AIM:To investigate the current status of COVID-19 vaccination in maintenance hemodialysis (MHD) patients and its influencing factors.METHODS:In total, 585 patients undergoing regular hemodialysis in Sichuan Province of China from January to March 2022 were selected to complete a questionnaire survey on their knowledge, attitudes and practices regarding COVID-19 vaccination. Independent t tests and logistic multivariate analysis were used to analyze the influencing factors of COVID-19 vaccination in hemodialysis patients.RESULTS:The survey showed that 37.44% of MHD patients had been vaccinated with the COVID-19 vaccine. Being married was associated with COVID-19 vaccination in patients with MHD (odds ratio [OR] = 1.969 95% CI 0 .870 ~ 4.453). MHD patients living in county areas have higher rates of COVID-19 vaccination (OR = 0.572 95% CI 0.301 ~ 1.087). Family /relatives/friends who are healthcare workers are associated with COVID-19 vaccination for MHD patients (OR = 1.840 95% CI 1.140 ~ 2.970). Other vaccination history within 5 years was a factor in COVID-19 vaccination for MHD patients (OR = 5.592 95% CI 2.997 ~ 10.434). Attitude (OR = 0.885 95% CI 0.808 ~ 0.905), and practice (OR = 0.756 95% CI 0.697 ~ 0.819) scores on the COVID-19 vaccination knowledge and practice questionnaire were related to the vaccination status of MHD patients.CONCLUSIONS:MHD patients had lower rates of COVID-19 vaccination. Marital status, living environment, whether family/relatives/friends were medical workers, and the score of the COVID-19 vaccine knowledge and practice questionnaire were the factors influencing their vaccination status. Clinical attention should be given to the adverse reactions of COVID-19 vaccination in MHD patients to improve the awareness of primary medical staff on hemodialysis, and families and society should pay more attention to COVID-19 vaccination in MHD patients.

Objective To investigate the status quo of willingness to get SARS-CoV-2 vaccines and its affecting factors in patients with maintenance hemodialysis, and to provide a basis for the plan of SARS-CoV-2 vaccination in the patients. Methods One hundred and fifty-one outpatients undergoing maintenance hemodialysis in a third-grade class-A hospital in Sichuan Province were selected as the research subjects. The self-made questionnaire was used to investigate the patients, and SPSS 20.0 software was employed to analyze the data. Results Among the 151 outpatients with maintenance hemodialysis, 138（91.4%） learned about SARS-CoV-2 vaccines from news sources, 84（55.6%） indicated a higher need for SARS-CoV-2 vaccination in MHD patients, 97（64.2%） indicated their willingness to receive SARS-CoV-2 vaccines. SARS-CoV-2 vaccines that were considered safe（OR=5.702, 95%CI:1.769-18.379）, the impact of the SARS-CoV-2 epidemic on timely hemodialysis that persisted（OR=0.659, 95%CI:0.437-0.993）, and considering that hemodialysis patients needed to be vaccinated more than the general population（OR=25.244, 95%CI:9.021-70.639） were factors influencing the willingness to receive SARS-CoV-2 vaccines in the patients with maintenance hemodialysis. Conclusion The patients with maintenance hemodialysis have a high willingness to vaccinate against SARS-CoV-2; and hence, we can strengthen the publicity of knowledge related to SARS-CoV-2 vaccines in clinical practice and enhance their confidence in vaccination. At the same time, it is recommended to implement the vaccination program among this group as soon as possible.

Based on quality indicators for hemodialysis care, this article reviews the sensitive quality indexes of hemodialysis care from three aspects: structural index, process index and outcome index, so as to provide a reference for the construction of unified and standardized sensitivity index in hemodialysis care in China.

老年血液透析患者衰弱综合征的发生率高,易发生跌倒、骨折等意外,导致患者感染,住院次数增加,住院时间延长,甚至死亡风险增加.衰弱综合征暂无公认的诊断金标准,本文对其常见的评分量表,与血液透析之间的关系以及常见干预措施进行综述,以期为提高对老年血液透析患者衰弱的重视和早期干预提供参考.

Aim: This study aimed to investigate the current situation of sarcopenia and anorexia of elderly maintenance haemodialysis patients and analyse the influencing factors. Design: A cross-sectional design was used in this study. Methods: One hundred and twelve elderly patients on MHD in 3 haemodialysis centres in Sichuan, China, were selected. Sarcopenia was diagnosed according to the criteria of the Asian Working Group for Sarcopenia (AWGS). Anorexia was assessed with the Functional Assessment of Anorexia Cachexia Therapy/Anorexia Cachexia Subscale (FAACT/ACS). The relationship between sarcopenia and anorexia was analysed by logistic regression. Results: The prevalences of sarcopenia and severe sarcopenia in elderly MHD patients were 52.7% and 39.3%, respectively, and the prevalence of anorexia was 25.9%. Severe sarcopenia was independently associated with anorexia, and weekly exercise frequency was independently associated with anorexia. The low SMI value and slow gait speed were strongly associated with anorexia. This study complied with the STROBE checklist.

目前对存在高出血风险的血液透析患者,枸橼酸局部抗凝(RCA)已成为首选的临床抗凝方案.RCA可以在透析装置局部发挥抗凝作用而避免造成患者全身的凝血抑制状态,与低分子肝素或无抗凝的血液透析比较,其临床疗效更加显著.近年来,RCA技术已逐渐简化,应用也愈加成熟,加之涌现了很多专用于RCA的商用透析液、透析机和与之相匹配的集成输液系统及管理软件,都使得RCA的临床应用更加便捷和安全.本文对RCA技术在血液透析中的应用机制及安全性进行综述.

钙化防御(Calciphylaxis)是一种少见的血管钙化性疾病,常见于终末期肾病的患者(end-stage renal dis-ease,ESRD),也被称为钙化性尿毒性动脉病(calcific uremic arteriolopathy,CUA).最早有关钙化防御的病例报道是在20世纪60年代[1].有研究表明糖尿病,体质指数较高,血清钙,磷和甲状旁腺激素水平较高与CUA的发病率相关[2].发生钙化防御的患者死亡率明显升高,为非钙化防御患者死亡率的3倍.目前学者对钙化防御发病机制的研究仍不透彻.但随着肾脏疾病大数据库的建立,有关钙化防御的研究愈来愈多,本文就钙化防御的发病机制、临床表现、诊断和治疗进展进行综述.

Objective To investigate the status of medical coping style and its correlation with perceived social support in maintenance hemodialysis (MHD) patients.Methods By convenient sampling,a total of 100 patients who underwent MHD in our hospital from July to June in 2017 were followed up for Medial Coping Modes Questionnaire (MCMQ) and Perceived Social Support Scale (PSSS).Results Avoidance was the main coping style in MHD patients (36 case,36％).The score of face dimension was lower than norm (t=-2.780,P=0.007),and the scores of avoidance and yield dimension were higher than norm (t=7.208 and 6.486 respectively,P＜0.001).The yield dimension was negatively correlated with the total scores and dimensions of perceived social support (r=-0.322,-0.318,-0.256 and-0.260;P=0.001,0.001,0.010 and 0.009),and the face dimension was positively correlated with other support dimensions (r=0.249,P=0.013).Conclusion This study suggests that the family and social support system for MHD patients should be improved to reduce their yield responses and improve their health conditions.

Objective To investigate the status of self-perceived burden and its correlation with coping style,self-efficacy and self-esteem in maintenance hemodialysis (MHD) patients.Methods A total of 114 MHD patients treated during the period from March to May in 2017 in one of the blood purification centers in Chengdu were recruited by convenience sampling method.The self-perceived burden scale (SPBS),medial coping modes questionnaire (MCMQ),general self-efficacy scale (GSES) and self-esteem scale (SES) were investigated in these patients.Results The total SPBS score of the MHD patients was 25.89±8.32,which is a mild level.Different degrees of self-perceived burden,mainly financial burden,were detected in 74.6％ (85 cases) MHD patients.Self-perceived burden was positively correlated with the yield response of coping style (r=0.499,P＜0.001),and negatively correlated with self-efficacy (r=-0.312,P=0.001) and self-esteem (r=-0.308,P=0.001).Conclusions Self-perceived burden is commonly present in MHD patients.Self-perceived burden can be alleviated by reducing the yield response of coping style and enhancing their confidence and self-efficacy to face the disease.

[目的]探讨短期强化胰岛素(CSII)治疗对2型糖尿病(T2DM)患者外周血单核细胞Toll样受体-4(TLR4)、白细胞介素-6(lL-6)、白细胞介素-lβ(IL-lβ)表达的影响.[方法]收集本院86例T2DM患者作为观察组,另选取健康体检者的80例作为对照组,观察组患者采用CSII治疗2周,检测观察组治疗前后外周血中空腹血糖(FPG)、餐后2h血糖(2hPG)、胰岛素抵抗指数(HOMA-IR)、三酰甘油(TG)、总胆固醇(TC)、糖化血红蛋白(HbAlc)、低密度/高密度脂蛋白(HDC-L)、低密度(LDC-L)/高密度脂蛋白(HDC-L)、TLR4、lL-6,IL-lβ水平并与对照组比较.[结果]治疗后FPG、2hPG、HOMA-IR、TG、TC、HbAlc均低于治疗前,其差异有统计学意义(P<0.05);与对照组相比,治疗后FPG、2hPG、HOMA-IR、TG、TC、HbAlc水平无明显变化(P>0.05).RT-PCR结果显示,治疗后外周血单核细胞TLR4、IL-lβ、lL-6 mRNA表达均低于治疗前,差异有统计学意义(P<0.05);与对照组相比,差异无统计学意义(P>0.05).[结论]CSII治疗T2DM能控制患者血糖及提高对胰岛素敏感性,这可能与抑制外周血单核细胞TLR4、lL-6,IL-lβ表达有关.

血液净化是一门年轻的、专科性强的专业,加之终末期肾脏病(end-stage renal disease,ESRD)病因复杂、发病人数不断增加及血液净化新技术的发展,对从事血液净化工作的护士的专业素质要求也越来越高,规范化血液净化专科护士培训对满足ESRD患者多层次、多样化的健康需求显得尤为重要.20世纪80年代末90年代初国内护理界就已提出要加速我国护理专业化发展[1].中国护理事业发展规划纲要(2011～2015年)明确指出,争取到2015年底建立5个国家级血液净化护理技术培训基地[2].

[目的]比较钝针扣眼穿刺法与锐针绳梯穿刺法对血液透析动静脉内瘘的影响,为临床选择合理有效的内瘘穿刺方式提供依据。[方法]采用临床随机对照研究设计,将在我院血液净化中心采用动静脉内瘘行维持性血液透析治疗的60例病人随机分为钝针扣眼穿刺组和锐针绳梯穿刺组各30例。钝针扣眼穿刺组由专人建立隧道并采用钝针扣眼穿刺,锐针绳梯穿刺组则采用锐针进行绳梯穿刺,3个月后比较两种不同穿刺方法对内瘘一次穿刺成功率、渗血率、感染率以及病人疼痛评分的影响。[结果]钝针扣眼穿刺组病人一次穿刺成功率高于锐针绳梯穿刺组,钝针扣眼穿刺组病人的渗血率与疼痛评分均低于锐针绳梯穿刺组,两组病人内瘘感染率比较差异无统计学意义(P >0.05)。[结论]钝针扣眼穿刺可提高内瘘一次穿刺成功率,减少穿刺点渗血,减轻病人穿刺疼痛感,不增加感染的发生。

目的：探讨自我效能和症状负担与维持性血液透析（M HD ）患者的生存质量的相关性。方法选取本院2013年4月至2016年4月收治的118例M HD患者作为研究对象，分别采用自我效能能量表（Secd6）、血液透析患者症状负担调查表（DF-SSBI），简明健康状况量表（SF-36）对本院收治的M HD患者进行自我效能、症状负担及生存质量情况的调查，并采用 Pearson线性相关分析确定自我效能和症状负担与生存质量各维度的相关性。结果 M HD患者的自我效能总得分为（5．24±1．93）分，处于较低水平；症状负担总得分为（77．40±21．36）分；S F-36总得分为（55．43±11．36）分，属于较差范畴。自我效能评分与生存质量评分呈正相关，自我效能的症状管理和共性管理与生存质量的生理机能、总体健康、社会功能、精神健康及精力5个维度评分呈正相关；症状负担评分与生存质量评分呈负相关，症状负担的发生频率、严重程度、困扰程度与生存质量的8个维度评分呈负相关。结论提高患者自我效能，减轻症状负担，可以在一定程度上提高M HD患者的生存质量。

目的 观察血液透析联合血液灌流治疗尿毒症皮肤瘙痒的临床效果.方法 选取我中心维持牲血液透析患者有皮肤瘙痒症状者30例,采取血液透析联合血液灌流治疗,每周1次.检测治疗前、中、后甲状旁腺激素、血β2微球蛋白,并观察患者皮肤瘙痒改善情况.结果 血液透析联合血液灌流治疗10周后,30例患者甲状旁腺激素,血β2微球蛋白较前清除显著增加(P＜0.05);患者皮肤瘙痒症状缓解有效率100％.结论 血液透析联合血液灌流能有效缓解尿毒症皮肤瘙痒症状,且设备要求较低,适于临床开展.

Objective To explore the optimal treatment for renal anemia by comparing the clearance ability for middle molecular uremic toxins,like inflammatory mediators,PTH,in three blood purification modalities and evaluating the erythropoietin(EPO) efficacy in this study.Methods A prospective,randomized and controlled,open-labeled trial was carried out from May to Auguest 2011.Sixty maintenance hemodialysis patients were randomly divided into three groups,twenty in each group.HDP group received 5 times hemodialysis(HD) and the combined treatment of HD and hemoperfusion(HP) once every two weeks.Hemodiafiltration(HDF) group received 5 times HD and HDF once every two weeks.HD group received six times HD every two weeks.The follow-up lasted for three months.The level of CRP,β2 microglobin,PTH,IL-6 and indicators of renal anemia were measured at the beginning and just after the trial.Results After three-month follow-up,the levels of the four uremic toxins decreased obviously in HDP and HDF group and the CRP concentration was evidently lower in HDP group(P<0.05).The Hb level was distinctly elevated and ERI dropped in both HDP and HDF groups.No significant change in levels of uremic toxins was observed in HD group with the increased ERI value.No severe adverse event occurred in the three groups.Conclusions HDP and HDF are superior to HD in the clearance ability for middle molecular uremic toxins and are preferred to alleviate the microinflammatory state in the treatment of renal anemia.Further studies are needed to evaluate the long-term effect of HDP and HDF.

目的采用促红细胞生成素抵抗指数（ERI）评价血液透析患者肾性贫血的治疗效果,并分析可能的影响因素。方法采用横断面研究方法,对2012年4月在四川大学华西医院血液透析中心行维持性血液透析的患者进行调查,按ERI指数分成3组:A组ERI＜15,B组ERI 15～25,C组ERI＞25。比较各组临床指标的差异,并通过相关性分析探讨ERI的影响因素。结果研究共纳入260例维持性血液透析患者,平均ERI为22.53±9.21。C组的超敏C反应蛋白（hs-CRP）、甲状旁腺激素（PTH）高于A、B组（P＜0.05）,而尿素清除指数（Kt/V）和转铁蛋白饱和度（TSAT）低于其他两组（P＜0.05）。3组患者的白蛋白、血脂、铁蛋白差异无统计学意义。相关性分析显示,hs-CRP、PTH、Kt/V、TSAT是ERI升高的影响因素。结论促红细胞生成素治疗血液透析患者肾性贫血的效果受诸多因素影响,在调整药物剂量前应首先对相关因素进行评估和干预,以避免盲目增加药量而导致的副反应和治疗花费。