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中医治疗慢性肾衰57例的临床研究
慢性肾功能不全(CRF为多种肾脏疾病的终结局,治疗棘手,预后较差.我们运用中医辨证治疗57例CRF患者,获得较为满意的疗效,并检测了血SCr、BUN、血浆中TNFα、sTNF αR的水平,发现其变化与中医辨证分型有一定的内在联系,现报道如下.
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下瘀血汤对5/6肾切除大鼠肾功能的影响
慢性肾衰竭(chronic renal failure,CRF)是由多种病因引起的肾脏功能慢性进行性毁损所引起的临床综合征,严重危害人民健康,预后极差.随着血液透析、肾脏移植等治疗手段的应用和发展,终末期肾衰的疗效已显著提高,但因价格昂贵、肾源缺乏等因素影响临床推广.
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Objective: To investigate the effect of Chinese drugs (CD) that invigorate Spleen to remove Dampness and activate the blood circulation to eliminate Turbid for retarding progression of chronic renal failure (CRF). Methods: Thirty-nine patients with CRF were divided into two groups at random: the 18 patients in group A (the control group) were treated with low protein diet and controlling blood pressure and 21 patients in group B (the treatment group) were treated similarly with that of the control group and additional CD. Levels of serous creatinine (SCr), blood urea nitrogen (BUN), blood albumin (Alb), total cholesterol (TC), triglyceride (TG), high-density lipoprotein (HDL) and hemoglobin (Hb) were checked every two months and the rate of progression of CRF was estimated by slope of the creatinine reciprocal (1/SCr) with time (months). Results: Levels of SCr and BUN in group B were lower and HDL higher than those in group A significantly, P<0.05. Mean slopes of the creatinine reciprocal with time in the two groups were markedly different, P<0.01. Conclusion: Additional CD treatment based upon the low protein diet and controlling blood pressure could retard the rate of progression of CRF evidently.
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Objective: To investigate the clinical effect of Xinqingning (XQN), a preparation of rhubarb, combined with low dose continuous gastrointestinal dialysis in treating uremia. Methods: Patients of uremia were divided into three groups at random, 18 patients in group A were treated with 1000 ml gastrointestinal dialysate (non-absorbed mannitol solution) orally 2-3 times a day, 20 patients in group B treated with the same therapy as that in group A, also combined with XQN 5-10 tablets 3 times per day and 19 patients in group C treated with orally taken coated aldehyde oxystarch 5-10 g, 3 times a day. The therapeutic course for the three groups was 11 months. The changes in clinical manifestation, renal function, nutritional condition, and electrolytes before and after treatment were observed. Results: After treatment, significant improvement was revealed in aspects of uremic symptoms, quality of life, nutritional condition, serum creatinine, urea nitrogen, serum phosphate, uric acid, CO2 combining power, creatine clearance, body weight and arm muscular circumference in group A and B, as compared with those in group C. In comparison of group A with B, group B showed a lower serum triglyceride and a slower progression of chronic renal failure (CRF). All the criteria were not improved in group C and with serum creatinine being raised significantly. Conclusion: XQN combined with low dose continuous gastrointestinal dialysis therapy was definitely effective in treating uremia. It provides a new therapeutic means of non-replacement therapy for CRF with uremia.
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Objective: To explore the protective effect of Baoyuan Qiangshen Capsule No. Ⅱ (BYQS) and its mechanism in treating chronic renal failure (CRF). Methods: Sixty CRF patients were divided into 2 groups randomly, the treated group used BYQS combined with Lotensin and the control group administered with essential amino acid combined with Lotensin. Changes of renal functions and tubular labelled proteins were observed. Results: The markedly effective rate and total effective rate of the treated group were 63.3% and 93.3% respectively, and those of the control group were 30.0% and 56.7% respectively, the effect of the treated group was obviously better than that of the control group (P<0.01). In the treated group after medication, blood urea nitrogen, serum creatinine and clearance rate of creatinine were improved significantly (P<0.01), while Tamm-Horfau protein increased significantly (P<0.01). Conclusion: BYQS could alleviate tubular interstitial injury significantly so as to improve the renal function and enhance the effective rate in treating CRF.
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The therapeutic effects of Shenshuailing Kou Fu Ye (SKFY肾衰灵口服液, the Oral Liquid for Renal Failure) and Shenshuailing Guan Chang Ye (SGCY肾衰灵灌肠液, the Enema for Renal Failure) were evaluated in treatment of chronic renal failure, with coateg aldehyde oxystarch as the controls. The changes in the clinical symptoms, serum creatinine, blood urea nitrogen and creatinine clearance rate were observed. The total effective rate in the former was 90.46%, and the latter 60.43%.
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慢性肾衰时蛋白质和氨基酸代谢的研究
慢性肾功能不全患者普遍存在蛋白质/氨基酸代谢异常 .其可能机制和影响因素主要包括厌食、低蛋白饮食及对低蛋白饮食适应性的损伤、酸中毒、激素抵抗、能量代谢的异常、细胞因子的异常及支链氨基酸代谢异常等.目前营养和药物治疗包括低蛋白饮食并补充酮酸/氨基酸制剂,使用影响蛋白质/氨基酸代谢的药物生长激素、重组人促红细胞生成素和磷酸二酯酶抑制剂Pentoxifylline和Amrinone等.
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胰岛素样生长因子-1对慢性肾功能不全大鼠骨骼肌蛋白质合成与分解的影响
目的探讨胰岛素样生长因子(IGF-1),在CRF大鼠及配对喂养的假手术(ShamOperated,SO)对照组大鼠骨骼肌蛋白质代谢上的作用.方法从两组大鼠血清和骨骼肌中提取IGF-1,用放射免疫分析法测定血清及骨骼肌中的IGF-1水平;用荧光测定法检测肱骨内上髁肌培养液中总酪氨酸的浓度,进而计算基础蛋白合成率及分解率.通过剂量反应试验,观察不同浓度重组人类胰岛素样生长因子-1(rhIGF-1)对骨骼肌蛋白质合成与分解的影响.结果CRF大鼠血清IGF-1浓度显著低于SO对照大鼠(170.3±16.4比410.4±49.3ng/ml),骨骼肌IGF-1含量也明显低于SO组(4.22±1.03比6.93±1.4lng/g),P值均<0.001.CRF组大鼠肱骨内上髁肌的基础蛋白合成串(24.0±2.1nmol酪氨酸·g肌肉-1·h-1)比SO组(30.8±2.4nmol酪氨酸·g肌肉-1·h-1)低22%,P<0.05.而基础蛋白分解率则比SO组高78%(234.4±13.8比131.7±8.4nmol酪氨酸·g肌肉-1.h-1,P<0.001.剂量反应试验发现,rhlGF-1对CRF大鼠骨骼肌蛋白质合成和分解的作用明显低于SO大鼠.浓度为25-500ng/ml的rhlGF-1对CRF大鼠蛋白质合成的促进作用仅为SO大鼠的25%~44%,对蛋白质分解的抑制作用仅为对照组的15%~42%.说明CRF大鼠骨骼肌对rhlGF-1促进蛋白质合成代谢的反应性降低.结论CRF时血清及骨骼肌的IGF-1含量减少,骨骼肌对IGF-1促进蛋白质合成代谢的作用存在抵抗,这些可能是CRF患者骨骼肌蛋白质合成减少、分解增强,进而导致营养不良、肌肉萎缩的主要原因.
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慢性肾衰竭患者血浆脑钠肽水平与心功能的关系研究进展
钠尿肽类激素主要分3种:①心房钠(ANP):由心房细胞分泌,应激反应为心房膨胀;②脑钠肽或称B型钠尿肽(BNP):由心室肌细胞分泌,应激反应为心室膨胀;③血管钠尿肽(CNP):由内皮细胞分泌,应激反应为内皮细胞坏死.
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Improvement of Cardiac Function by Dry Weight Optimization Based on Interdialysis Inferior Vena Caval Diameter(2)
Among 306 HD patients,31 fluid overloaded patients(IVCe>16mm) with a reduced EF (EF<55%) were chosen for DW optimization(WTBZTable 1).The etiology of chronic renal failure in these patients was as follows:chronic glomerulonephritis 24,diabetic nephropathy 5,lupus nephritis 1,and polycystic kidney 1. No β-blockers were used during the study period.In these patients,DW was reduced to achieve an interdialytic IVCe<16mm.
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近期欧美肾性贫血诊疗指南的解读与思考
2004年欧洲发布了<欧洲慢性肾衰竭患者贫血治疗佳实践指南>(European Best Practice Guidelines for the Management of Anemia in Patients with Chronic Renal Failure,EBPG)[1],这是欧洲肾脏病学会及欧洲透析移植学会(ERA-EDTA)于1999年发布第一版指南后的修订版.
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小儿慢性肾衰竭的心血管并发症及干预措施
慢性肾衰竭(CRF)可导致全身各系统功能紊乱,心血管病变是CRF常见的并发症,也是CRF患儿死亡的主要原因.Kristian[1]认为在维持性透析患儿中,约80%合并心血管并发症,半数以上死于心血管并发症.上海地区从1998~2000年做了CRF合并心血管并发症的调查,结果86.0%有各种类型心血管并发症,44.2%死于心血管并发症[2].Agarwal[3]报告249例儿童CRF,62例死于心血管并发症(24.5%).我院总结31例CRF,7例(22.6%)合并心血管并发症,2例死亡.目前国内儿科对CRF心血管并发症的认识尚有待提高,本文介绍这些并发症的发病机制,提出早期干预,旨在减少病死率,提高CRF患儿的生存质量.
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从病理生理学探讨儿童慢性肾衰竭的营养、感染和骨代谢的一些问题
慢性肾衰竭(CRF) 是各种原因引起的肾脏损害并进行性恶化,病情发展至晚期所出现的一系列临床综合征.各种血液净化疗法及肾移植是治疗该病的重要手段.但上述两种治疗方法需支付高额医疗费用, 且不能解决该病的早、中期的防治问题.
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中西医结合治疗慢性肾衰的临床观察
目的 观察中西医结合治疗慢性肾衰的临床效果.方法 采用中成药百令胶囊及中药灌汤配合优质低蛋白低磷饮食,口服降压药如伲福达或/和倍他乐克及维生素C、维生素B6、叶酸、硝酸亚铁、皮下注射生血素治疗,为分治疗组和对照组对比观察及治疗组和对照组治疗前后血生化的变化各自对比观察.结果 治疗组总有效率90.0%,对照组总有效率70.8%,两组有显著性差异;治疗组治疗前后各生化指标变化有显著性差异,对照组治疗前后各生化指标变化无显著性差异.结论 中西医结合治疗慢性肾衰临床疗效理想.
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彩色多普勒对尿毒症病人肾脏的观察与研究
本文对南方医院既往住院病人中慢性肾功能衰竭尿毒症期患者233人的466只肾脏的彩超检查结果进行回顾性分析,发现尿毒症病人肾脏的改变显著,并且肾脏的血液供应亦有明显改变.
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中药保留灌肠治疗慢性肾衰竭的护理
慢性肾衰竭(CRF)是多种原因造成的肾小球滤过率下降,导致代谢废物不能排除所引起的综合征[1].中药灌肠是使药物在结肠内发挥作用,排除体内的毒素以达到治疗的目的.用中药保留灌肠能促进血液及肠管周围组织向肠腔中分泌代谢产物,并排出体外,从而减少了氮质潴留,减轻了健存肾单位的负担,是一种治疗慢性肾衰竭的有效方法[2].我院2006年1月-2008年6月采用保留灌肠法结合西医治疗慢性肾衰病人60例,效果较好.现介绍如下.
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结肠透析联合中药灌肠治疗慢性肾衰竭合并高尿酸血症病人效果观察
肾衰竭(CRF)已经成为威胁公众健康的主要疾病之一.由于肾功能受损,导致尿酸等多种代谢产物蓄积,进一步加重肾脏损伤;改善病人的高尿酸血症,将有助于延缓CRF的进程[1].我院采取结肠透析联合中药灌肠治疗CRF合并高尿酸血症病人,取得了较好的疗效.现报告如下.
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慢性肾功能不全病人夜间收缩压负荷增加原因分析及护理
50%以上慢性肾功能不全病人死于心血管并发症,其中绝大多数病人血压升高,收缩压与舒张压均上升[1].了解其血压昼夜节律,有针对性地加强预防和护理,可有效地控制或缓解心血管并发症.现对20例慢性肾功能不全病人与45例II期高血压病人行24h动态血压监测,分析肾功能不全病人夜间心脏收缩负荷增加的原因,并提出预防护理措施.
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慢性肾衰竭病人的中药治疗及护理
慢性肾衰竭是肾脏疾病的终末期,中药对其有一定的疗效.我院2000年-2003年用中药灌肠配合西医对症治疗部分慢性肾衰竭病人,收到一定效果.现介绍如下.
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点滴式中药保留灌肠法治疗慢性肾衰竭的临床观察及护理
慢性肾功能不全是多种慢性肾脏疾病晚期出现的严重综合征候群,临床治疗难度大、预后差.当临床出现代谢功能失调,表现出代谢产物潴留、水电解质、酸碱失衡及全身各系统症状,则处于危及生命的急危重状态.因此,保护肾功能,提高临床治疗效果,延缓病情进展,一直是肾病治疗领域的焦点.我院2005年1月-2007年1月采用点滴式中药保留灌肠法治疗慢性肾衰竭病人96例取得较好效果,且无任何副反应.现将护理报告如下.