝮蛇(65.7%),其次为不明蛇类咬伤(21.7%)、眼镜蛇咬伤(10.0%)、五步蛇咬伤(1.07%)、竹叶青咬伤(0.7%)、银环蛇咬伤(0.8%);患者多为男性农民,且40岁以上多见;毒蛇咬伤时间集中在每年夏秋季节,以4～10月份为主;被咬伤后大部分患者能在4 h内来院就诊,蛇伤以轻型为主,预后良好,无死亡病例。结论湖南省衡阳市毒蛇咬伤具有显著流行病学特点(致伤蛇种以蝮蛇最多,季节分布以夏秋季为主,其中男性多于女性,就诊时间以4 h内为主),针对性宣教、预防可明显降低毒蛇咬伤的发生率。     

Randomised controlled trial of enalapril and beta blockers in non-diabetic chronic renal failure.

OBJECTIVE--To compare the ability of angiotensin converting enzyme inhibitors and beta blockers to slow the development of end stage renal failure in non-diabetic patients with chronic renal failure. DESIGN--Open randomised multicentre trial with three year follow up. SETTING--Outpatient departments of six French hospitals. PATIENTS--100 hypertensive patients with chronic renal failure (initial serum creatinine 200-400 mumol/l. 52 randomised to enalapril and 48 to beta blockers (conventional treatment). INTERVENTIONS--Enalapril or beta blocker was combined with frusemide and, if necessary, a calcium blocker or centrally acting drug in patients whose diastolic pressure remained above 90 mm Hg. RESULTS--17 patients receiving conventional treatment and 10 receiving enalapril developed end stage renal failure. The cumulative renal survival rate was significantly better in the enalapril group than in the conventional group (P < 0.05). The slope of the reciprocal serum creatinine concentration was steeper in the conventionally treated patients (-6.89 x 10(-5)l/mumol/month) than in the enalapril group (-4.17 x 10(-5)l/mumol/month; P < 0.05). No difference in blood pressure was found between groups. CONCLUSION--In hypertensive patients with chronic renal failure enalapril slows progression towards end stage renal failure compared with beta blockers. This effect was probably not mediated through controlling blood pressure.     

Zinc content in lymphocytes and the activity of zinc ion efflux from lymphocytes in primary arterial hypertension

Clinical observations and experimental data show that zinc (Zn) plays a role in regulating arterial blood pressure and in arterial hypertension etiopathogenesis. To determine the direction of changes in Zn metabolism in primary arterial hypertension, Zn absorption from the alimentary tract, Zn levels in blood serum, its content in lymphocytes, Zn efflux rate constants from lymphocytes, and urinary Zn excretion in patients with hypertension and in healthy subjects were studied. In this article, Zn levels in blood serum, its content in lymphocytes, and Zn efflux rate constants from lymphocytes are presented. In primary arterial hypertension, on the basis of this study, decreasing Zn levels in blood serum and its decreasing content in lymphocytes were found. The Zn efflux rate constants from lymphocytes increased at the initial stage of hypertension (mild arterial hypertension) and decreased in the late stage of the hypertension disease (severe arterial hypertension). Taking into consideration all of the directions of changes and the fact that Zn can be a factor that increases arterial blood pressure, the changes in Zn distribution can be regarded as having, to a certain extent, a protective character leading to weakening of the pressor reaction, assuming a genetic existence of relative or absolute Zn excess in the body. The changes of Zn distribution can lead, after some time, to Zn deficiency and the resulting metabolic changes (e.g., carbohydrate intolerance).     

蛇毒清合剂治疗蝮蛇咬伤的疗效观察

目的观察蛇毒清合剂对蝮蛇咬伤的临床疗效。方法选择2008年11月～2011年11月我院收治的蝮蛇咬伤患者62例,随机分成两组,其中观察组31例,在常规治疗的基础上加服蛇毒清合剂,对照组31例采用常规治疗。比较两组患者血清酶学3项（CK、LDH、AST）、肿胀消退时间、疼痛缓解情况、肾功能衰竭、呼吸衰竭发生率、局部组织坏死发生率、致残率以及住院时间。结果观察组的血清酶学3项（CK、LDH、AST）、肿胀消退时间、疼痛缓解情况、肾功能衰竭、呼吸衰竭发生率、局部组织坏死发生率、致残率以及住院时间均明显优于对照组（均P〈0.05）。结论蛇毒清合剂治疗对蝮蛇咬伤有显著疗效。     

Serum Folate and Vitamine B12 Levels in Acute and Chronic Renal Disease. Effect of Peritoneal Dialysis

Serum folate and vitamin B₁₂ levels have been measured in 32 patients with renal failure. The initial mean serum folate level was raised above normal in seven patients with acute renal failure whereas the mean level in eight patients severely ill from chronic renal failure was significantly lower than normal. Serum folate levels fell during peritoneal dialysis and rose between dialyses in all these patients and also in one patient who was dialysed for acute pancreatitis.The mean serum B₁₂ level was raised in patients with both acute and chronic renal failure, but there was no consistent change in serum B₁₂ level during dialysis.Hypersegmented polymorphs were present in the peripheral blood film of most of the patients with acute or chronic renal failure. Their presence bore no relation to the clinical state, blood urea, serum folate, or serum B₁₂ level of the patients.     

Electrophoretic and immunochemical research of rat urine proteins in dynamics after intravenous injection of thorium dioxide (thorotrast)

Rats were treated with a single intravenous injection of thorotrast (thorium dioxide)--the source of alpha-rays. Dynamic investigation of urine protens of rats by methods of electrophoresis and immunoelectrophoresis was carried out during 22 months after thorotrast injection. Already the month after drug injection the selectivity of tubular reabsorbtion was disturbed. Three months after thorotrast injection the content of urinal proteins of tissue (in particular renal) origin was decreased. Finally the selectivity of renal filtration of proteins was damaged 4-6 months after thorotrast introduction. Serum proteins which were absent in normal urine (for example transferrin and lipoproteins) appeared in urine of affected rats. The urine proteins of serum origin were less degraded than those in normal urine. The alterations of glomerular filtration was increased up to 20-22 months when the spectrum of urine proteins became similar to the spectrum of serum proteins. The death of treated rats was occurred in this period. Thus the monitoring of urine proteins of rats treated with alpha-ray producing preparation throtrast allows to register the successive alterations of reabsorbtion, excretion and filtration functions of kidney.     

Acute changes in plasma renin activity, plasma aldosterone concentration and plasma electrolyte concentrations following furosemide administration in patients with congestive heart failure--interrelationships and diuretic response

We studied the effects of furosemide on plasma renin and plasma aldosterone in 8 patients with mild to moderate congestive heart failure. In particular, we tried to correlate these effects with changes in plasma electrolyte concentrations and with the diuretic response on furosemide. We concluded that the diuretic response in patients with congestive heart failure is not dependent on the initial serum renin nor on the initial serum aldosterone concentration. The diuretic response did not correlate either with the changes in serum renin and/or serum aldosterone concentration. Serum renin and serum aldosterone correlated mutually before and after intravenous furosemide. We confirmed the inverse correlation between serum sodium and serum renin. SeNa and SeK correlated at all times with serum aldosterone; SeCl correlated with serum aldosterone only before intravenous furosemide administration. Indirect evidence could be provided that in patients with congestive heart failure a decreased renal blood flow is present, using the urinary beta 2-microglobulin concentration. Aldosterone has again, indirectly, proved to be integrated in the renal magnesium handling.     

The dialysis of Ochratoxin A (OTA)

Standard dialysis did not result in a decrease of the OTA level in the blood serum of patients regularly treated by dialysis. Therefore, we examined the effect of dialysis on both OTA bound to the blood plasma proteins and free OTA. We carried out an in vivo experiment to determine OTA levels in the serum of patients in the terminal stage of chronic renal insufficiency (CHRI) before and after dialysis and also in the dialysate in which we did not find OTA. OTA bound to blood plasma proteins did not penetrate the dialysis membrane. In contrast, free OTA during an in vitro experiment with the identical dialyzer (as during the in vivo experiment), easily penetrated the same dialysis membrane.     

Efficacy of benzbromarone in hyperuricemic patients associated with chronic kidney disease

We have retrospectively evaluated the uric acid control status and renal function changes over a period of up to 7 years in 35 patients with renal impairment who had stage 3 or higher chronic kidney disease (CKD; stage 3 in 32 patients, stage 4 in 2 patients, and stage 5 in 1 patient) associated with hyperuricemia and were receiving monotherapy with benzbromarone as an antihyperuricemic drug. Serum uric acid levels significantly decreased from 8.5 ± 0.9 to 6.1 ± 0.8 mg/dL at 6 months and were subsequently controlled at less than 7.0 mg/dL in most patients. Most patients received benzbromarone at a dose of 25-50 mg/day, whereas 150-200 mg/day was used in some patients with stage 4 or 5 CKD. No significant changes in estimated glomerular filtration rate (eGFR) from the baseline value of 46.2 ± 11.5 mL/minute/1.73 m(2) were found after benzbromarone therapy. Although the renal function impairment did not improve by reducing the serum uric acid levels with benzbromarone, the renal function did not deteriorate further on the therapy. These results suggest that benzbromarone is applicable to the management of hyperuricemia associated with renal impairment.     

Pregnancy and the Nephrotic Syndrome

Nineteen patients with nephrotic syndrome, 13 with histological diagnosis, were studied throughout 31 pregnancies. Eight were diagnosed for the first time during pregnancy.Antenatal problems due to severe oedema, urinary tract infection, and refractory orthochromic anaemia were encountered. Eight patients were hypertensive at booking, and in two of these pregnancy was terminated; three others had a significant increase in blood pressure. In 12 of the remaining pregnancies a rise in blood pressure of 20 mm. Hg or more occurred towards term.There were 29 live births (including one set of twins), one stillbirth due to a cord accident, and one neonatal death. The infant birth weight, apart from being affected by hypertension, was related to the maternal serum albumin level.The patients have been under observation for up to 20 years. Fifteen have not shown any deterioration of renal function during the prolonged period of observation. One developed oliguric renal failure immediately post partum and three others died, two, four, and 12 years after their pregnancies.     

Change in the cholesterol and triglyceride content in the blood in self-stimulation and avoidance reactions]

The changes in the blood serum cholesterol and triglyceride content were studied or rabbits of both sexes during reactions of self-stimulation and avoidance. Self-stimulation was accompanied by a significant decrease in the blood serum cholesterol and triglyceride content. During the reaction of avoidance the character of the cholesterol changes varied. The reaction of avoidance of the "agression" type was accompanied by elevated blood serum cholesterol content, whereas the reaction of the "fear" type was associated with a decrease in its content. The maximal changes in the cholesterol and triglyceride content as compared to the initial level were observed in all types of the reactions 15--30 minutes following stimulation.