Objective To understand the prevalence,treatment and influence factors of hypertension in maintenance hemodialysis (MHD) patients in Anhui Province.Methods A total of 2724 adult patients on MHD from January 1st 2014 to March 31st 2014 in 26 hospitals of southern,northern and central Anhui Province were investigated.Their demographic characteristics,primary disease,complications,medications,dialysis and laboratory examination were explored.The prevalence treatment rate and control rate of hypertension were analyzed.Associated factors for controlling hypertension [systolic blood pressure (SBP) ＜ 140 mmHg and diastolic blood pressure (DBP) ＜ 90 mmHg] were assessed by logistic regression analysis.Results (1) The prevalence of hypertension in the hemodialysis patients was 87.0％.Their treatment rate and control rate were 93.2％ and 23.9％ respectively.The average of SBP was (145.90±21.18) mmHg,and the DBP on average was (83.60± 12.21) mmHg.The most commonly used anti-hypertensive drug is calcium channel blocker (88.2％).Over one third (45.7％) of patients were treated with two kinds of anti-hypertensive drug,26.2％ with 1 kind,21.7％ with 3 kinds,and 6.4％ with 4 kinds or more.(2) Compared with non-hypertension patients,patients with hypertension have older age,higher body mass index (BMI),phosphorus,SBP and DBP,as well as lower hemoglobin and Kt/V (all P ＜ 0.05).(3) The multivariate logistic regression analysis showed that Ca ＞ 2.50 mmol/L (OR=2.084,95％CI 1.008-4.307,P=0.047) positively correlated with controlling hypertension,while smoke (OR=0.594,95％CI 0.356-0.911,P=0.046) and BMI 18.5 ～ 23.9 kg/m2 (OR=0.516,95％CI 0.293-0.907,P=0.022) negatively correlated with it.Conclusions High prevalence yet low control rate of hypertension in MHD patients in Anhui Province were observed.Hypocalcemia may be a protective factor for hypertension control,while smoke and BMI may be risk factors for it.

Objective To explore the prevalence of anemia,percentage of patients with hemoglobin（Hb）reaching the guideline target,and its impact factors in maintenance hemodialysis（MHD）patients in Anhui Province.Methods Two thousand six hundred and one cases of MHD patients were investigated in hemodialysis centers of 26 hospitals in southern,northern and central Anhui Province

目的 探讨安徽省成人高尿酸血症患病率及相关危险因素.方法 应用2010年安徽省成人慢性肾脏病调查数据,分析安徽省成人高尿酸血症患病情况及相关危险因素.结果 研究调查了安徽省18岁以上常驻居民3 800例,其中资料完整者3 374例.检出高尿酸血症患者260例,其中男性133例,女性127例,粗患病率为7.70％.经安徽省常驻人口年龄、性别校正后,高尿酸血症患病率分别为7.04％、7.88％.Logistic回归分析发现民族、文化程度、肥胖、饮酒、高血压、高脂血症及慢性肾脏病可能是高尿酸血症的独立危险因素.结论 高尿酸血症的危险因素与国内外研究一致,积极控制体质量和血脂、减少饮酒有助于预防高尿酸血症.

Objective To understand the mineral and bone disorder (MBD) status in the maintenance hemodialysis (MHD) patients in Anhui province; To explore the risk factors of hyperphosphatemia.Methods The cases of MHD patients were investigated in hemodialysis centers of 26 hospitals,including 19 tertiary hospitals,seven secondary hospitals,of southern,northern and central Anhui province from January 1st,2014 to March 31st,2014.Research content included general demographic characteristics,laboratory examination,clinical manifestation and medications,etc.Taking KDOQI and KDIGO guidelines as standard respectively,success rates of adjusted serum calcium,phosphorus,intact parathyroid hormone (iPTH) was observed and then compared with the dialysis outcomes and practice patterns study (DOPPS) 3 and DOP S4.At last,success rate of adjusted serum calcium,phosphorus,intact parathyroid hormone (iPTH) in patients with MHD was compared in different hospitals of various grades.Results (1) Among the selected 2774 cases,1662 cases of male,1112 cases of female,with mean age (52.4±14.4) years old and the average dialysis time (45.4± 39.1) months,the top three original diseases were chronic glomerulonephritis (49.8％),hypertensive nephrosclerosis (18.7％) and diabetic nephropathy (15.4％).(2) On the basis of KDOQI guidelines:the success rate of adjusted serum calcium,serum phosphorus,iPTH in MHD patients was 40.1％,36.9％,23.0％,lower than DOPPS3 (50.4％,49.8％,31.4％) and DOPPS4 (56.7％,52.6％,29.6％) (P ＜ 0.01);Compared with the developed areas in China,the success rate of iPTH was lower (P ＜ 0.05),while the success rate of adjusted serum calcium and serum phosphorus had no obvious difference (P ＞ 0.05).(3) On the basis of KDIGO guidelines,the success rate of adjusted serum calcium,serum phosphorus,iPTH in MHD patients was 52.0％,21.6％ and 47.8％ respectively.(4) Comparing different hospitals of various grades:the success rate of serum phosphorus and iPTH in tertiary hospital patients was significantly higher than secondary hospitals (P ＜ 0.05),while the success rate of adjusted serum calcium has no obvious difference (P ＞ 0.05).(5) The treatment situation of MBD:on the basis of KDIGO guidelines,the inappropriate treatment of low serum calcium,hyperphosphatemia and secondary hyperparathyroidism (SHPT) accounted for 46.4％,47.0％ and 31.8％ respectively.(6) Gender,age of dialysis,hemoglobin,region distribution and economic income level had nothing to do with hyperphosphatemia incidence; Overweight,and elevated serum albumin were independent risk factors of hyperphosphatemia; Tertiary hospitals and increasing age were protection factors of hyperphosphatemia.Conclusions The success rate of serum calcium,phosphorus and iPTH in MHD patients of Anhui province is not optimistic.MHD patients in tertiary hospitals with MBD are in more ideal control situation than the basic-level hospitals,thus it indicates that closer monitoring and management are expected to improve the success rate.Independent risk factors of hyperphosphatemia are overweight,elevated serum albumin; Tertiary hospitals and increasing age are protection factors of hyperphosphatemia.

目的探讨运用多种血液净化方法联合治疗尿毒症并发症的疗效及护理。方法在156例维持性血透(MHD)患者中选择合并难治性高血压10例、皮肤瘙痒15例、不安腿综合征5例等共30例,采用高通量透析(HFHD)、血液透析滤过(HDF)、血液透析加血液灌流(HD+HP)等多种血液净化方法联合治疗。结果 30例患者透析并发症症状均得到改善。结论多种血液净化方法联合治疗尿毒症并发症的疗效确切,可靠。

目的:探讨维持性血液透析用动静脉内瘘血栓栓塞药物溶栓的方法、护理及效果。方法:用生理盐水20ml稀释尿激酶10万u,用4?号头皮针朝吻合口离心方向刺入血管内,用微量泵在30分钟内将尿激酶匀速注入,保留针头。注入尿激酶时,在穿刺点上方5～10cm处束扎止血带,定时松解,同时用手轻压栓塞部位。注意内瘘血管震颤和血管杂音变化情况。血流恢复后每日皮下注射低分子肝素钠5000u,连用3天,并在24小时内安排血液透析1次。结果:32例,44例次内瘘溶栓,成功30例,失败2例与栓塞时间过长有关。结论:尿激酶联合低分子肝素钠早期局部溶栓治疗内瘘栓塞创伤小、操作简便、并发症少,疗效确切,值得推广。

ANCA即抗中性粒细胞胞浆抗体(anti neutrophil cytoplasmic antibodies ANCA).中性粒细胞是白细胞中数量最多的一种,胞浆中有些特殊颗粒及嗜天青颗粒,颗粒中具有杀菌作用的酶,它们有广泛的生物学活性,当受到炎症刺激时可以在细胞表面表达,诱导免疫反应产生ANCA[1].ANCA的本质足免疫球蛋白G(即IgG).

Objective:Cerebral infarction is frequently seen in haemodialytic patients,we investigated the characteristics pe- ripheral artery atherosclerosis and cerebral infarction,in order to explorate association between them.Methods:In 42 patients with end-stage renal disease who underwent haemodialysis therapy(HD group) and 42 age-matched healthy (control group), color Doppler ultrasonography was performed to check the atherosclerotic plaque of paries posterior of carotid and femoral ar- teries and Gofman's index,CT for cerebral infarction.Results:Compared with control group,the patients in HD group showed thicker atheroscierotic plaque of paries posterior of carotid and femoral arteries (1.52±0.49 mm vs 0.88±0.26mm,P＜0. 001;1.37±0.48mm vs 0.86±0.33mm,P＜0.05,respectively),higher Gofman's index (4.00±3.03 vs 0.43±0.96,P＜0. 001;1.45±1.91 vs 0.24±0.86,P＜0.05,respectively),higher positive rate of C-reactive protein (33.3% vs 0%,P＜0. 001);higher incidence of cerebral infarction (28.6% vs 0%,P＜0.001).Atherosclerotic plaques of carotid and femoral arteries demonstrate mixed echogenicity.Conclusion:Atherosclerosis is a common complication,and significant carotid artery stenosis or ulcerations releasing microemboli to the brain are responsible for many occlusive cerebrovascular diseases.Color Doppler ultra- sonography may be used for detection of atherosclerosis in hemodialytic patients,and providing evidence for working out thera- peutic schedule.

动静脉内瘘是慢性肾衰竭维持性血液透析患者赖以生存的"生命线".内瘘对透析效果和患者长期生存有重要影响.目前国内外采用的内瘘手术方法大多是上肢前臂腕纹上桡动脉头静脉吻合术,实践中该术式时有因增加回心血量,诱发充血性心力衰竭.本文采用鼻咽窝桡动脉远心端与头静脉近心端端端吻合能有效地控制吻合口血流量,既不诱导高输出性心力衰竭,又不增加远期内瘘并发症,且能满足常规血液透析的血流量要求.现将研究结果报道如下.

目的探讨维持性血液透析患者的最佳内瘘手术方式.方法153例慢性肾功能衰竭患者随机分为两组,鼻咽窝组78例,于手背鼻咽窝处0.6～1 cm切口,应用9个零无损伤尼龙线行桡动脉远端头静脉近端端端吻合8～12针.前臂组75例,于左前臂腕纹上3 cm纵形切口2～5 cm,用9个零无损伤尼龙线间断作桡动脉头静脉两近心端端端吻合.手术1年后,应用彩色多普勒超声检查测定吻合口血流量;记录透析血流量;以及1年间充血性心衰发生率与内瘘并发症.结果78例鼻咽窝组内瘘吻合口血流量与透析血流量均较理想,无并发症发生.结论手背鼻咽窝处应用9个零无损伤尼龙线行桡动脉远端头静脉近端端端吻合建立血透通路为最佳选择.既不诱导高输出性心力衰竭,又不增加远期内瘘并发症,且能满足常规血透的血流量要求.

Objective: To investigate the influence on maintenance hemodialysis patients' dialysis tolerance of integrating L-carnitine with erythropoietin(EPO). Method: Twenty-six maintenance hemodialysis patients were divided into two groups: A and B .in group A(n=13),1g of L-carnitine was infused to the patients at the and end of each hemodialysis treatment. In group B(n=13) apart from L-carnitine, Epo (120u/kg,each week)was infused to the patients for ten weeks. The improvement of clinical symptom, blood and biochemistry target were observed separately.Result: Both of them were improved in physical and mental status, appetite, intra-dialytic hypotension and cramps, the group B was improved significantly. Net weight, hemoglobin, hemotocrit and serum albumin were rising, and the group B was rising significantly. Conclusion: To integrate L-carnitine with Epo can improve maintenance hemodialysis patients' dialysis tolerance.