Objective To investigate the efficacy and safety of polyethersulfone highflux dialyzer for uremic patients. Methods Forty eligible uremic patients were randomized into two groups, i.e. polyethersulfone (PES) group and polysulfone(PSF) group, according to a random number table. The PES group received hemodialysis for 4 hours with polyethersulfone highflux dialyzer (Chengdu OCI Medical Device Co., Ltd), and the PSF group with polysulfone highflux dialyzers (Fresenius Polysulfones, Fresenius Medical Care, Bad Homburg, Germany). Changes in serum creatinine, urea, β2-microglobulin, hemoglobin and albumin levels were determined for efficacy and safety evaluation. Results All the 40 patients completed the trial. The serum creatinine, urea, β2-microglobulin levels of all the patients in the two groups decreased (gt;30%) after the hemodialysis with different highflux dialyzers, and no significant difference was observed between the two groups (Pgt;0.05). Changes in solute clearance index (KT/V) value, hemoglobin and albumin levels were also comparable between the two groups (Pgt;0.05). Conclusions The efficacy and safety of the PES hollow fiber membrane hemodialyzer is equivalent to that of the PSF hemodialyzer in hemodialysis for uremic patients.
目的 总结妊娠合并尿毒症患者血液透析的护理措施。 方法 回顾性分析2001年3月－2012年6月收治的15例妊娠合并尿毒症患者行血液透析的临床资料。患者年龄平均30.5岁；2例为早期妊娠，孕13周，其中1例伴有尿毒症急性发作，其余均为中晚期妊娠，孕24+周，均血清肌酐＞445 μmol/L（5 mg/dL），尿氮素＞20 mmol/L。15例患者入院后即刻行血液透析治疗，治疗过程中进行必要的心理干预，在透析前、中、后护理中，密切观察患者心理状况，孕妇各项生命体征及胎儿胎心胎动等，择期终止妊娠。 结果 9例经维持性血液透析治疗后，病情稳定，顺利产下胎儿；另外3例患者经血液透析治疗后病情稳定，其中1例产下一死婴，另2例行人工钳取术终止妊娠；还有3例患者由于经济条件限制而中途退出治疗。 结论 适时的干预和加强妊娠合并尿毒症患者血液透析的护理，可取得很好的治疗效果，有可能改变妊娠的结果。
Objective To investigate the therapeutic effect of continuous renal replacement therapy (CRRT) plus hemoperfusion (HP) on patients with diabetes and uremic encephalopathy. Methods Fifty-five patients with diabetes and uremic encephalopathy from January 2010 to December 2017 were retrospectively collected in this study and divided into CRRT plus HP (CRRT+HP) group (n=28) and hemodialysis (HD) plus HP (HD+HP) group (n=27). The changes of vital signs, related biochemical indicators before and after treatment and curative effects were compared between the two groups. Results The two groups were comparable in general. No significant differences were found in blood pressure or heart rate before and after treatment between the two groups (P>0.05). The incidence of hypotension events in CRRT+HP group was significantly lower than that in HD+HP group (P<0.05), and the effective rate of cardiac function improvement in CRRT+HP group was significantly higher than that in HD+HP group (P<0.05). After treatment, the blood urea nitrogen, creatinine, parathyroid hormone, β2-microglobulin, phosphorus, C-reactive protein and brain natriuretic peptide in the two groups were significantly decreased than those before treatment (P<0.05). Parathyroid hormone, β2-microglobulin, C-reactive protein and brain natriuretic peptide were significantly decreased in CRRT+HP group as compared with those in HD+HP group (P<0.05). The remission rate of uremic encephalopathy in CRRT+HP group was significantly higher than that in HD+HP group (P<0.05). Conclusions As compared with HD+HP pattern, CRRT+HP pattern is more stable in the hemodynamics, and more effective in the improvement of heart failure and the clearance of inflammatory mediators, middle molecular and macromolecular substances associated with uremic encephalopathy. CRRT+HP pattern is suitable for the treatment of patients with diabetes and uremic encephalopathy.
ObjectiveTo summarize the current treatment status of uremic secondary hyperparathyroidism (SHPT) in order to improve the understanding of uremic SHPT and to guide clinical work.MethodThe relevant literatures at home and abroad on surgical treatment of uremic SHPT were readed and reviewed.ResultsFor intractable SHPT patients with ineffective medical treatment, surgical treatment was still irreplaceable, which could significantly improve biochemical indicators and quality of life of SHPT patients. However, there was no unified standard for surgical indications and the choice of different operation methods. In addition, there was a certain controversy about whether there was a need for preoperative parathyroidectomy in patients with SHPT who were willing to have a kidney transplant.ConclusionAlthough there are still some problems need to be solved in surgical treatment of SHPT, however, it’s widely recognized and used by clinicians, which can improve the symptoms of SHPT patients and bring bettersurvival benefits.
目的探讨为维持性血液透析患者行肘部动静脉内瘘的手术方法及技巧。 方法回顾性分析我院2009年8月至2012年8月期间行肘部动静脉内瘘68例患者的临床资料。 结果68例患者手术均成功。所有患者术后血流量都能满足血液透析需要，无感染、皮下血肿等并发症。随访至今，未发现血管内血栓形成、造瘘口狭窄等。 结论对于腕部自体动静脉不能行造瘘术时，肘部动静脉内瘘为血液透析患者提供了一条新的血管通路。
ObjectiveTo investigate the effectiveness of a suture bridge technique for quadriceps tendon rupture repair in uraemic patients. MethodsBetween March 2010 and September 2012, 10 uraemic patients (14 sides) with quadriceps tendon rupture were treated with the suture bridge technique. Of them, 8 were male and 2 were female, aged from 30 to 62 years (mean, 54.2 years). The duration of uremia was 3-11 years (mean, 5.5 years);the duration of quadriceps tendon rupture was 5 days to 2 months (median, 12 days). Six cases had a trauma history, and one case had diabetes. The left side was involved in 2 cases, the right side in 4 cases, and both sides in 4 cases. The active range of motion (ROM) of the knees was (115.0±8.3)°in flexion, and (72.5±21.2)°in extension. Lysholm score was 19.5±16.3. X-ray films showed downward shifting of patella. MRI revealed discontinuity between distal quadriceps tendon and upper pole of patella. ResultsThe operation time was 30-50 minutes (mean, 40.3 minutes). Primary healing of incision was obtained in all patients without complications. All patients were followed up 12-25 months (mean, 16.3 months). There was no re-rupture of quadriceps tendon or loosening of internal fixation during follow-up. At last follow-up, the active ROM of the knees was (121.0±7.9)°in flexion, showing no significant difference when compared with preoperative one (t=-2.075, P=0.058); the active ROM was (8.2±6.1)°in extension, showing significant difference when compared with preoperative one (t=11.702, P=0.000). Lysholm score was 84.6±12.4, showing significant difference when compared with preoperative score (t=-16.226, P=0.000). According to the American Knee Society score (KSS), the results were excellent in 4 sides, good in 9 sides, and fair in 1 side, and the total excellent and good rate was 92.9%. At last follow-up, the active ROM of the knee, Lysholm score, and KSS score were significantly better in young patients (<45 years) than in elder patients (≥45 years), and in patients receiving early operation (<2 weeks) than in patients receiving late operation (≥2 weeks) (P<0.05). ConclusionFor fewer traumas and early functional exercise after operation, the suture bridge technique benefits functional restoration of knee joint in uraemic patients. Operation chance and age seem to be important factors to the results. Early operation should be considered when quadriceps tendon ruptured.
ObjectiveTo explore the changes of serum irisin in maintenance hemodialysis (MHD) patients with sarcopenia.MethodsFrom January to June 2019, 56 MHD patients from Shanxi Provincial People’s Hospital were selected. Judging by the results of body composition analyzer, the MHD patients were divided into the sarcopenia group (n=31) and the non-sarcopenia group (n=25). The serum irisin level was detected by enzyme-linked immunosorbent assay. The muscle cross-sectional area at the third lumbar level was measured by CT. SPSS 21.0 software was used for inter-group comparison, correlation analysis, and regression analysis.ResultsThe serum irisin concentration in the sarcopenia group was lower than that in the non-sarcopenia group [medium (lower quartile, upper quartile): 175.46 (126.00, 220.52) vs. 459.10 (233.83, 616.91) pg/mL; Z=−4.195, P<0.001]. The results of Spearman correlation analysis showed that serum irisin level was positively correlated with lean tissue index (rs=0.265, P=0.048), however negatively correlated with serum creatinine level (rs=−0.311, P=0.020). The results of logistic regression analysis showed that serum irisin level [odds ratio (OR)=0.957, 95% confidence interval (CI) (0.925, 0.990), P=0.012], walking speed [OR=0.000, 95%CI (0.000, 0.050), P=0.031], and grip strength [OR=0.658, 95%CI (0.434, 0.997), P=0.048] were protective factors of sarcopenia in MHD patients.ConclusionsThe level of circulating irisin in MHD patients with sarcopenia is lower than that in MHD patients without sarcopenia. Irisin is a protective factor of sarcopenia in MHD patients.