【摘要】 目的 探讨开展优质护理服务对早期慢性肾功能衰竭患者治疗的影响。 方法 将2009年9月-2010年6月收治的80名早期慢性肾功能衰竭患者，随机分成对照组和试验组，每组各40例。试验组实施优质护理服务，对照组按常规护理，半年后采用自测健康评定量表（SRHMS V1.0）对患者进行问卷调查，从而了解和评判优质服务对早期慢性肾功能衰竭患者治疗的影响及效果。 结果 试验组在器官功能、日常生活功能、生理健康子量表总分3个维度，在负向情绪、正向情绪、认知功能、心理健康子量表总分4个维度，在角色活动、社会健康子量表总分2个维度与对照组比较，差异均有统计学意义（Plt;0.05），在社会支持和社会资源方面与对照组的差异无统计学意义（Pgt;0.05）。 结论 开展优质护理服务能明显提高患者治疗疾病的信心，对有效控制患者病情发展有一定的影响与作用。【Abstract】 Objective To investigate the impact of quality care on early chronic renal failure patients. Methods Eighty patients in early stages of chronic renal failure in our department between September 2009 and June 2010 were randomly divided into the control group and the experimental group with 40 patients in each group. Quality and Conventional care were implemented on the two groups respectively. Six months later, self-rated health measurement scale (SRHMS V1.0) was used to analyze the impact of quality care on the patients. Results The results of the measurement showed that there were significant differences between the two groups in organ function, daily life function, physiologic health, negative emotion, positive emotion, cognitive ability, psychological health, role activity and social health (Plt;0.05). There were no significant differences between them in social support and social resources. Conclusion Carrying out high-quality care can significantly improve the active treatment confidence of the patients and can effectively control the development of the disease.
Objective To evaluate the effectiveness and safety of reduced glutathione in the treatment of acute renal failure. Methods Twenty-three patients with acute renal failure were divided into the treatment group (n=10) and the control group (n=13) by simple randomisation. Patients in the treatment group received intravenous reduced glutathione 1200 mg daily. Patients in the control group were not treated with reduced glutathione. The therapeutic course for both groups was 4 weeks. Serum creatinine and urea nitrogen were determined before treatment as well as at the end of each of the 4 weeks. Proximal and distal renal tubular functions were evaluated at the end of the treatment. The time when clinical symptoms were improved was recorded and adverse drug reactions were monitored. Results The durations of nausea and vomiting as well as the oliguria stage were shorter in the treatment group than in the control group. The serum creatinine level in the treatment group decreased more markedly than that in the control group. At the end of the treatment, the renal tubular function was better in the treatment group than in the control group. Conclusion Reduced glutathione contributes to the early recovery of renal function in patients with acute renal failure. However, more high-quality and large-scale randomized controlled trials are needed.
目的 测定多发性骨髓瘤（MM）患者血清胱抑素C （Cys-C） 的水平，探讨Cys-C与国际分期体系（ISS）、血β2-微球蛋白、溶骨性损害等指标的关系。 方法 收集2008年1月－2010年9月32例初治和8例复发的MM患者作为研究对象，同时收集40例健康体检者的检查资料作为对照组，测定血清Cys-C、血肌酐（Scr）、血β2-微球蛋白。采用核素全身骨显像（ECT）观察患者的溶骨性病变部位数。 结果 患者血清Cys-C水平（1.40 mg/L）明显高于健康对照组（0.90 mg/L）（P＜0.01）；在MM患者中Cys-C比Scr更敏感，能反映肾小球滤过率；血清Cys-C水平与ISS分期晚，血β2-微球蛋白升高以及溶骨性病变进展密切相关。 结论 MM患者的Cys-C水平高于健康者。Cys-C是骨髓瘤肾损害的早期敏感标志物，与肿瘤负荷及溶骨性损害密切相关，可作为评价肿瘤负荷的潜在指标。Objective To evaluate the serum levels of cystatin-C in patients with multiple myeloma (MM), and to explore its possible correlations with clinical data, including ISS stage, serum β2-microglobulin, and advanced lytic lesions. Methods From January 2008 to September 2010, serum cystatin-C, creatinine (Scr), and β2-microglobulin in 32 patients with MM, 8 patients with relapsed disease, and in 40 healthy controls were detected by automatic biochemistry analyzer detection. According to skeleton ECT, grading of osteolytic lesion was observed. Results The levels of serum cystatin-C of patients with MM were significantly higher than those of the controls. Serum cystatin-C could reflect the glomerular filtration rate , and was more sensitive than Scr in patients with renal lesion. Serum cystatin-C had ber correlations with advanced ISS stages, high levels of serum β2-microglobulin, and extensive bone diseases. Conclusion Serum cystatin-C is a sensitive marker of renal lesion in patients with MM, it could be a potential indicator to assess the tumor burden.
ObjectiveTo investigate the change of renal endothelin (ET) excretion and its relation to renal dysfunctions in obstructive jaundice.MethodsSixty male Wistar rats were randomized into two groups, the common bile ducts were ligated to establish the model of obstructive jaundice in experimental group, and only sham operation was done in control group. Ten rats were taken from each group at 5, 10 and 15 days respectively after operation, renal functions were evaluated by paminohippuric acid clearance (CPAH), inulin clearance (CIN) and fractional sodium excretion (FENa+); furthermore, plasma endotoxin (EX) level was determined, and ET1 contents in renal arterial plasma, renal venous plasma and renal tissue were detected. ResultsOnly FENa+ was significantly increased at the 5th day in experimental group; since the 10th day, all the three renal functional parameters gradually decreased, and FENa+ was significantly lower than that in control group at 15th day (P＜0.01 vs control). ②The plasma EX sustained at significantly higher levels after operation in experimental group (P＜0.01 vs control). ③The renal arterial plasma ET1 was significantly decreased, while the contents in renal venous plasma and renal tissue were significantly increased after operation in experimental group (P＜0.01 vs control). ④There were positive correlation between plasma EX and renal ET1 content, negative correlation between renal ET1 content and CPAH/CIN, and positive correlation between renal ET1 content and FENa+ (P＜0.01).ConclusionThe increased excretion of renal ET stimulated by endotoxemia may play an important role in the renal dysfunctions in obstructive jaundice.
ObjectiveTo summarize the perioperative management experience and the treatment strategy of hyperkalemia after simultaneous pancreas and kidney transplantation (SPK).MethodThe clinical data of patients with diabetes combined with end-stage renal disease who accepted SPK in the Organ Transplantation Center of West China Hospital of Sichuan University from November 2017 to November 2019 were retrospectively analyzed.ResultsA total of 6 patients accepted SPK totally. The cold ischemia time of all allografts was less than 8 h. The levels of fasting blood glucose and serum creatinine were normal in the 5 surviving patients, and the diabetic complications were relieved or improved, except for 1 patient who died of cardiac arrest due to acute left heart failure. There were 1 case of delayed primary renal function recovery, 2 cases of bleeding in the surgical area of pancreas transplantation, 1 case of gastrointestinal bleeding, 3 cases of microthrombosis in the blood vessels of pancreas transplantation, 2 cases of perirenal effusion infection, 2 cases of pulmonary infection, and 1 case of ureterobladder anastomotic leakage, all of which were cured after symptomatic treatment. Only 2 patients occurred hyperkalemia after SPK (the highest level was 6.49 mmol/L and 6.67 mmol/L respectively), and transfusion of 10% glucose injection contain insulin, emergency dialysis and oral fludrocortisone were successively performed on them to restore the potassium density in 1 month and 2 months after surgery. There were no complications of perioperative surgical technical hemorrhage, intestinal leakage, large arteriovenous thrombosis, necrotizing pancreatitis, etc.ConclusionsSPK is the most effective treatment for patients with diabetes combined with end-stage renal disease. Transfusion of 10% glucose injection contain insulin, emergency dialysis, and oral fludrocortisone are effective strategies in treating hyperkalemia after SPK.
目的：研究银杏达莫对糖尿病大鼠肾功能的影响，并从抗氧化应激反应的角度探讨其可能的作用机制。方法：50只Wistar大鼠随机分为正常组（10只），糖尿病模型组（20只）及糖尿病模型加银杏达莫组（20只）。采用单次腹腔注射链脲佐菌素（55 mg/kg）诱导糖尿病肾病（DN）大鼠模型，腹腔注射银杏达莫水溶液。生化法测定血糖，血、尿肌酐及尿白蛋白；尾静脉取血ELISA法检测血清血管内皮先长因子（VEGF）水平；肾脏匀浆后测肾脏丙二醛（MDA）、一氧化氮（NO）的含量。结果：糖尿病模型组和银杏达莫组生化指标均高于正常组（Plt;0.05），银杏达莫组MDA、NO及VEGF的表达减少与模型组比较差异有显著性（Plt;0.05）。结论：银杏达莫具有减轻糖尿病大鼠蛋白尿，提高尿肌酐排泄，减轻肾脏损害的作用，其机制可能与提高肾脏抗氧化系统功能有关。
ObjectiveTo explore the value of Aquaporin-3 (AQP-3) on the detection of early renal function damage by investigating the expressions of renal AQP-3 mRNA and protein of rats with obstructive jaundice (OJ). MethodsForty mature male Wistar rats were divided into two groups randomly: experimental group (n=20) in which the model of OJ rats was established, and control group (n=20, sham operation group). The levels of serum total bilirubin (TBIL), direct bilirubin (DBIL), creatinine (Cr)， and blood urea nitrogen (BUN) were detected by fullautomatic biochemical analyzer on 7 d and 14 d after operation. The expressions of renal AQP-3 mRNA and protein of rats were detected by RT-PCR and Western blotting, respectively. ResultsThe levels of serum TBIL and DBIL were significantly higher on 14 d than those on 7 d after operation in experimental group (P=0.000), which were significantly higher than those at corresponding time point in control group (P=0.000), while the difference within control group was not significant (P=0.154). Thus, the OJ models of rats were established successfully. The difference of serum Cr levels of rats between inter-and intragroup were not significant (Pgt;0.05). Serum BUN level on 14 d after operation in experimental group was significantly higher than those on 7 d after operation in experimental group and on 14 d after operation in control group (P=0.001), although serum Cr levels were not different between 7 d and 14 d after operation in control group (P=0.288). The expressions of AQP-3 protein of rats on 7 d and 14 d after operation in experimental group were significantly lower than those at corresponding time point in control group (P=0.033, P=0.000), meanwhile on 14 d after operation in experimental group was significantly lower than those on 7 d after operation in experimental group (P=0.000). The expressions of AQP-3 mRNA of rats on 7 d and 14 d after operation in experimental group were significantly higher than those at corresponding time point in control group (P=0.000), but the difference at different time point in two groups was not significant (P=0.139, P=0.059). ConclusionsThe changes of renal AQP-3 protein and mRNA expressions are prior to the changes of serum Cr and BUN levels of rats suffered from OJ complicated renal function damage, which are promised to improve the early diagnosis rate of renal function damage in rats with OJ.
Experienc of nurtitional treatment to 7 patients with acute renal failure (ARF) and nitrogemia after biliarty (tract) surgery is reported in this article. Nittrogen source inn all cases was obtained from "Renal Amine" and "7% Vamin" etc,which are composed of 8 essential amino acids (EAA), and the nergery sources are mainly supplyed by Intralipid (20 or 10%) and suitable amount of glucose. The nutritional admicture of "all in one" were employed as parenteral nutrition (PN). Satisfactary curative effecs in these patients were obtained. The suthors consider that (a) the nutritional treatment of different casuses of ARF should be providing enough energy and more EAA requirments than in normal need to synthesizw non-essential amino acide (NEAA) and protein from excessive blood urea nitrogen (BUN) for redcuing pritein breakdown and nitrogemia, and (b) 20% Intralipid is an effective low-volume, highly calories nutritional agent specially in ARF patients with restiction of waterr.