目的:提高群蜂蛰伤致急性肾衰竭(ARF)的诊断和治疗水平。方法:回顾性分析我科7年来收治的23例群蜂蛰伤致ARF的临床资料,初步探讨其疗效及死因等。结果:23例群蜂蛰伤致急性肾功能衰竭患者,少尿型ARF为20例(占87%)无尿型ARF为3例(占13%);均伴有心肌酶、肌酸激酶、乳酸脱氢酶、谷丙转氨酶(ALT)升高;主要并发症为中毒性心肌炎(23/23,1000%)、横纹肌溶解肌症(23/23,1000%)、血红蛋白尿(21/23,913%)、血管内溶血(21/23,913%)、中毒性肝炎(16/23,696%)等;入院后12h内,10例行血液透析(hemodialysis,HD),13例行血液灌流(hemoperfusion,HP)/透析联合治疗(HP/HD);两组患者总治愈好转率为870%,病死率为130%;其中HD组治愈好转率为700%(7/10),病死率为30%(3/10),HP/HD组治愈好转率为100%(13/13),病死率为0,两组间疗效存在显著差异(P=0034);但所观察的病例中,HD组为我科前3年治疗蜂毒致ARF的方案,HP/HD组为我科后4年主要治疗蜂毒致ARF的方案,组间存在时间差异,并且病例数亦较少,因此两组的疗效对比有待进一步研究。3例患者死亡原因为多系统脏器功能衰竭(MSOF)。结论:蜂毒中毒所致急性肾功能衰竭以少尿型为主,同时伴有心、肝、血液、神经系统等重要组织器官的损伤,病情重;患者主要死亡原因为全身多系统器官功能衰竭(MSOF);尽早行血液净化是治疗群蜂蛰伤有效手段,其中条件允许的医院建议首选HP/HD联合治疗。
After comparative interpretation of the essentials and highlights of the expert recommendations based on European experience published in 2019 and the expert recommendations based on Asia Pacific experience published in 2021, this article summarizes the core principles of adsorptive hemofiltration for sepsis in following aspects, including patient selection, laboratory index, and key factors in the implementation of treatment (covering initiation timing and duration, choice of anticoagulant mode, discontinuation, etc) combined with the experience in West China Hospital of Sichuan University as well, to provide references for sepsis management with adsorptive hemofiltration in clinical practice.
With the development of medical information technology, smart teaching has been widely applied in various fields of medical education. The application of smart teaching technologies such as virtual simulation, intelligent evaluation, and smart teaching platform in blood purification specialized nursing teaching have gradually increased. This article provides an overview of the application of smart teaching mode in blood purification specialized nursing teaching both domestically and internationally, and introduces the integration of online and offline smart teaching mode, in order to provide a theoretical basis for improving the quality of blood purification specialized nursing teaching.
End-stage renal disease is a late complication of chronic kidney disease (CKD) and one of the leading causes of high mortality worldwide. Over the years, the impacts of gut microbiota and their associated uremic toxins on kidney diseases through the intricate “gut-kidney axis” have been extensively studied. However, translation of microbiome-related omics results into specific mechanisms is still a significant challenge. In this paper, we review the interaction between gut microbiome and blood purification, as well as the current microbiota-based therapies in CKD. Additionally, the current sequencing technologies and progresses in the gut microbiome research are also discussed.
Blood purification, as a critical medical intervention for renal function replacement, metabolic waste clearance, and homeostasis maintenance, relies heavily on the optimization of therapeutic solutions to ensure clinical efficacy. In recent years, significant advancements have been made in the formulation design, biocompatibility, and clinical outcomes of blood purification solutions, driven by progress in clinical medicine and biomedical engineering. This article systematically elaborates on the latest research developments in key therapeutic solutions, including continuous renal replacement therapy replacement fluids, hemodialysis dialysate, hemodialysis catheter lock solutions, and peritoneal dialysate. By synthesizing current evidence, the aim is to offer scientific guidance for clinicians in selecting optimal treatment regimens while exploring future directions and emerging trends in the development of blood purification solutions.
Sepsis is a common clinical critical illness, which often leads to multiple organ damage including the kidney damage, which is difficult to treat and has a high mortality rate. In recent years, extracorporeal blood purification therapy has made some progress in the field of sepsis. There are a variety of blood purification modes to choose, but there is still no unified standard for the initiation timing of blood purification therapy. Clinicians mainly evaluate the indicators and the initiation timing of blood purification therapy according to the patient’s needs for renal function replacement and/or inflammatory mediator clearance. This article mainly summarizes and discusses the initiation timing of blood purification therapy in sepsis.
Blood purification is not only an effective treatment for patients with acute and chronic renal failure, but also plays an important role in the rescue of various critically ill patients. The current blood purification devices is relatively bulky and not suitable for use in daily life and disaster rescue sites. Portable blood purification devices can be divided into portable artificial kidney, wearable artificial kidney, implantable artificial kidneys and mobile continuous renal replacement therapy machine, which have not yet been widely applied in clinical practice. In recent years, with the advancement of materials science and computer science, efficient regeneration of dialysate and intelligent operation of equipment have become possible, and portable blood purification devices is also expected to experience rapid development. This article briefly reviews the development history and future research directions of portable blood purification devices.
In recent years, Regional citrate anticoagulation (RCA) technology has been widely used not only in adult blood purification, but also in children’s blood purification, and its advantages in patients with high bleeding risk, active bleeding and heparin-induced thrombocytopenia have been repeatedly confirmed. Therefore, this article reviews and analyzes the application of RCA in different blood purification modes at home and abroad in recent years. It is found that its anticoagulation is not only safe and effective, but also can prolong the life of filter and reduce bleeding complications, which is suitable for the practice of blood purification.
ObjectiveTo investigate the therapeutic effect of B ultrasound-guided percutaneous catheter drainage combined with veno-venous hemofiltration at different time points and multi-site in treatment of hyperlipidemic severe acute pancreatitis (HL-SAP). MethodsThe clinical data of 34 patients with HL-SAP initially underwent B ultrasound-guided percutaneous catheter drainage combined with veno-venous hemofiltration at different time points and multi-site from January 2010 to June 2014 were retrospectively analyzed. According to the different of the onset to treatment time, 34 cases were divided into the≤24 h group and > 24 h group. The serum platelet activating factor (PAF) and triglyceride (TG) at the time of admission and after admission 1, 3, 5, 7, and 10 days were detected, and the hospitalization time, mortality, and the rate of conversion to open surgery were observed. ResultsThe levels of PAF and TG in the both groups tended to gradually decrease with different degrees, were significantly lower than that the before treatment (P < 0.05), and the decline of PAF and TG in≤24 h group were more significant than > 24 h group. The hospitalization time, mortality, and the rate of conversion to open surgery in the≤24 h group were significantly lower than those of the > 24 h group (P < 0.05). ConclusionThe early using of B ultrasound-guided percutaneous catheter drainage combined with veno-venous hemofiltration at different time points and multi-site would have a beneficial impact on the management of HL-SAP and complications.