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Development of Liver Transplantation of Severe Hepatitis

急性肾功能衰竭预后相关因素分析

【摘要】目的 探讨急性肾功能衰竭(ARF)的年龄分布、病因、临床类型、治疗对策和预后。 方法 2003年1月-2009年10月住院ARF患者266例,将临床资料进行回顾性分析。 结果 ＜15岁者4例,无死亡；15～39岁66例,死亡2例；40～59岁91例,死亡13例；＞60岁者105例,死亡33例。肾前性113例,死亡36例,肾实质性139例,死亡12例,肾后性14例,无死亡。少尿型101例,死亡22例；非少尿型165例,死亡26例。接受血液净化治疗107例,死亡18例；激素或免疫抑制剂治疗者67例,死亡9例；对症治疗92例,死亡21例。 结论 随年龄增加ARF患病率增加,病死率亦增加； 肾实质性ARF居首位,其次为肾前性；少尿型病死率高于非少尿型,血液净化可降低病死率,明确病理类型,及时激素或免疫抑制剂治疗,可改善预后。

腹膜透析治疗小儿心脏手术后并发急性肾功能衰竭

目的 总结腹膜透析（PD）治疗小儿心脏手术后并发急性肾功能衰竭(ARF)的临床经验。 方法 27例ARF患者，年龄3个月～12岁（4.20±3.58岁）；体重4.2～30.0 kg（12.35±7.65 kg）。因心脏手术后发生ARF进行PD。动态监测血气分析、电解质、血清肌酐(Cr)、尿素氮（BUN）、平均动脉压（MAP）和中心静脉压（CVP）的变化。 结果 PD后 5d Cr、BUN与PD前比较明显下降（Plt;0.01），血钾、血钠、碳酸氢根（HCO3-）恢复正常。术后死亡8例（29.6%），死于低心排血量3例，感染并发多器官功能衰竭3例，恶性心律失常1例，肺动脉高压危象1例。发生并发症9例（33.3%），其中管周漏液3例，腹膜炎3例，透析管堵塞3例（其中感染堵塞1例、大网膜堵塞2例）。 结论 小儿心脏手术后ARF早期行PD疗效肯定、安全，操作方便，可降低死亡率。

急性生理改变与慢性健康评估综合评分系统在预测急性肾功能衰竭患者预后中的应用

目的　探讨急性生理改变与慢性健康评估综合评分系统（APACHEⅡ）在预测急性肾功能衰竭患者预后中的应用。 方法　对2007年1月－2009年10月重症医学科（ICU）诊断为急性肾功能衰竭的50例患者行APACHEⅡ评分，并就APACHEⅡ评分值与病死率、死亡风险间的关系进行分析。 结果　6～16分段病死率21.9%，死亡风险8.43 ± 9.15；17～26分段病死率65.0%，死亡风险22.64 ± 16.32；27～36分段病死率70.6%，死亡风险48.93 ± 26.53；37～46分段病死率100.0%，死亡风险77.42 ± 23.18；其中17～36分段占74.0%，随着APACHEⅡ评分升高， 死亡风险及病死率随之升高，并且呈正相关。 结论　APACHEⅡ是一种较好的疾病严重度分类系统，对于判断急性肾功能衰竭患者预后有较重要的价值。

糖尿病酮症酸中毒横纹肌溶解致急性肾功能衰竭一例

【摘要】 目的 报道糖尿病酮症酸中毒（DKA）横纹肌溶解（RM）并致急性肾功能衰竭的临床诊治经验。〖HTH〗方法〖HTSS〗 2009年10月8日收治1例DKA患者,病程中出现意识障碍、RM、急性肾功能衰竭，行连续性血液净化治疗。结果 48 h后患者意识障碍恢复,血肌酸激酶下降,酸中毒纠正,治疗效果显著。结论 提高对DKA患者发生RM的认识和常规肌酶谱的动态监测,做好早期诊断以及预防极其重要,是RM合并急性肾损伤(AKI)治疗的关键,有利于提高糖尿病患者的生存率。

创伤性主动脉夹层并发肾功能衰竭一例

Analysis of Etiological Factor for 139 Cases of Acute Renal Failure

目的:探讨住院患者急性肾功能衰竭(ARF)的临床病因方法:回顾性分析139例ARF患者的临床资料,探讨其病因、肾衰类型及危险因素。结果:139例ARF患者中,肾前性90例,肾性37例,肾后性12例。其中,60岁以上的老年人73例,占52.5%。引起ARF的根本病因中,感染、心衰及创伤为引起ARF的主要病因。结论:注意有效血容量不足的症状及体征、及时扩容及控制感染可以减少ARF的发生。同时,60岁以上老年人仍是高危人群,应重在预防。

A Randomized Controlled Trial of Reduced Glutathione in the Treatment of Acute Renal Failure

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.

Application of the Clinical Score Developed by Cleveland University to Predict Acute Renal Failure after Cardiac Surgery in Chinese Patients

Abstract: Objective To investigate the application value of the Clinical Score developed by Cleveland University in predicting the occurrence ratio of acute renal failure in Chinese patients after cardiac surgery. Methods A total of 456 adult patients , 230 males and 226 females , with cardiac surgery during August 2008 to July 2009 were included in our study. Their age ranged from 18 to 88 years with an average age of 56.7 years. Before the surgery, Clinical Score was used to predict acute renal failure after cardiac surgery. Based on the score of ≤5, 610, or ≥11, the patients were divided into group Ⅰ (n=401), group Ⅱ (n=42) and group Ⅲ (n=13). The occurrence rate of acute kidney injury (AKI), continuous renal replacement therapy in hospital, multiple organ failure, mortality and other clinical indexes were compared among the 3 groups. Results Occurrence ratio of AKI of group Ⅰ, Ⅱ, Ⅲ was respectively 2.74%, 28.57% and 76.92% (χ2=73.004, P=0.000). Continuous renal replacement therapy rate was respectively 0.50%, 9.52%, and 38.46% (χ2=36.939, P=0.000). Multiple organ failure rate was respectively 0.50%, 4.76%, and 23.08% (χ2=19.694, P=0.000). Mortality rate was respectively 0.25%, 2.38%, and 15.38% (χ2=14.061, P=0.001). There were significant differences among the three groups. Conclusion The Clinical Score to Predict Acute Renal Failure developed by Cleveland University can effectively predict the occurrence rate of acute renal failure in the Chinese patients after cardiac surgery before the operation. Therefore, corresponding preventive methods can be taken for highrisk patients.

成人心内直视手术后急性肾功能衰竭的治疗

目的　探讨体外循环心脏手术后发生急性肾功能衰竭的治疗方法及疗效。 方法　回顾性分析2011年1月至2012年7月福建医科大学附属协和医院33例行体外循环心脏手术后发生急性肾功能衰竭患者的临床资料，其中男21例，女12例；年龄25～67 （45.21±7.27） 岁。28例采用床旁连续肾脏替代疗法治疗，5例采用腹膜透析联合间歇床旁连续肾脏替代疗法治疗。对比分析经两种治疗方法患者治疗前、后的尿量、尿素氮、血肌酐、血钾和平均动脉压的变化。 结果　33例患者经床旁连续肾脏替代疗法或腹膜透析联合间歇床旁连续肾脏替代疗法治疗后血钾、血肌酐和尿素氮较治疗前明显降低，平均动脉压治疗6 h后较治疗前升高（P＜0.05）。围术期死亡9例，死亡率为27.27%，主要死亡原因为多器官功能衰竭、重症肺部感染合并气道出血、恶性心律失常和消化道出血等。24例患者于治疗后5～14 d尿量恢复正常，肾功能指标正常。随访24例，随访3个月，复查肾功能各项指标均正常。 结论　床旁连续肾脏替代疗法治疗心脏手术后急性肾功能衰竭可获得满意的治疗效果，但应监测电解质及出凝血情况。对有出血倾向及血小板减少症患者采用腹膜透析联合间歇床旁连续肾脏替代治疗，也可获得良好的疗效。