参芎注射液治疗慢性肾功能不全58例

目的:总结参芎注射液治疗慢性肾功能不全的临床疗效。方法:选择慢性肾功能不全患者116例随机分为对照组和观察组各58例,给予对照组西医常规治疗4周,观察组在对照组基础上加用中药参芎葡萄糖注射液静滴。结果:观察组患者治疗后血肌酐(Scr)、内生肌酐清除率(Ccr)、血色素(Hb)、红细胞(RBC)、血尿素氮(BUN)值的变化情况与治疗前相比较、与对照组治疗后相比较均有明显差异,两组相比较有统计学意义(P<0.05)。结论:参芎注射液能显著改善慢性肾功能不全患者的肾功能,效果显著,值得应用。

单次快速静脉滴注科莫非对肾性贫血患者凝血功能的影响

目的探讨单次快速静脉滴注科莫非对肾性贫血患者凝血功能的影响,为该改进方案的安全性提供依据。方法回顾分析本院采用静脉滴注科莫非治疗肾性贫血的96例慢性肾脏病患者的凝血功能情况,依据用药方案将患者分为传统方案和改良方案(单次快速静脉注射)。分析治疗前、治疗后30min和24h的凝血四项(凝血酶时间TT、凝血酶原时间PT、活化部分凝血活酶时间APTT、纤维蛋白原FIB)、血小板参数(血小板计数PLT、血小板比积PCT、平均血小板体积MPV、血小板体积分布宽度PDW)和D-二聚体水平及用药1周内的不良反应情况。结果传统方案和改进方案在静脉注射后30min、24h的凝血四项、血小板参数和D-二聚体水平与治疗前比较,差异无统计学意义(P>0.05);用药1周内,除改进方案组有2例首次用药疼痛外,且疼痛均发生静脉注射位置,未有其他不良反应报道。结论快速静脉注射科莫非可有效的节省时间和医疗资源,同时对患者凝血功能的影响较小,患者耐受好,安全性高。

Real-time shear wave elastography combined with biochemical indicators for evaluating liver injury in patients with chronic kidney disease

Objective To observe the value of real-time shear wave elastography(SWE)combined with biochemical indicators for evaluating liver injury in patients with chronic kidney disease(CKD).Methods Totally 210 patients with CKD(CKD group)and 64 healthy subjects(control group)were retrospectively enrolled.Patients in CKD group were further divided into CKD1—5 subgroups according to CKD stages.SWE parameters of liver and kidney,including mean value,the maximum value and the median value of Young's modulus(EQI mean,EQI max and EQI med)were compared between CKD subgroups and control group.Spearman correlation analysis were performed to explore the correlations of liver and kidney SWE parameters with CKD stage,as well as of liver SWE parameters with biochemical indicators.Multivariate logistic regression analysis was used to screen independent predictors of liver injury in CKD patients.Receiver operating characteristic curves were drawn,the area under the curves(AUC)were calculated to evaluate the efficacy of the independent predictors alone and their combination for assessing liver injury in CKD patients.Results Significant differences of liver and kidney SWE parameters were found among CKD subgroups and control group(all P≤0.001).Pairwise comparison showed that liver SWE parameters in CKD5 subgroup and liver EQI max in CKD4 subgroup were all higher than those in control group(all P<0.003).Kidney SWE parameters in CKD3 subgroup were all higher than those in control group,while in CKD4 subgroup were all higher than those in control group and CKD1—3 subgroup(all P<0.003).Kidney EQI mean and EQI med in CKD5 subgroup were all higher than those in control group and CKD1—4 subgroup,while kidney EQI max in CKD5 subgroup were higher than those in control group and CKD1—3 subgroup(all P<0.003).Liver and kidney SWE parameters were lowly-moderately and positively correlated with CKD stages(r=0.364—0.665,all P<0.001).Liver SWE parameters of CKD were weakly and positively correlated with alkaline phosphatase(ALP)(r=0.229—0.248,all P<0.01).Theγ-glutamyl transferase,ALP and liver EQI max were all independent predictors of liver injury in CKD patients(all P<0.01),with AUC for evaluating liver injury in CKD patients alone of 0.645,0.756 and 0.741,respectively,lower than that of their combination(0.851,all P<0.01).Conclusion Real-time SWE combined with liver function indicators could reflect degree of liver injury in patients with different CKD stages.

Investigation and prediction of enteral nutrition problems after percutaneous endoscopic gastrostomy

AIM： To investigate and predict enteral nutrition problems after percutaneous endoscopic gastrostomy （PEG）. METHODS： We retrospectively analyzed data for 252 out of 285 patients who underwent PEG at our hospital from 1999 to 2008 after PEG were defined as： Enteral nutrition problems （1） patients who required ≥ 1 mo after surgery to switch to complete enteral nutrition, or who required additional parenteral alimentation continuously; or （2） patients who abandoned switching to enteral nutrition using the gastrostoma and employed other nutritional methods. We attempted to identify the predictors of problem cases by using a logistic regression analysis that examined the patients＇ backgrounds and the specific causes that led to their problems. RESULTS： Mean age of the patients was 75 years, and in general, their body weight was low and their overall condition was markedly poor. Blood testing revealed that patients tended to be anemic and malnourished. A total of 44 patients （17.5%） were diagnosed as having enteral nutrition problems after PEG. Major causes of the problems included pneumonia, acute enterocolitis （often Clostridium difficile-related）, paralytic ileus and biliary tract infection. A multivariate analysis identified the following independent predictors for problem cases： （1） enteral nutrition before gastrectomy （a risk reduction factor）; （2） presence of esophageal hiatal hernia; （3） past history of paralytic ileus; and （4） presence of chronic renal dysfunction. CONCLUSION： Enteral nutrition problems after PEG occurred at a comparatively high rate. Patient background analysis elucidated four predictive factors for the problem cases.

Risk of contrast-induced nephropathy in hospitalized patients with cirrhosis

AIM:To evaluate the incidence of contrast-induced nephropathy(CIN)in cirrhotic patients and to identify risk factors for the development of CIN.METHODS:We performed a retrospective review of 216 consecutive patients with cirrhosis who underwent computed tomography(CT)with intravenous contrast at the University of Rochester between the years 2000-2005.We retrospectively examined factors associated with a high risk for CIN,defined as a decrease in creatinine clearance of 25%or greater within one week after receiving contrast.RESULTS:Twenty-five percent of our patients developed CIN,and 74%of these patients had ascites seen on CT.Of the 75%of patients who did not develop CIN,only 46%had ascites.The presence of ascites was a significant risk factor for the development of CIN(P=0.0009,OR 3.38,95%CI 1.55-7.34)in multivariate analysis.Patient age,serum sodium,Model for End-stage Liver Disease score,diuretic use,and the presence of diabetes were not found to be significant risk factors for the development of CIN.Of the patients who developed CIN,11%developed chronic renal insufficiency,defined as a creatinine clearance less than baseline for 6 wk.CONCLUSION:Our results suggest that in hospitalized cirrhotic patients,especially those with ascites,the risk of CIN is substantial.

Self-care actions for the maintenance of the arteriovenous fistula:An integrative review

Objective:To identify self-care actions for the maintenance of arteriovenous fistula of renal patients.Method:An integrative review study was conducted and literature were searched in Medline/PubMed,Scopus,CINAHL LILACS,BDENF and SciELO Library databases using the descriptors chronic renal insufficiency,arteriovenous fistula,self-care,and knowledge.The inclusion criteria were that the documents be written in Portuguese,English,and Spanish,full text available,published in the last five years,and that they address the research question.Reflection articles,theses,dissertations,editorials of nonscientific journals,and research studies that did not follow the necessary methodological rigor were excluded.Data were analyzed with the IRAMUJTEQ software.Results:Fifteen articles were selected and comprised the final sample.Seven classes of self-care actions emerged from the text segments analysis and grouped into three categories:(1)Self-care actions that maintain the arteriovenous fistula;(2)Self-care actions for the prevention and the monitoring of complications with arteriovenous fistula;(3)Self-care actions directed at the perioperative period of arteriovenous fistula preparation.Conclusion:The results allowed us to identify important care for the maintenance of arteriovenous fistula functionality.The self-care actions identified in this study can guide a nursing care policy for implementation with protocols that help identify problems related to self-care actions and,thus,subsidize the development of actions aimed at the renal patient.However,more studies with high levels of evidence that identify self-care actions with arteriovenous fistula and the factors involved in its implementation are needed.