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中医治疗慢性肾衰的思考
慢性肾功能衰竭(CRF)属于世界性的难治病.之所以难治,关键在于其复杂,致病原因复杂、发病机理复杂、临床表现复杂、发展变化也复杂.对于复杂性的难治病,如何发挥中医的优势、突出中医的特色,就显得格外重要.
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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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To explore the therapeutic effect and mechanism of Bushen Huoxue Xiezhuo Decoction (BHXD) in treating minute lesion nephropathy (MLN) in rats. Methods: The MLN model rats established by a single intravenous injection of Adriamycin were divided into the model and the BHXD groups, and a normal group was set up for control. The effects of treatment on renal function, hemorrheologic parameters, renal tissue transforming growth factor β1 (TGF-β1) expression and poly-anion sites on glomerular basement membrane were observed dynamically. Results: After treatment, all the parameters between the BHXD group and the model group were significantly different respectively, morphological observation also showed the pathological changes in the BHXD group were milder than those in the model group. Conclusion: BHXD treatment could markedly improve the renal function, alleviate blood hypercoagulability and hyperviscosity, protect the anion barrier and delay the progression of glomerular fibrosis and sclerosis.
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中医药对透析患者残余肾功能的影响
残余肾功能(residual renal function,RRF)是指尿毒症患者健存肾单位所承担的清除体内小分子及中大分子物质、调节水电解质酸碱平衡以及部分内分泌功能~([1]).近年来的研究表明,RRF对透析患者,尤其是腹透患者的生存率与生活质量起着非常重要的作用,采取有效措施大限度地保护透析患者的RRF受到极大的关注.本文在讨论透析患者RRF作用的基础上,对发挥中医药治疗优势保护RRF的对策及相关研究综述如下.
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延肾1号冲剂对血液透析患者残余肾功能的影响
血液透析是尿毒症患者常用的肾功能替代治疗方法,但血液透析并不能保护残余肾功能(residual renal function, RRF),相反却能加速其丢失,从而影响透析质量,增加透析次数.近年来,我们根据中医理论,结合临床实践,研制了具有保护残余肾功能、增加毒素排泄的药物延肾1号冲剂,现将初步的临床观察报告如下.
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静脉营养及生长激素联合应用在外科危重病人的临床效果
目的研究静脉营养及生长激素联合应用在外科危重病人的临床效果.方法1998年1月~1999年12月,对16例外科危重病人应用静脉营养联合生长激素治疗.其中,多器官功能衰竭4例,胰腺癌术后3例,结肠癌术后4例,卵巢癌伴肠粘连1例,脑出血2例,急性坏死性胰腺炎1例,淋巴瘤术后1例.男:女=11:3,平均年龄65.86±12.4岁,生长激素4.5~8U/d,生长激素应用时间:8.07±4.5d.结果(1)16例患者中痊愈出院9例,7例因严重感染,多器官功能衰竭,呼吸衰竭死亡.(2)在14例肾功能正常组(血肌酐<115μmol/L),治疗前血浆BUN9.439±2.068μmol/L,治疗后BUN7.056±1.882μmol/L,二者差异有非常显著性(P<0.01).(3)2例肾功能不正常的病例,治疗前BUN分别为19.19及28.02μmol/L,治疗后为28.81及33.74μmol/L.(4)血浆总蛋白及白蛋白水平治疗前后差异无显著性(治疗前31.8±5.1g/L,治疗后32.47±6.43g/L,P>0.05).结论在肾功能正常的情况下,术后危重患者应用生长激素可以降低血浆尿素氮水平,其临床意义及机理有待于进一步研究探讨.
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肾动脉狭窄支架术对肾功能、血压的作用
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老年人肾功能评估的现状难点与展望
随着社会人口老龄化,老年人的肾脏问题日益引起人们的关注.由于老年人肾脏结构和功能的生理性变化,那些通常用来评价肾功能的方法并不完全适于这一群体.同时,老年人是发生肾损害的高危人群,只有早期诊断才有可能及时干预.因此,如何早期诊断老年患者的肾功能损害,已成为一个亟待解决的重要问题.
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Objective To study the effect of percutaneous renal artery intervention on renal function and blood pressure in patients with renal artery stenosis.
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厄贝沙坦治疗老年原发性高血压的疗效及对肾功能的影响
高血压是常见的心血管疾病,发病率逐年增高,可导致严重的心脑等靶器官损害.近年研究表明,28%的终末期肾病与高血压有关,因此对高血压早期肾功能损害的诊断及干预,是改善肾血流动力学、延缓肾功能损害的关键[1].目前公认血管紧张素转换酶抑制剂(ACEI)在有效降压同时对肾功能有保护作用,而血管紧张素Ⅱ受体拮抗剂(ARB)亦是肾功能衰竭时首选降压药物之一,但ARB对高血压病人早期肾损害的影响报道较少.本研究选用新型的ARB药物厄贝沙坦,并与依那普利进行比较,了解其对老年高血压病人的降压疗效及对肾功能的影响.
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Objective To evaluate postoperative renal function in children with congenital moderate or severe hydronephrosis. Methods 99m Tc-labeled diethylenetriaminepenta-acetic acid scintigraphy was performed in 50 children with unilateral moderate or severe hydronephrosis to determine postoperative renal function. We also analyzed the factors influencing renal function recovery. Results Average postoperative renal function in 50 cases was 40.62%±10.09%. Among them, 32% of patients had nearly normal renal function and differentiated renal function reached up to 45%. Average preoperative and postoperative renal function in 25 cases was 23.89%±11.65% and 39.33%±8.59% respectively and the increase of renal function was about 15.44%±11.18% (P=0.0003). Renal parenchyma thickness was negatively correlated with postoperative renal function (r=-0.62, P=0.0009). The follow-up period was positively correlated with postoperative renal function (r=0.58, P=0.0026). The patients'age had no correlation with renal function recovery (r=-0.05, P=0.80). Recovery of renal function in hydronephrosis with extrarenal pelvis was greater than that in hydronephrosis with intrarenal pelvis (P=0.016). Conclusions Postoperative renal function in children with moderate or severe hydronephrosis can recover to normal. Recovery of renal function was more obvious in hydronephrosis with thinner renal parenchyma, longer follow-up period and extrarenal pelvis.
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护理干预对降低脑卒中病人应用甘露醇致肾功能损害的对照研究
甘露醇作为临床使用多的渗透性利尿剂,在降低颅内压方面效果确切,成为治疗颅内高压的首选药物[1].但近几年来越来越多的文献资料表明,该药对肾脏的毒副反应可导致肾衰竭.为降低急性脑卒中病人应用甘露醇的副反应,自2001年5月-2003年12月,对86例住院病人实施护理干预,以确保病人输液安全.
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中药保留灌肠保留时间长短对肾功能影响的临床观察
中药保留灌肠治疗慢性肾衰竭疗效显著,教科书上认为中药在肠腔内保留1 h以上达到治疗目的[1].
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腹膜透析患者残余肾功能保护的研究进展
腹膜透析(peritoneaI dialysis,PD)作为常用的肾脏替代疗法,它对延长患者生命,提高患者生活质量有着明显的临床疗效.大量研究表明,PD对残余肾功能(residual renal function,RRF)的保护作用优于血液透析(hemodialysis,HD),并且认为PD应作为一线透析选择[1].
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透析患者中残肾功能保护的重要性及其策略
残肾功能(residual renal function,RRF)在慢性肾脏疾病(chronic kidney disease,CKD)患者中的重要性已为肾脏科医生所熟知.近年来研究表明,在透析患者,特别在腹膜透析(简称腹透)患者中,残肾功能尽管低,仍对患者整体健康发挥着重要的作用.本文旨在讨论残肾功能在透析患者中的重要性以及如何有效保护残肾功能.
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CKD患者残存肾功能的意义及保护策略
残存肾功能(residual renal function,RRF)是指肾组织受损后健存肾单位的残留功能,包括清除毒素、调节体内水电解质和酸碱平衡以及多种内分泌功能.2006年K/DOQI的RRF定义为:GFR≥5.0 ml·min-1·1.73 m-2,或尿量≥100 ml/d.对慢性肾脏病(CKD)患者,尤其是终末期肾病(ESRD)和进入透析治疗的患者而言,RRF的存在不仅可维持患者肾脏内分泌功能,保证体内体液平衡,并且在清除机体代谢产物方面起着重要的辅助作用.因此,维持或保护好RRF是保证CKD患者生存质量和生存率的一个重要的环节.
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肾移植病人的饮食康复治疗
Background:Now renal transplantation is extensively used and recetpted in the clinic for treating chronic renal failure.Nutrition support and diet treatment are necessary for postoperative rehabilitation of patients underwent renal transplantation.Rigid nutrition treatment could prevent and treatment postoperative diabetes mellitus,hypertension and hyperlipemia.Diet control was also necessary for patients receiving immunodepressant.Standards and protocol for diet treatment are unavailable now.The incidence of acute rejection and allograft failure during the first year posttransplantation has been greatly reduced by advances in operative techniques, immunosuppressive agents and our understanding of their toxicities, donor selection and preservation, and donor and patient management. However, life-long immunosuppression is required to prevent the development of chronic rejection. Thus, either chronic rejection or the adverse side effects of chronic immunosuppression limit long-term survival. There is increasing incidence that posttransplant lipoprotein abnormalities may contribute to the development of cardiovascular disease (CVD). CVD is one of the most common causes of morbidity and mortality following renal transplantation. In addition, there is some indirect evidence that posttransplant lipoprotein abnormalities may influence the progression of chronic transplant nephropathy. While there are no intervention trials examining whether antilipemic therapy is beneficial in the prevention of CVD in renal transplant patients, it is reasonable to assume that the benefits of treating hyperlipidemia in renal transplant recipients may be comparable to those found in the general population. Objective:Protocol for diet treatment was determined for patients underwent renal transplantation to reduce renal load,promote recovery of renal function,and decreased the incidence of complications.
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3种中药保留灌肠方法治疗慢性肾功能衰竭的疗效比较
中药保留灌肠治疗慢性肾功能衰竭是一种有效、经济、方便、实用的方法.临床实践发现,不同的灌肠方法对临床疗效有一定影响~([1]).2004年11月-2008年12月,本研究运用自拟大黄降浊汤,对120例慢性肾功能衰竭患者进行了传统保留灌肠方法、推注保留灌肠法与滴注保留灌肠方法灌肠效果的比较研究.现报道如下.
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腹膜透析患者残余肾功能的影响因素及保护策略
腹膜透析(peritoneal dialysis,PD)是治疗终末期肾病(end stage renal diseases,ESRD)的替代疗法之一.残余肾功能(residual renal function,RRF)是指肾组织受损后尚健存的清除及内分泌功能.有RRF的PD患者其残肾清除率明显高于无RRF患者,多项研究已做了相关报道.保护RRF能够有效的提高透析患者的生活质量.然而,随着腹膜透析时间的延长,RRF逐渐下降.本文就有关影响残余肾功能下降的各种因素及保护策略作一综述.
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对比剂肾功能损害防治的研究进展
冠心病的介入检查和治疗已经十分普遍,而且发展迅猛.通过直接向冠状动脉内注入不透X线的对比剂,显示冠状动脉分支和病变,可以鉴别和诊断冠心病,以此决定治疗冠心病的方案以及评价冠心病介入治疗的效果.对比剂进入人体后大部分经肾脏排泄,可影响肾脏的正常生理过程,尤其是对原有肾功能不全、糖尿病、心功能不全的患者,对比剂可导致急性肾功能下降(对比剂肾病).有研究显示在药物所致的急性肾功能衰竭(ARF)中,对比剂仅次于氨基苷类抗生素而居第二位.