重症肺炎致急性呼吸窘迫综合征(ARDS)病情重、进展迅速、病死率高,是肾移植患者死亡的重要原因.我们回顾性分析以霉酚酸酯联合环抱素治疗的肾移植患者术后发生ARDS的临床情况.

目的:探讨彩色多普勒超声、核素动态显像在肾移植术后早期并发症诊断与鉴别诊断中的应用价值.方法:收集肾移植术后肾功能恢复不佳且行彩色多普勒超声和核素肾动态显像检查的患者59例,分为3组:急性排斥反应组18例,加速性排斥反应组12例、急性肾小管坏死组29例,同时收集术后肾功能恢复良好的正常组20例,分剐统计上述4组彩色多普勒的阻力指数(RI)、移植肾体积、血流分布,分析彩色多普勒在鉴别诊断中的价值.计算核素肾动态显像的指标:灌注相内1 min时腹主动脉放射性计数与移植肾放射性计数比值(K1 minA1 min),功能相20 min时膀胱/移植肾放射性计数比值(B/K),分析其诊断价值.结果:彩色多普勒检查指标中,当移植肾体积增大、血流减少、阻力指数升高均提示移植肾病变,以阻力指数较敏感,但特异性不高.根据核素肾动态显像指标的计算数据,K1 min/A1 min比值联合B/K比值在诊断排斥反应与肾小管坏死方面准确性较高,分别达到96.7%和89.7%;K1 min/A1 min<4和B/K<1提示排斥反应,K1 min/A1 min≥4和B/K<1提示肾小管坏死.结论:彩色多普勒联合核素动态显像对于肾移植术后排异、急性肾小管坏死、移植肾功能延迟恢复的诊断与鉴别诊断具有很好的临床价值,二者联合应用,互补长短.

Objective To investigate whether daytime continuous venovenous haemofitration(daytime CVVH)is superior to intermittent hemodialysis (IHD) in critically ill patients.Methods Seventy-four multiple organ dysfunction syndrome(MODS) patients were divided into two groups,daytime continuous venovenous haemofitration(n=34) and IHD(n=40) group.Patients characteristics on baseline were not different in term of severity of illness.We analyzed parameter during therapy,such as blood pressure,heart rate,dosage of dopamine,and fatality rate and survival time.Results In contrast to daytime CVVH,IHD caused a increase in heart rate [(8±11)times per minute vs(-1±7)times per minute,P<0.05]and decrease in systolic blood pressure [(-13±30)mm Hg(1 mm Hg=0.133 kPa) vs(-2±11)mm Hg,P<0.05]after 1 hour;daytime CVVH can decreased dosage of dopamine[(17.5±2.8)μg/(kg·min) vs(5.8±4.9)μg/(kg·min),P<0.05]during therapy;the density of IL-6 and TNF-α is evidently decreased [(82±25)pg/ml vs(45±30)pg/ml,P<0.05] and [(103±39)pg/ml vs(80±30)pg/ml,P<0.05].The fatality of daytime CVVH and IHD were 58 percent and 75 percent respectively.Conclusion In contrast to IHD,improved blood pressure stability and decreased heart rate,during daytime CVVH in critically ill patients.Daytime CVVH maybe decrease in-hospital fatality rate.

肾脏功能主要是通过肾小球的滤过及肾小管的重吸收和分泌,以排出代谢产物和维持水、电解质、酸硷平衡,其中肾小球滤过功能起着最重要的作用.能准确、方便地测定肾小球滤过功能在临床上是非常重要的.血胱蛋白C(Cystatin C)是其中最敏感指标.作者对肾功能不全患者各期血Cystatin C并与血肌酐比较,以探讨血Cystatin C的临床意义.