Objective:To investigate the efficacy of hemodiafiltration combined with hemoperfusion in the treatment of secondary hyperparathyroidism (SHPT) in patients undergoing maintenance hemodialysis (MHD).Methods:A total of 40 patients with SHPT undergoing MHD who received treatment at the Blood Purification Center of The First Affiliated Hospital of Anhui University of Science and Technology from February 2021 to March 2023 were included in this prospective cohort study. They were randomly divided into a control group and an observation group ( n = 20/group).The control group received a single high flux hemodialysis, while the observation group used a combination of hemodialysis filtration and hemoperfusion for 3 months. In both groups, the changes in hemoglobin, blood urea nitrogen, serum creatinine, serum calcium, serum phosphorus,and parathyroid hormone levels were compared before and after dialysis. Results:After dialysis, the hemoglobin level in the observation group was (119.45 ± 5.27) g/L, which was significantly higher than (106.30 ± 6.52) g/L in the control group ( t = -7.02, P < 0.001). The serum phosphorus level in the observation group was (1.18 ± 0.17) mmol/L, which was significantly lower than (1.52 ± 0.22) mmol/L in the control group ( t = 5.49, P < 0.001). The parathyroid hormone level in the observation group was (122.14 ± 40.57) ng/L, which was significantly lower than (168.78 ± 78.27) ng/L in the control group ( t = 2.39, P = 0.023). Conclusion:Hemodiafiltration combined with hemoperfusion can reduce clinical symptoms, increase hemoglobin level, and reduce phosphorus and parathyroid hormone levels in patients with SHPT undergoing MHD, which deserves clinical promotion.

目的:观察连续性血液净化(CBP)危重患者采取集束化护理的应用效果.方法:选择2016年1月～2018年12月淮南市第一人民医院血液净化中心收治并采取CBP危重症患者40例,分为常规组与集束化护理干预组,比较治疗前、中、后患者对病情的认知度、不良反应发生程度,患者及家属护理满意度等.结果:两组患者血压、心率和体温变化差异在上机治疗过程中均无统计学意义(P>0.05).干预组血氧饱和度、病情认知得分、满意度治疗后均高于常规组(P<0.05).两组患者在治疗过程中不良事件发生情况差异均无统计学意义(P>0.05).结论:集束化护理模式应用于CBP可以改善患者的氧代谢,改善呼吸功能,提高临床治疗效果及患者和家属对病情的认知度、护理满意度.

Objective To evaluate the effect of oxycodone on migration of human colon cancer cells and the role of μ and κ receptors.Methods The human colon cancer HCT116 cells at the logarithmic growth phase were seeded in 24-well or in 6-well plates at a density of 1 × 106 cells/mnl (0.5 ml/well or 2 ml/well,144 wells in total).The cells were divided into 6 groups (n=24 each) using a random number table:control group (group C),1,5 and 10 μmol/L oxycodone groups (group O1,group O2 and group O3),oxycodone plus μ receptor antagonist CTOP group (group O2+CTOP) and oxycodone plus κ receptor antagonist nor-binaltorphimine group (group O2+BNI).The cells were incubated for 24 h with oxycodone 1,5 and 10 μmol/L in O1,O2 and O3 groups,respectively.The cells were incubated for 24 h with 5 μmol/L oxycodone plus 20 μmol/L CTOP and 5 μmol/L oxycodone plus nor-binahorphimin 20 μmol/L in O2+CTOP and O2+BNI groups,respectively.The invaded and migrated cells were counted,and the levels of Ras homolog gene family member A (RhoA),Rho-associated protein kinase 1 (ROCK1),matrix metalloproteinase-2 (MMP-2) and MMP-9 were detected.Results Compared with group C,the number of invaded and migrated cells was gradually decreased,and the levels of RhoA,ROCK1,MMP-2 and MMP9 were gradually decreased in O1,O2 and O3 groups (P＜0.05),and no significant change was found in the parameters mentioned above in group O2+BNI (P＞0.05).Compared with group O2,the number of invaded and migrated cells was significantly increased,and the levels of RhoA,ROCK1,MMP-2 and MMP9 were increased in group O2 + BNI (P＜0.05),and no significant change was found in the parameters mentioned above in group O2+CTOP (P＞0.05).Conclusion Oxyc odone can inhibit the migration of human colon cancer cells,and the mechanism is totally related to inhibition of RhoA/ROCKl signaling pathway activation after activating κ receptors,but not related to μ receptors.

血液灌流是通过灌流器内吸附树脂的吸附作用清除内源性和外源性毒物，对某些尿毒症患者的不能通过血液透析清除的毒性物质尤其是中大分子物质有较好的清除作用[1]，与血液透析联合运用能使维持性血透患者甲状旁腺激素（PTH）、β2微球蛋白（β2-MG）水平显著下降，并能有效缓解皮肤瘙痒等症状[2，3]。但此项技术普通预冲复杂且并发症多，严重影响透析效果。而我科使用的多功能连接管应用于血液透析串联血液灌流预冲及回血方法具有简便、省时、减少体外凝血和二次污染的优点，现报告如下。

目的 分析维持性血液透析患者并发出血性脑卒中的原因及临床表现,探讨维持性血液透析患者并发出血性脑卒中的护理对策,以降低维持性血液透析患者出血性脑卒中的发生率.方法 采用回顾性研究方法,对2009年7月-2015年2月收治的维持性血液透析治疗患者324例的临床资料进行分析,其中并发出血性脑卒中患者26例.针对维持性血液透析患者并发出血性脑卒中的原因及临床表现,对患者进行病情认知、饮食指导、合理用药、个性化使用抗凝剂、生活指导等护理干预措施.结果 维持性血液透析患者并发出血性脑卒中的主要原因为高血压、糖尿病、左心功能衰竭及抗凝剂的应用,出血性脑卒中发生后患者的主要临床表现为头痛、头晕、恶心呕吐,肢体感觉、运动障碍,严重的患者可出现烦躁不安、嗜睡、肢体抽搐、昏迷等,均经头颅CT检查可明确诊断,其中基底节出血9例,脑干出血17例.通过护理干预,并发出血性脑卒中的26例中,死亡21例,存活5例,存活率19.2％.结论 对维持性血液透析患者,应根据每例患者不同的基础疾病和脑出血发病的因素,对患者进行全面护理评估,结合患者的个体情况,实施病情认知、饮食指导、合理用药、个性化使用抗凝剂、生活指导等针对性的护理对策,预防维持性血液透析患者出血性脑卒中的发生,降低维持性血液透析患者出血性脑卒中的发生率.

护理临床教学是护生在临床护理教师的指导下，参与临床护理实践，以验证、巩固、深化所学的护理理论知识的过程，临床教学质量直接关系到未来护理队伍的质量[1]。血液净化专业专科特点鲜明，专业性强，血透室跟普通病房相比，护士在专业理论知识和和操作技能以及工作性质上都有很大的特殊性和专业性[2]，护生容易产生恐惧茫然的心理，因此实习生在血液透析中心学习的过程中心理问题不容忽视[3]。本文针对血液净化专业的特点，对本院血透室实习护生进行心理干预，现将带教效果介绍如下。

动静脉内瘘是慢性肾功能衰竭血液透析患者的“生命线”[1]，需要它方便、耐用、血流量充足。因此，平时对动静脉内瘘的护理非常重要。我院透析室对38例维持性血液透析患者的内瘘穿刺和护理方面给予了足够的重视，采取了多方面的护理措施，有效减少了内瘘的并发症，保证充足的血流量，确保了透析的成功，现将护理体会总结如下。

职业暴露是指因职业原因暴露在某种危险因素中，有感染或引发某种疾病的潜在危险。随着血液净化技术的广泛应用和透析人群的不断扩大，透析护士因其工作特殊性常暴露于多种职业危害因素中，因此加强血液净化中心的管理，针对各种暴露因素制定有效干预，对降低职业暴露因素、控制医院感染、保护医护人员有着重要意义。

Objective To investigate clinical efficacy of catheter-sealed treatment with ceftazidime on central venous catheter-related infection in hemodialysis patients.Methods All 15 hemodialysis patients with central venous catheter related infection from 2009.1 to 2011.12 were enrolled in this study.1 case was infected within 3 weeks after the indwelling catheter,2 cases within 4 weeks,3 cases within 5 weeks,and 9 cases within 4-12 months(long term indwelling Jugular vein catheters).The intravascular catheter blood culture specimens were analyzed in all infected patients.We changed dressings on the hemodialysis day,and sealed the catheters with Ceftazidime for 2 weeks at first,and then once time every week.1 patient with diabetes experienced pain,heat,swelling and pain in the skin around the catheters,and produced purulent secretions,and received the routine local disinfection treatment and external 2% mupirocin ointment.Results After catheter-sealed treatment with Ceftazidime for 1-2 weeks,the infection symptoms of 15 hemodialysis patients with central venous catheter related infection were relieved,and the sealing treatment was changed to one time every week.The catheter-sealed treatment was stopped one month later.The follow up of 5 months did not find infection case.Conclusion Broad spectrum of Ceftazidime is very effective to Gram-negative bacteria and Positive bacteria such as Staphylococcus aureus,Staphylococcus epidermidis.For hemodialysis patients with central venous catheter related infection,the efficacy of catheter-sealed treatment with Ceftazidime is very significant.

目的 观察依托咪酯单次静脉注射对老年全髋置换术患者TNF-α、IL-6、IL-10浓度的变化,探讨单次静脉注射依托咪酯对老年患者围术期机体炎症反应的影响.方法 60例ASAⅠ～Ⅱ级、年龄60～80岁的全髋置换术患者随机分为3组,每组20例,即对照组(C组),异丙酚组(P组),依托咪酯组(E组).所有患者均采用硬膜外麻醉,手术开始即刻P组给予异丙酚2 mg/kg静脉注射,E组给予依托咪酯0.3 mg/kg静脉注射,C组则给予等容量的生理盐水静脉注射.分别于硬膜外麻醉前(T0)、手术开始即刻(T1)、手术开始后5 min(T2)、手术开始后30 min(T3)、术后2 h(T4)、术后24 h(T5)采集外周静脉血3 mL,采用酶联免疫吸附法测定血清TNF-α,IL-6,IL-10浓度.结果 与C组比较,T1时间点P组血压明显降低(P<0.05),E组血压无变化;P组患者血清TNF-α、IL-6升高幅度降低,E组患者血清TNF-α、IL-6及IL-10升高幅度降低(P<0.05);E组患者IL-10升高幅度比P组低,T5时各组IL-10比较差异无统计学意义.结论 单次静脉注射依托咪酯对老年全髋置换术患者血清促炎症因子TNF-α、IL-6的作用与异丙酚相似,对抗炎因子IL-10的抑制作用强于异丙酚.

AIM To observe the effects of desflurane on serum neron-specific enolase(NSE)and S-100 β protein levels in the old patients undergoing coronary artery bypass grafting(CABG)and investigate the brain protection of desflurane.METHODS Thirty patients(over 65 years old,cardiac function Ⅱ-Ⅲ)scheduled for CABG were randomly divided into two groups,15 in each.The anesthesia inductions were identical in the two groups and intravenous-inhalation combined anesthesia were adopt in both groups.During cardiopulmonary bypass,diazepam and ketamine in the control group and 1.0 MAC desflurane in the desflurane group were applied to maintenance of anesthesia.Serum NSE and S-100 β protein levels was assayed at four time points:preoperative(T1),the end of cardiosurgery(T2),12 h after cardiosurgery(T3),and 24 h after cardiosurgery(T4).The mean mini-mental state examination(MMSE)scores were measured at T1 and T4.RESULTS Compared with T1,serum NSE level increased at T2 and T3(P 0.05),and serum S-100 β level only increased at T2 in the control group(P 0.01).The serum S-100 β level raised in the desflurane group at T2(P 0.05),but the serum NSE and S-100 β levels in the desflurance group were less than those in the control group at T2(P 0.05).The MMSE scores decreased(1.1 ± s 0.4)in the control group and(0.6 ± 0.3)in the desflurance group,with significant difference between the two groups(P 0.05).CONCLUSION Desflurane have some brain protection role in the old patients undergoing CABG by reducing the serum NSE and S-100 β levels.

AIM To investigate the effects of 6% hydroxyethyl starch 130/0.4 on the nuclear factor kappa B (NF-κB) activity of neutrophils in patients undergoing cardiac valve replacement with cardiopulmonary bypass (CPB). METHODS Sixty ASA Ⅱ orⅢ patients undergoing cardiac mitral valve replacement with CPB were randomized into 2 groups (re = 30 each). Heart-lung machine were processed with 6% hydroxyethyl starch 130/0.4 (group Ⅴ) and succinylated gelatin (group C) 15 mL·kg~(-1), respectively. The 6% hydroxyethyl starch 130/0.4 or succinylated gelatin 10 mL·kg~(-1) was intravenously infused between the time after intubation and before CPB. Intraoperative hemodynamic changes, aortic cross-clamping time, the CPB turn around time and operation time were recorded. Neutrophiles were isolated from peripheral blood, which were collected from peripheral artery after induction of anesthesia (T_0), opeing aortic cross-clamping in CPB (T_1), at the end of CPB (T_2) and at the end of operation (T_3). neutrophil cytoplasmic protein were extracted and quantitated, and the content of activation of NF-κB p65, acidification of NF-κB p65 and total NF-κB were tested. RESULTS There were no significant differences in aortic cross-clamping time, CPB time, operation time and mean arterial pressure, heart rate, central venous pressure, hematocrit, neutrophil number and total amount of NF-κB at four time point between two groups. There were no significant difference in the content of activation of NF-κB p65 and acidification of NF-κB p65 of neutrophils at T_0 (P > 0.05) between two groups. Compared with group C, the content of activation of NF-κB p65 and acidification of NF-κB p65 were significantly lower at T_1, T_2 and T_3 in group V (P < 0.05) . CONCLUSION The application of 6% hydroxyethyl starch 130/0.4 in CPB could inhibit the expression of NF-κB in peripheral blood neutrophils, thereby reducing the inflammatory response triggered by CPB.

AIM To investigate the effect of 6 % hydroxyethyl starch 130/0.4 on renal function in patients undergoing cardiac valve replacement with cardiopulmonary bypass during perioperative period. METHODS Forty ASAⅡorⅢpatients undergoing cardiac mitral valve replacement were randomly divided into 2 groups(n = 20 each),with 6 % hydroxyethyl starch 130/0.4 15 mL·kg~(-1)and succinylated gelatin 15 mL·kg~(-1)prefilled in extracorporeal heart-lung machine for trial group and control group,respectively.Liquid intake and output,hemodynamics,balance of electrolytes and renal function were recorded before induction of anesthesia(T_0),at the end of operation(T_1),12 h after operation(T_2),24 h after operation(T_3)and 48 h after operation(T_4).RESULTS Comparing with control group,the infusion volumes of artificial colloid were significantly lower at the first and second 12 h after operation in trial group(P0.01)and the infusion volume of R-L was significantly lower at the second 12 h after operation in trial group(P0.01).The urea nitrogen (BUN)and creatinine(Cr)in blood serum were significantly higher at T_3 than those at T_0,with significant difference(P0.05)in both groups.The cystatin C in blood serum were significantly higher at T_1,T_2 and T_3 than that of T_0(P0.05).The retinol binding protein(RBP)andβ2-microglobulin in urine were significantly higher at T_1 and T_2 than those at T_0,showing statistical significance(P0.05).There was no statistical difference on renal function in all the times between the two groups(P0.05).CONCLUSION Cardiopulmonary bypass effects renal function in patients undergoing cardiac valve replacement during the perioperation period and 6% hydroxyethyl starch 130/0.4 would not aggravate renal dysfunction.

Objective To investigate the effect of 6% hydroxyethyl starch 130/0.4 （HES 130/0.4） on the expression of intercellular adhesion molecule-1 （ICAM-1）, vascular cell adhesion molecule-1 （VCAM-1） and platelet endothelial cell adhesion molecule-1 （PECAM-1） in patients undergoing cardiac valve replacement with cardiopulmonary bypass （CPB）. Methods Sixty patients （ASA Ⅱ ～ Ⅲ） undergoing cardiac mitral valve replacement under CPB were randomly divided into 2 groups （n = 30）. HES130/0.4 （Group Ⅴ） or succinylated gelatin （group C） with a volume of 15 ml/kg was infused into heart-lung machine, followed by intravenous infusion of 10 ml/kg of HES130/0.4 （Group Ⅴ） or succinylated gelatin （group C） after intubation and before CPB. Serum levels of sICAM-1, sV- CAM-1 and sPECAM-1 were assayed at time-points of anesthesia induction （To）, opening aortic cross-clamping （T1）, end of CPB （T2） and of operation （T3）, respectively. Results Serum levels of sICAM-1, sVCAM-1 and sPECAM-1 in group V were significantly lower than those in group C at T2 and T3 （P〈O.05）, without difference between two groups at To and %. Conclusion HES130/0.4 significantly reduces the expression of adhesion molecule, thereby reducing CPB-triggered inflammatory response.\r\n\r\nKey words: \r\nhydroxyethyl starch;  adhesion molecule;  cardiopulmonary bypass