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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。

The Effect of Simvastatin in Patient with Chronic Renal Insufficiency MOU Hong,CHEN Tong,HE Long

目的：研究羟甲戊二酰辅酶A还原酶抑制剂辛伐他汀治疗慢性肾功能不全的临床疗效。方法：选择慢性肾功能衰竭患者共40例，随机分成两组，在原有基础治疗上治疗组20例患者予以辛伐他汀治疗，对照组20例单纯以基础治疗，在24周时监测TC、TG、24 h尿蛋白、Scr、BUN、C-反应蛋白的值。结果：与治疗前相比，两组TC、TG、24 h尿蛋白、Scr、BUN、C-反应蛋白均明显下降，与对照组相比，治疗组血脂有显著下降（P＜0.01）而且24h尿蛋白、Scr、BUN、C-反应蛋白均明显下降(P＜0.05)。结论：辛伐他汀能降低蛋白尿，延缓慢性肾功能不全的进展

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。

创伤性主动脉夹层并发肾功能衰竭一例

Hepatic and Renal Insufficiency Induced by Intravenous Injection with Amiodarone: A Case Report and Literature Review

【摘要】　目的　报道1例静脉滴注胺碘酮致肝肾功能不全患者。　方法　2010年10月收治1例扩张性心肌病患者，治疗过程中使用胺碘酮注射液，导致严重的肝肾功能不全。系统查阅中国期刊全文数据库及外文数据库Pubmed、Embase建库至2011年8月关于胺碘酮致肝肾功能不全的相关文献，进行静脉胺碘酮致肝肾功能不全的可能性评估，探索胺碘酮静脉滴注致肝功能不全的的作用机制。　结果　根据查阅文献结果分析，此患者静脉注射胺碘酮致肝功不全的可能性高，Naranjo概率评分分别为7分。　结论　提出临床医师和临床药师应进行胺碘酮静脉的药学监护，高度的重视胺碘酮相关的不良反应，从而及时识别和防治胺碘酮所致肝肾功能不全，减少其不良预后。【Abstract】　Objective　To report a case of hepatic and renal insufficiency induced by intravenous injection with amiodarone, and to evaluate the possibility of the adverse drug reaction.　Methods　A patient with dilated cardiomyopathy was admitted in October, 2010. During the procedure, the use of amiodarone hydrochloride injection made the patient suffer from liver and kidney dysfunction. We retrieved the literatures about liver and kidney toxicity of amiodarone from CNKI, Pubmed, and Embase (from the establishment of the databases to November 2011). We also ssessed the possibility of the adverse drug reaction, discussed the mechanism of amiodarone-induced hepatic insufficiency.　Results　According to the literature, There was a great possibility of hepatic insufficiency induced by amiodarone, and the total score of the Naranjo probability score was 7.　Conclusion　It is important to pay more attention to the pharmaceutical care of amidarone to timely recognize and effectively prevent or treat hepatic and renal insufficiency induced by intravenous injection with amiodarone.

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.

The research and application advances of medical imaging techniques in early renal function assessment of chronic kidney disease

Chronic kidney disease (CKD) is now recognized as a worldwide public health challenge, and the incidence rate and hospitalization rate have significantly increased in recent years. Without prompt diagnoses and effective treatment in the early renal function damage of CKD, the symptoms will continue to worsen and eventually develop into end-stage renal disease. Functional imaging techniques such as single photon emission computed tomography (SPECT), contrast-enhanced ultrasound (CEUS), computerized tomography perfusion (CTP), and magnetic resonance perfusion weighted imaging (MR-PWI) could be used to quantitatively analyze renal perfusion and renal filtration function. Their diagnostic values are increasingly evident and have become the research hotspot in evaluating renal function. The aim of this review is to briefly evaluate the research and application advances in the early renal function damage assessment of CKD, so as to raise the efficiency of clinical applications.