糖尿病对动静脉内瘘成熟影响的临床研究

目的 探讨糖尿病对终末期肾病(end Stage Renal Disease,ESRD)患者动静脉内瘘(arteriovenous Fistula,AVF)术后3个月时成熟的影响.方法 选择北京市海淀医院就诊的ESRD患者,按照是否合并糖尿病分组,综合评估后确定手术方案并建立AVF.术后3个月应用超声复查内瘘,结合物理检查判断AVF成熟情况.结果 研究共纳入118例患者,观察组AVF成熟率明显低于对照组,差异有统计学意义(72.0％比95.6％,x2=13.001,P＜0.001);观察组血管钙化发生率明显高于对照组,差异有统计学意义(x2=5.002,P=0.025);单因素Logistic回归分析显示,糖尿病(OR 8.426,95％ CI 2.270～31.283,P=0.001)和桡动脉内径＜1.5mm(0R6.257,95％ CI 2.020～19.381,P=0.001)影响AVF成熟,差异有统计学意义;多因素二元Logistic回归分析显示,糖尿病(OR 9.086,95％ CI 2.302～35.866,P=0.002)和桡动脉内径＜1.5mm(OR 6.789,95％ CI 2.022,P=0.002)是AVF不成熟率增加的独立危险因素.结论 糖尿病和桡动脉内径＜1.5mm影响AVF成熟,是AVF不成熟率增加的独立危险因素.

We have previously reported that the diameter of the inferior vena cava(IVC) reflects the amount of body fluid in hemodialyzed (HD) patients. The present study was undertaken to depict the criteria of IVC diameters for determining dry weight (DW) in anuric HD patients. In healthy subjects, the maximal diameters during quiet expiration (IVCe) and the minimal diameters during quiet inspiration (IVCi) were (16.7±3.2) and (5.7±5.4)mm,respectively (mean±SD).The collapsibility index (CI,1-IVCi/IVCe), which inversely correlates with the central venous pressure,was 0.68±0.29. In anuric HD patients,the IVCe/CI values before and after HD were 14.9±3.2/0.68±0.24 and 8.2±2.3/0.94±0.09, respectively. IVCe decreased proportionally to the amount of ultrafiltration. In HD patients with hypervolemic pulmonary edema, the IVCe and CI values were 22.4±2.9 and 0.22±0.11, respectively. We proposed that IVCe/CI after HD is (8±3)mm/0.9 ± 0.1 as the markers of DW in anuric HD patients and that an IVCe value≥22mm together with a CI≤0.22 implies the warning level of body fluid retention.

INTRODUCTIONA newly discovered DNA virus,transfusion transmitted virus (TTV), was reported as a cause of post-transfusion hepatitis of unknown etiology in Japan[1]. In order to investigate TTV prevalence in southern China, a study was carried out among blood donors, patients with liver diseases and hemodialysis to determine the epidemiological charateristics.

Objective:To analyze the influence of hemoperfusion combined with hemodialysis on serum inflammatory factors, homocysteine (Hcy), parathyroid hormone (PTH) andβ2microglobulin (β2-MG) and other indexes in patients with chronic renal failure.Methods:94 cases with chronic renal failure from December 2013 to January 2015 in our hospital were randomly divided into two groups, according to the order of treatment. The control group of 47 patients with regular hemodialysis treatment, the observation group of 47 cases with blood perfusion combined with hemodialysis treatment. The serum interleukin-1 (IL-1), interleukin-6 (IL-6), tumor necrosis factorβ (TNF-β), high sensitive C reactive protein (hs-CRP), phosphorus (P), Hcy, PTH, BUN,β2-MG and Scr indexes of two groups of patients before and after treatment were detected.Results:After treatment, serum IL-1, IL-6, TNF-β and hs-CRP levels of observation group were (1.72±0.16) ng/L, (12.38±1.67) ng/L, (1.26±0.31) mg/L, (6.78±1.42) ng/mL, were significantly decreased compared with the group before treatmentand control group after treatment (P<0.05). After treatment, serum PTH, Hcy and P levels of observation group were (24.53±4.82) μmol/L, (21.65±2.38) pmol/L, (1.50±0.29) mmol/L, were significantly decreased compared with the group before treatment and control group after treatment (P<0.05). After treatment,β2-MG, BUN, Scr levels of observation group were (1.92±0.26) mg/L,(6.76±1.23) mmol/L, (410.62±13.20) μmol/L, were significantly decreased compared with the group before treatment and control group after treatment. The skin itching relieving rate of observation group was 91.49% (43/47) was significantly higher than the control groups’ 59.57% (19/47), the differences were statistically significant.Conclusion:The curative effect of blood perfusion combined with hemodialysis in the treatment of chronic renal failure is significant, can effectively reduce the serum level of inflammatory factors, can clean out Hcy, PTH,β2-MG significantly, and can effectively improve renal function and skin itching symptoms, is worthy of clinical popularization and application.

Application of nursing sensitive indicators in improving the quality of hemodialysis

To explore the application value of hemodialysis-related nursing sensitive indicators in improving the quality of hemodialysis.Methods Totally 40 outpatients undergoing dialysis treatment from January 2016 to December 2016 served as observation group.Another 40 outpatients who received dialysis from January 2015 to December 2015were selected as control group.Patients in control group received routine nursing and health education on hemodialysis,and those in observation group were given interventions based on nursing sensitive indicators.The hemodialysis-related nursing sensitive indicators and satisfactory degree of patients on nursing service were compared between two groups.Results Observation group had a better outcome of hemodialysis nursing sensitive indicators compared with control group (observation group:Kt/V [1.30 ±0.06],Hib [115.0 ±4.8] g/L,serum Ca [2.31 ±0.06] mmoL/L,serum P [1.75 ±0.18]mmoL/L,product of Ca and P [30.95 ± 0.58] mg2/dl,PTH [305 ± 65] pg/mL.control group:Kt/V [1.18 ±0.07],Hb [99.0 ±5.2] g/L,serum Ca[2.52 ±0.07] mmoL/L,serum P [2.07 ± 0.21] mmoL/L,product of Ca and P [39.75 ±0.74] mg2/dl,PTH [420 ± 84]pg/mL.P ＜ 0.05 respectively.) The satisfactory degree of patients on nursing service was 97.5％ (39/40) in observation group and 80.0％ (32/40) in the control group,with a significant difference (P ＜ 0.05).Conclusion Hemodialysis-related nursing sensitive indicators provide a scientific basis for nursing quality improvement in patients with hemodialysis,and also play a certain role in promoting high quality nursing service.