目的 探讨手术前左室收缩功能对自体动静脉内瘘(AVF)吻合术后头静脉内径及血流量的影响.方法 选择2015年6月至2016年12月中国人民解放军第一零五医院收治并拟建立AVF的终末期肾脏病(ESRD)患者54例,根据术前左室射血分数(LVEF)将54例患者分为LVEF正常组33例(LVEF>50％)和LVEF降低组21例(LVEF≤50％).采用彩色多普勒超声测量两组患者术前头静脉内径及术后2周、4周、6周、8周头静脉内径和血流量,比较两组患者头静脉内径及血流量的差异,采用Pear-son相关分析术前LVEF与术后头静脉内径和血流量变化值的相关性.结果 两组患者术后2～8周内头静脉内径及血流量均逐渐增加,差异有统计学意义(P<0.05).LVEF正常组术后4周、6周、8周头静脉内径均大于LVEF降低组,差异均有统计学意义(P<0.05),LVEF正常组术后6周、8周头静脉血流量均大于LVEF降低组,差异有统计学意义(P<0.05).Pearson相关性分析显示,术前LVEF与术后2～4周、4～6周及6～8周头静脉内径变化值成正相关(r=0.270、0.305、0.308;P均<0.05),术前LVEF与术后4～6周及6～8周头静脉血流量变化值成正相关(r=0.318、0.299;P均<0.05).结论 AVF吻合术前LVEF影响术后头静脉内径及血流量的变化,高LVEF有利于术后头静脉的扩张及血流量的增加.

Objective To understand the quality of life（QOL）and its influencing factors in maintenance hemodialysis patients（hemodialysis maintenance,MHD）,and to provide theoretical basis for improving QOL of patients.Methods A cross-sectional study was conducted in the blood purification centre in 8 hospitals in Hefei,and patients’clinical data were collected.KDQOL-SF self-ad-

Objective To compare the effects of different dialysis flux and speed of the hemodialysis on dialysis.Methods Factorial design was applied concerning dialysis flux and speed.The factor of dialysis flux was set at high and low levels,and the factor of dialysis speed was set at HD,SCD and MSCD modes.Then the incidence of hypotension and related blood biochemical indexes were monitored. The changes of indexes were compared.Results The blood pressure (systolic pressure)was the worst at HD mode.The six blood bio-chemical indexes including Na were closer to normal value at high dialysis flux and low speed modes.The index of AGEs declined markedly at low speed mode,which was 60.9% compared with only 2.1% at HD mode.In addition,the occurrence of severe cardiovas-cular and cerebrovascular events was less at high dialysis flux and low speed modes.Conclusion High dialysis flux and low speed modes were optimal,which was suggested as clinical priorities.

1 临床资料 患者男性,79岁,因慢性肾功能不全在外院血液透析治疗2年半,治疗效果尚好;其初始治疗经过是先行右颈内静脉插管,随后已分别进行左、右前臂内瘘手术.近期患者因内瘘闭塞临时行股静脉插管透析,现要求建立长期血管通路收住.体温36.8℃,脉搏80次/min,血压140/80 mmHg.营养一般,神志清晰,查体配合,面部及四肢无肿胀,心肺听诊正常,腹部平坦无压痛,右股静脉置管在位、无渗出,双上肢可见陈旧性手术瘢痕,双上肢动静脉内瘘听诊无血管杂音.

Objective To compare the incidence of hypotension and disbalance syndrome in hemodialysis patients in different ages and ultrafiltration volumes.Methods 100 hemodialysis patients were randomly divided into three groups:<2.0L group,2.0-3.0L group,>3.0 group by ultrafiltration volumes,while another three group:<39 ages group,40-60 ages group and >61 ages group by ages.Hypotension,vomiting,muscle spasms,headache,sore waist and aching back were observed and analyzed during three months.Results The incidence of hypotension and disbalance syndrome increases in patients with large ultrafiltration in the same age group,while in patients with eldly age in the same ultrafiltration group.Conclusion To reduce the incidence of hypotension and disbalance syndrome,ultrafiltration volume should be strictly controlled.Age and ultrafiltration volume are the risk factors of hypotension and disbalance syndrome.

Objective To investigate the effect of ultrasound-guided biopsy of renal tissue success rate, complications and the related factors.Methods Under ultrasound guided, biopsy of renal tissue near the outer edge of renal cortical was carried out, and the related factors were analyzed.Results Of 224 cases, a injection success accounted for 215 cases and two injections accounted for 9 cases in fear of insufficient number of glomeruli. Renal tissue were removed, the average number of glomeruli was 10-24, the overall success rate of biopsy was 100%, which meet the needs of three mirror checks of microscope, and make a complete pathological diagnosis. Among complications, gross hematuria accounted for 21 cases (9.4%), kidney hematoma for 11 cases (4.9%), uroschesis for 14 cases (6.3%), waist discomfort was 16 cases (7.1%). Hypertension before operation, renal insufficiency, uncooperative patients possess a higher incidence of complications (P<0.05 ).Conclusion Ultrasound-guided biopsy of renal tissue is a method with a high success rate, few complications. Good communication with patients before operation, controlling blood pressure, strengthening the breath-holding training, and so on, can reduce the risk of complications.

Objective To investigate the common causes and prevention strategies of low tolerance in old patients with uraemia during hemodialysis.Methods The incidence of hypotension during dialysis was observed and compared between the old people group and the young people group.Results Hypotension of the old patients during hemodialysis was closely related to ultrafiltration volume and having meal during dialysis.For the former reason,672 out of 1542(43.5%) had hypotension,while for the latter reason 186 out of 1542(27.68%) had it.Conclusion The incidence of hypotension in old patients during hemodialysis is significantly decreased by reducing ultrafiltration volume,guiding rational diet,and keeping optimistic,etc.

Objective To observe the effect of percutaneous sclerotherapy for treating patients with simple renal cystis(SRC) and their progrosis.Methods Under the continous ultrasound guidance,the SRC was washed with the sclerosant,after it was punctured,liquid was drawed out one time or many times,and in the meantime the infection was controlled.Results Of the 1020 samples,the successful rate of the SRC puncture one time was 99.23%,the total effective rate and the curative rate after one year of the SRC with the sclerotherapy was 100% and 83.53% respectively,and there was no serious complication.Conclusion Our study revealed that the sclersant(alcohol),which was washed out the SRC without reservation,may effectively make the cystis closed,and no serious side effect occur,but if the sclerousant isn't enough,the SRC would easily get recurred.

肾脏移植是治疗终末期肾功能衰竭的有效措施之一.本院自1998年2月～1999年12月行肾脏移植术13例,疗效满意.现就其在移植前准备工作的体会总结如下.