End-stage renal disease（ESRD） patients undergoing outpatient hemodialysis（HD） and home peritoneal dialysis（PD） are high risk population of severe and critical types caused by SARS-CoV-2 infection. In order to improve the quality of diagnosis and treatment in dialysis patients with SARS-CoV-2 infection, we wrote this recommendation for primary care clinicians. During the epidemic period of SARS-CoV-2 infection, all patients should be instructed to strengthen self-management. Once the SARS-CoV-2 infection was found in dialysis patients, early stratified management should be carried out within 72 hours after the first positive nucleic acid or antigen test results, which includes early antiviral therapy, early recognition, and transferring severe patients from community or primary hospital to a referral hospital promptly. Guidance for dietary and sports rehabilitation after SARS-CoV-2 infection should also be started as soon as possible.

目的 探讨 TRPC6 离子通道在内质网应激(endoplasmic reticulum stress,ERS)诱导的肾小球系膜细胞(HBZY-1)凋亡中的作用及机制.方法 实验分为正常对照组(NC)、thapsigargin(TG)、TG+SKF96365 和 TG+TRPC6 siRNA组.qRT-PCR和 Western blot技术检测TRPC6 和 ERS相关蛋白(GRP78 和 Caspase12)的 mRNA和蛋白表达.流式细胞术和 Hoechst33258 方法检测细胞凋亡.Fluo-4AM Ca2+成像技术测定细胞内 Ca2+内流(intra-cellular calcium,[Ca2+]i)的变化情况.结果 TG组细胞出现核浓缩或核碎裂为特征的凋亡形态变化,细胞凋亡率增加.TRPC6 和 ERS 相关蛋白(GRP78 和 Caspase12)的表达明显高于 NC 组(P＜0.05).SKF96365 和 TRPC6 siRNA预孵育 HBZY-1 细胞可减轻细胞凋亡(P＜0.05).TG 刺激后[Ca2+]i 也增加(P＜0.05).与 TG 组相比,SKF96365 和TRPC6 siRNA处理后TRPC6、GRP78 和 Caspase12 的表达下调,并伴有[Ca2+]i 的减少(P＜0.05).结论 抑制TRPC6 可以减轻TG诱导的 HBZY-1 细胞凋亡.

目的 探究超声引导下经皮肾穿刺活检后出血的高危因素.方法 以西安交通大学第二附属医院肾病内科2019年1月至2021年12月接受肾活检的1026例患者为研究对象,根据肾活检病例是否发生术后出血分为无出血组(对照组,683例)和出血组(病例组,343例).采用单因素分析筛选影响因素,采用多因素Logistic回归模型分析肾活检后出血的危险因素.结果 超声下可探及出血的343例(33.4％)患者中,需治疗的大出血5例(0.49％).单因素分析显示,出血组病例女性比例及平均体质量指数、血红蛋白浓度、红细胞数量、血小板数量、尿相对密度、尿蛋白定量、三酰甘油及总胆固醇浓度、凝血酶原活动度及凝血酶时间低于无出血组(P<0.05);而出血组病例的凝血酶原时间、国际标准化比值高于无出血组(P<0.05).出血组中血肿面积与空腹血糖、活化部分凝血活酶时间呈显著正相关.多因素Logistic回归分析显示,血小板计数与肾穿刺后出血有关(OR=0.996,P<0.05).结论 血小板计数降低是超声引导下经皮肾穿刺活检后出血的高危因素.

Objective:To explore the effect of aerobic exercise combined with diet management on volume overload and cardiac function in patients with peritoneal dialysis.Methods:A total of 100 patients who received peritoneal dialysis in the Second Affiliated Hospital of Xi ′an Jiaotong University from August 2017 to March 2019 were recruited in the present study. Patients were randomly divided into intervention group and control group according to the random number table (50 cases in each group). The control group received routine nursing, while the intervention group carried out aerobic exercise combined with diet management on the basis of routine nursing. Before and after 6 months of intervention, the volume status, edema degree and cardiac function were compared between the two groups. Results:After 6 months of intervention, the levels of body weight, 24 h urine volume, 24 h ultrafiltration volume, systolic pressure, extracellular water, and extracellular water/total body water were (58.99 ± 7.30) kg, (366.41 ± 66.92) ml, (565.08 ± 102.24) ml, (142.64 ± 11.70) mmHg (1 mmHg=0.133 kPa), (12.30 ± 2.01) L, 0.39 ± 0.08 in the intervention group, significantly lower than in the control group (63.46 ± 12.90) kg, (431.90 ± 78.92) ml, (625.35 ± 91.31) ml, (150.11 ± 11.44) mmHg, (14.37 ± 4.12) L, 0.43 ± 0.07, the differences were statistically significant ( t values were 2.026-4.208, all P<0.05); the left ventricular ejection fractions, E/A were (61.38 ± 9.42)%, 1.15 ± 0.35 in the intervention group, significantly higher than in the control group (57.04 ± 7.83)% and 1.00 ± 0.29, the differences were statistically significant ( t values were 2.358, 2.113, all P<0.05). After 6 months of intervention, the normal ratio increased and Ⅲ grade ratio decreased in the intervention group, the difference of edema degree between the two groups was statistically significant ( Z value was 3.153, P<0.01). Conclusions:Aerobic exercise combined with diet management can effectively control the volume overload status and improve the cardiac function of patients with peritoneal dialysis.

目的:观察中医外治法火龙灸联合中药穴位贴敷治疗脾肾阳虚型泄泻的临床效果.方法:将64例中医辨证为脾肾阳虚型泄泻患者随机分为观察组和对照组各32例,对照组给予口服中药汤剂,3周1个疗程;观察组给予火龙灸,联合穴位贴敷,3周1个疗程,3个疗程后进行疗效比较.结果:3个疗程后观察组有效率(90.63％)显著高于对照组(71.88％),两组疗效有统计学意义(P＜0.01).结论:火龙灸联合中药穴位贴敷治疗脾肾阳虚型泄泻效果显著,值得临床推广.

目的 探讨动静脉内瘘成形术患者出院准备度应用情况.方法 选择2016年10月至2017年11月本院收治的112例行动静脉内瘘成形术的终末期慢性肾脏病(CKD)患者,分为干预组(n=60)和对照组(n=52),干预组在常规护理的基础上进行出院准备干预,对照组采取常规护理.比较两组患者出院准备度量表4个维度21个条目评分.结果 干预组出院准备度评分与对照组比较差异具有统计学意义(P<0.05);受教育程度越高患者的出院准备度评分越高;与家人同居的患者出院准备度评分(139.9±12.34)明显优于独居患者的出院准备度评分(79.3±7.38),差异具有统计学意义(P<0.05).结论 正确的出院准备干预显著提高了患者出院准备度水平,医护人员应高度关注末期慢性肾脏病患者动静脉内瘘成形术后的出院准备度水平.

目的 分析不同类型肾疾病患者的肾脏巨噬细胞(Mφ)浸润情况,探讨肾脏Mφ与肾功能损害及患者预后的关系.方法 取肾脏病临床患者的肾穿刺活检标本110例和11例正常肾组织标本,石蜡包埋切片,用Mφ标记物CD68免疫染色,随机选取视野,计算每例患者肾脏Mφ浸润程度,并对肾脏Mφ浸润程度与肾功能及肾组织纤维化进行相关性分析.结果 不同类型肾疾病患者的肾组织均可见Mφ浸润,主要发生在肾小管间质区,Mφ浸润程度自高向低依次为狼疮性肾炎、系膜增生性肾炎伴慢性间质或血管病变、IgA肾病、糖尿病肾病、紫癜性肾炎、膜性肾病、系膜增生性肾炎,除系膜增生性肾炎外的其余各组均较正常对照组明显升高(P＜0.01).各类型肾疾病的肾脏Mφ浸润程度与患者血液的肌酐、尿素氮、胱抑素C水平呈正相关,与肾小球滤过率显著负相关,与肾脏纤维化程度呈正相关(P＜0.01).结论 肾脏Mφ浸润程度在不同类型肾疾病中存在统计学差异,与患者肾功能损害程度、肾脏纤维化程度呈正相关,提示Mφ与肾疾病的类型和转归密切相关.

目的 解决长期门诊血液透析(Hemo dialysis HD)患者在透析过程中的肢体固定问题.方法 采用方便抽样法选择201 7年6月-2018年5月在我院长期行HD的40例患者为研究对象,按照入院先后时间顺序分为观察组和对照组各20例,观察组患者在HD过程中采用笔者研制的专用肢体固定器进行穿刺侧肢体固定,而对照组患者采用传统胶布固定穿刺针方法.观察两组患者穿刺针脱落或针头移位的发生率及在整个治疗过程中患者满意度.结果 在3 779次血液透析过程中,观察组发生穿刺针脱落0次,穿刺针移位10次;对照组发生穿刺针脱落38次,穿刺针移位63次;观察组患者满意度明显高于对照组,差异有统计学意义(P＜0.05).结论 血液透析患者肢体固定器可有效固定患者手臂,降低穿刺针脱落或移位等并发症的发生,提高患者满意度,值得临床推广应用.

目的:观察补肾祛瘀方对慢性肾衰(CRF)患者肾功能及生活质量的影响.方法:选择2015年3月～2018年5月在我院肾脏内科确诊CRF患者96例,以是否给予补肾祛瘀方治疗干预将其分为治疗组(n=48)和对照组(n=48).对照组患者常规临床护理干预;治疗组在常规治疗基础下煎服补肾祛瘀方,4周为1疗程,连续干预两周,比较两组肾功能指标血清尿素(BUN)、血肌酐(SCr)、血β2-微球蛋白(β2-MG)、24小时尿蛋白定量(Upr/ 24h)、肾小球滤过率(GFR);中医证候积分;免疫功能CD3+、CD4+、CDs+;生活质量;不良反应.结果:干预后,治疗组患者肾功能BUN、Scr、β2-MG、Upr/24h、URBC/h较对照组显著降低,GFR较对照组显著升高,有统计学差异(P＜0.05);干预后,治疗组患者中医证候积分明显低于对照组,有统计学差异(P＜0.05);干预后,治疗组GFR分期进展率4(8.33％)较对照组16 (33.33％)明显降低,而治疗组分期减轻率20 (41.67％)较对照组7(14.58％)显著升高,有统计学差异(P＜0.05);治疗组患者中医治疗总有效率93.75％明显高于对照组62.50％,有统计学差异(P＜0.05);干预后,治疗组患者免疫水平较对照组明显升高,有统计学差异(P＜0.05);干预后,两组患者生活质量较治疗前明显上升,有统计学差异(P＜0.05);干预后,治疗组患者生活质量明显优于对照组,有统计学差异(P＜0.05);治疗组患者总不良反应率12.50％明显低于对照组29.17％,有统计学差异(P＜0.05).结论:补肾祛瘀方可提高慢性肾衰患者治疗效果,促进肾功能恢复,提高免疫力,延缓CRF病程进展,也可使不良反应减少,提高患者日常活动能力及生活质量,值得临床推广应用.

目的:探讨个体化教育与心理干预在慢性肾脏病(CKD)患者中的应用效果.方法:按照随机分配原则将65例患者分为干预组35例和对照组30例,干预组给予个体化教育与心理干预,对照组给予常规护理.观察比较两组自我效能感量表(GSES)、自我护理能力测量表(ESCA)、肾小球滤过率(eGFR)和肌酐(Cr),分别于开始前和干预12周后收集.结果:干预后干预组GSES评分、ESCA评分与对照组比较差异有统计学意义(P<0.05);干预组eGFR、Cr与对照组比较差异有统计学意义(P<0.05).结论:个体化教育与心理干预可改善未经透析治疗的CKD患者的自我效能和自我护理行为.

目的 探讨BOPPPS和思维导图相结合的教学模式在内科学临床实践教学中的应用及教学效果.方法 以西安交通大学2012级临床医学本科生为研究对象,将其分为新教学模式组和传统教学模式组,分别应用BOPPPS结合思维导图的新教学模式和教师授课的传统教学模式开展教学,对学生学习效果进行评价及总结分析.结果 应用BOPPPS与思维导图相结合的新教学模式组的学生基础理论考试成绩与传统教学模式组无差异(P＞0.05),总成绩与病例分析部分成绩明显高于传统教学模式组(P＜0.05).结论 BOPPPS和思维导图相结合的教学模式有助于临床医学学生专业知识的掌握和临床思维的培养,值得推广.

This study planned to explore the effects of M2c macrophages on epithelial-to-mesenchymal transition (EMT) of human renal proximal tubular epithelial cells (HK-2). Human monocytic leukaemia cells were induced by TPA and IL-10 to differentiate M2c macrophages. Subsequently HK-2 cells were co-cultured with the M2c macrophages in Transwell chamber. After 48 h of co-culturing the HK-2 cells were detected in the mRNA and protein expression of E-cadherin, α-SMA and vimentin with RT-PCR, immunofluorescence and Western blot respectively. Besides, the migration ability of the HK-2 cells was estimated with Transwell migration assay. ANOVA was used to compare the difference between groups and Student's t-test to conduct multiple comparisons of two groups. P < 0.05 was considered statistically significant. The results showed that the mRNA and protein expression of α-SMA and vimentin of the HK-2 cells were increased but the E-cadherin decreased significantly after 48 h co-culturing with the M2c macrophages (P < 0.05 or P < 0.01). And the migration ability of HK-2 cells were also increased significantly (P < 0.05). It may be concluded that polarized M2c macrophages may have a promoting effect on the EMT of HK-2 cells.

目的 对传统护理腰带进行改良设计,解决长期腹膜透析患者透析管路的护理问题.方法 本着方便、安全、可靠的原则,对传统的腹膜透析腰带进行改进.选择2013年5月-2015年5月在西安某院肾病内科长期行腹膜透析治疗的终末期肾脏病患者90例为研究对象.将其中2013年5月-2014年4月接受治疗的45例患者设为对照组,采用传统护理腰带进行护理;将2014年5月-2015年5月接受治疗的45例患者设为观察组,采用改良的腹膜透析护理腰带进行护理.观察比较两组患者腹膜透析期间的透析管出口处感染、导管脱落及隧道炎的发生情况.结果 经改良的腹膜透析护理腰带设计合理,能妥善固定腹膜透析管路,安全方便.观察组患者的出口处感染和导管脱落明显低于对照组,差异有统计学意义(P<0.05);观察组无隧道炎发生,也明显低于对照组,差异有统计学意义(P<0.05).结论 经过改良的腹膜透析管路护理腰带使长期腹膜透析患者的护理更方便、安全、有效,它能减少腹膜透析相关性腹膜炎的发生率,值得临床推广应用.

目的:评价人文关怀在尿毒症患者血液透析期问的应用效果.方法:选取我院2014年2月~2015年2月收治的尿毒症患者69例作为研究对象,均行血液透疗法,以血液透析期问小同护理干预为依据分为研究组35例和对照组34例.研究组开展人文关怀,对照组开展一般护理,对照两组血液透析总有效率、护理满意度.结果:护理后,研究组护理满意度为94.29%,血液透析总有效率为97.14%,对照组为79.41%、76.47%,组问对比,差异有统计学意义(P<0.05).结论:临床对尿毒症患者行血液透析疗法的过程中,同时予以人文关怀,可大大提升效果.

Hippocampus plays an important role in spatial learning and memory. Ghrelin, a brain-gut peptide, participates in the mnestic functions of hippocampus through its receptor growth hormone secretagogue receptor (GHS-R) distributed in hippocampus. This study was to investigate whether there was a correlation between the changes of ghrelin system in hippocampus and the spatial cognitive impairment caused by chronic renal failure (CRF).

Objective To investigate the clinical efficacy of multi-targets therapy in treatment of elderly nephrotic syndrome. Methods Sixty-three elderly nephrotic syndrome patients in our hospital from May 2012 to May 2014 were randomly divided into the multi-target group and control group. Patients in multi-target group were treated with prednisone, mycophenolate mofetil( MMF) , tacrolimus, while patients in control group were treated with prednisone and cyclophosphamide. Clinical efficacy, urine and blood biochemical indexes were estimated after 3-month treatment. Results After 3-month treatment, the total effective rate in multi-target group was 96. 88%(31/32), significantly higher than in control group(83. 87%,P<0. 05). The urinary protein,serum creatinine,cholesterol and serum albumin were significantly improved in multi-target group compared with control group(P<0. 05). The recurrence rates and incidences of side effects were significantly lower in multi-target group than in control group(P<0. 05). Conclusion The clinical efficacy of multi-targets therapy in treatment of elderly nephrotic syndrome is significant.

目的 探讨腹膜透析患者实施健康教育-互动模式后对预防腹膜透析并发症发生的重要性.方法 采用健康教育-互动模式对我院肾病科35例腹膜透析患者或家属通过反复的知识培训,提高患者的认知程度,观察培训前后患者及家属对腹膜透析相关知识的认知程度及腹膜炎、出口处感染、容量负荷过多、血压控制不佳等腹膜透析相关并发症的发生情况.结果 采用健康教育-互动模式培训后,患者及家属对腹膜透析相关知识的认知程度提高,培训前后腹膜透析相关并发症的发生率分别是:腹膜炎(17％ VS 9％),出口处感染(48％ VS 9％),容量负荷过多(29％ VS 6％),血压控制不佳(49％ VS 20％),培训后较培训前均有显著下降(均P＜0.05).结论 对腹膜透析患者实施健康教育-互动模式,能有效提高腹膜透析患者的生活质量,对降低腹膜透析常见并发症的发生率具有重要意义.

总结了开展 B 超实时引导下肾穿刺活检术的护理体会。主要包括术前护理、术中护理、术后护理及术后并发症的护理。179例行超声实时引导下肾活检术的住院患者，通过多方面、全方位的护理，减轻了焦虑程度，降低了并发症发生，取材成功率达到了98．45％，并发症发生率仅6．14％，患者满意度100％。认为实时超声引导下肾活检术安全、可靠，而手术前后优质护理的实施是减少或避免各种并发症、保证手术成功的重要环节。

Objective To evaluate the application effect of clinical nursing pathway on renalbiopsy patients.Methods 330 cases underwent renal biopsy were randomized divided into observation group and control group with 165 cases in each group.The control group was treated with routine nursing care of renal medicine and the observation group with the basis of the establishment of specialty nurses,using clinical nursing path form the content of nursing care.Results The results of implementation of clinical pathway for management of patients after the nursing job satisfaction improved significantly(P0.005).Conclusion On the basis of percutaneous renal biopsy with demand for the implementation of clinical nursing path management,shorten the hospital days,refinement of the nursing work,improve the quality of care and patient satisfaction.