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Analysis of Etiological Factor for 139 Cases of Acute Renal Failure

目的:探讨住院患者急性肾功能衰竭(ARF)的临床病因方法:回顾性分析139例ARF患者的临床资料,探讨其病因、肾衰类型及危险因素。结果:139例ARF患者中,肾前性90例,肾性37例,肾后性12例。其中,60岁以上的老年人73例,占52.5%。引起ARF的根本病因中,感染、心衰及创伤为引起ARF的主要病因。结论:注意有效血容量不足的症状及体征、及时扩容及控制感染可以减少ARF的发生。同时,60岁以上老年人仍是高危人群,应重在预防。

急性生理改变与慢性健康评估综合评分系统在预测急性肾功能衰竭患者预后中的应用

目的　探讨急性生理改变与慢性健康评估综合评分系统（APACHEⅡ）在预测急性肾功能衰竭患者预后中的应用。 方法　对2007年1月－2009年10月重症医学科（ICU）诊断为急性肾功能衰竭的50例患者行APACHEⅡ评分，并就APACHEⅡ评分值与病死率、死亡风险间的关系进行分析。 结果　6～16分段病死率21.9%，死亡风险8.43 ± 9.15；17～26分段病死率65.0%，死亡风险22.64 ± 16.32；27～36分段病死率70.6%，死亡风险48.93 ± 26.53；37～46分段病死率100.0%，死亡风险77.42 ± 23.18；其中17～36分段占74.0%，随着APACHEⅡ评分升高， 死亡风险及病死率随之升高，并且呈正相关。 结论　APACHEⅡ是一种较好的疾病严重度分类系统，对于判断急性肾功能衰竭患者预后有较重要的价值。

Clinical Features and Prognosis of Patients with Acute Renal Failure

【摘要】　目的　总结急性肾功能衰竭（acute renal failure， ARF）的病因特点、治疗情况与预后的关系。　方法　回顾性分析2007年8月-2008年4月77例ARF的临床资料，总结各种因素与患者预后的关系。　结果　肾性因素是最主要的致病病因，占77.92%，其中以药物和中毒居多。老年患者、少尿型患者或合并多脏器功能衰竭患者病死率较高，分别为25.93%，29.55%，83.33%。　结论　ARF应早期诊断，积极给予综合治疗，包括肾脏替代治疗，老年ARF患者易出现多脏器功能衰竭、合并感染等，应放宽透析指征，并注意去除高危因素以提高存活率。【Abstract】　Objective　To explore the clinical features, treatment, and prognosis of acute renal failure (ARF).　Methods　The clinical data of 77 patients with ARF from Auguest 2007 to April 2008 were retrospectively analyzed.　Results　Renal factor was the most important cause of ARF, accounting for 77.92%. The mortalities of elderly patients, oliguric patients and with multiple organ failure were 25.93%, 29.55%, and 83.33%, respectively.　Conclusion　Patients with ARF should be diagnosed as early as possible and given comprehensive treatments, including renal replacement therapy; the elderly patients with multiple organ failure and infection should be relaxed dialysis indications. We should pay attention to the removal of risk factors to improve the survival rate.

Application of the Clinical Score Developed by Cleveland University to Predict Acute Renal Failure after Cardiac Surgery in Chinese Patients

Abstract: Objective To investigate the application value of the Clinical Score developed by Cleveland University in predicting the occurrence ratio of acute renal failure in Chinese patients after cardiac surgery. Methods A total of 456 adult patients , 230 males and 226 females , with cardiac surgery during August 2008 to July 2009 were included in our study. Their age ranged from 18 to 88 years with an average age of 56.7 years. Before the surgery, Clinical Score was used to predict acute renal failure after cardiac surgery. Based on the score of ≤5, 610, or ≥11, the patients were divided into group Ⅰ (n=401), group Ⅱ (n=42) and group Ⅲ (n=13). The occurrence rate of acute kidney injury (AKI), continuous renal replacement therapy in hospital, multiple organ failure, mortality and other clinical indexes were compared among the 3 groups. Results Occurrence ratio of AKI of group Ⅰ, Ⅱ, Ⅲ was respectively 2.74%, 28.57% and 76.92% (χ2=73.004, P=0.000). Continuous renal replacement therapy rate was respectively 0.50%, 9.52%, and 38.46% (χ2=36.939, P=0.000). Multiple organ failure rate was respectively 0.50%, 4.76%, and 23.08% (χ2=19.694, P=0.000). Mortality rate was respectively 0.25%, 2.38%, and 15.38% (χ2=14.061, P=0.001). There were significant differences among the three groups. Conclusion The Clinical Score to Predict Acute Renal Failure developed by Cleveland University can effectively predict the occurrence rate of acute renal failure in the Chinese patients after cardiac surgery before the operation. Therefore, corresponding preventive methods can be taken for highrisk patients.

体外循环心脏手术后急性肾功能衰竭的肾脏替代治疗

目的 探讨体外循环（CPB）心脏手术后急性肾功能衰竭(ARF)的发生原因及肾脏替代治疗的方法，总结其治疗经验。 方法 回顾性分析我院2004年2月至2008年2月14例体外循环心脏手术后发生急性肾功能衰竭患者的临床资料，所有患者除常规治疗外，分别给予持续血液滤过1例、血液透析5例、腹膜透析7例。 结果 14例患者中死亡7例，其中5例死于多器官功能衰竭，1例死于低心排血量综合征，1例死于腹膜透析并发败血症。余7例经肾脏替代治疗8～39 d肾功能恢复，治愈出院。生存的7例患者随访1～48个月，肾功能无明显异常，尿素氮4.16±3.19 mmol/L(2.96±8.18 mmol/L)，肌酐56±16 μmol/L(55~89 μmol/L)。 结论 急性肾功能衰竭是体外循环心脏手术后严重并发症之一，死亡率较高。采取适当的预防措施可减少该并发症的发生，血液滤过、血液透析及腹膜透析是有效的肾脏替代治疗方法。

A Randomized Controlled Trial of Reduced Glutathione in the Treatment of Acute Renal Failure

Objective　To evaluate the effectiveness and safety of reduced glutathione in the treatment of acute renal failure. Methods　Twenty-three patients with acute renal failure were divided into the treatment group (n=10) and the control group (n=13) by simple randomisation. Patients in the treatment group received intravenous reduced glutathione 1200 mg daily. Patients in the control group were not treated with reduced glutathione. The therapeutic course for both groups was 4 weeks. Serum creatinine and urea nitrogen were determined before treatment as well as at the end of each of the 4 weeks. Proximal and distal renal tubular functions were evaluated at the end of the treatment. The time when clinical symptoms were improved was recorded and adverse drug reactions were monitored. Results　The durations of nausea and vomiting as well as the oliguria stage were shorter in the treatment group than in the control group. The serum creatinine level in the treatment group decreased more markedly than that in the control group. At the end of the treatment, the renal tubular function was better in the treatment group than in the control group. Conclusion　Reduced glutathione contributes to the early recovery of renal function in patients with acute renal failure. However, more high-quality and large-scale randomized controlled trials are needed.

Development of Liver Transplantation of Severe Hepatitis

对高龄重症急性肾功能衰竭患者连续性肾脏替代疗法的护理

目的探讨在连续性肾脏替代疗法（CRRT）中，对高龄重症急性肾功能衰竭（SARF）患者的护理方法。 方法2010年2月－2012年 7月，对收治的 28例高龄 SARF患者行 CRRT治疗后，根据治疗结果分为存活组（22例）和死亡组（6 例），观察两组患者治疗前后心功能、并发症及器官衰竭的数量，总结有针对性的护理对策。 结果在CRRT 治疗中，两组患者在心功能指标和器官衰竭数量比较，差异均有统计学意义（P＜0.05）。 结论CRRT 是抢救高龄 SARF 患者的有效方法，并且根据生命体征监测数据制定有针对性的护理措施能够有效地提高其存活率。

Prevention of Postoperative Acute Renal Failure in Patients with Malignant Obstructive Jaundice

Objective　To investigate the protection of renal function and the prevention of acute renal failure （ARF） in patients with malignant obstructive jaundice in perioperative period of radical resection. Methods　A series of clinical interventions had been taken since 2004 in our treatment team, including control of endotoxemia, depression of biliary tract before operation, maintenance of adequate effective blood volume, nutritive support, administration of mannitol and low dose of furosemide, and avoidance of disseminated intravascular coagulation. The incidence of perioperative ARF in 206 patients with malignant obstructive jaundice who had been radically resected from 2000 to 2007 was retrospectively studied, and the RIFLE criteria was used for ARF classification. This study was progressed in two periods. The first one was from Jan. 2000 to Dec. 2003, and the second one was from Jan. 2004 to Dec. 2007. Results　After 2003, the proportion of radical resection rose from 44.8% to 57.1% （P＜0.05), and the rate of perioperative ARF dropped from 15.1% to 6.7%（P＜0.05), among which the proportion in the RIFLE-R (Risk) stage had no significant change, while in the RIFLE-F (Failure) stage it dropped from 10.5% to 2.5% (P＜0.05). Finally, perioperative mortality rate dropped from 16.3% to 5.8% (P＜0.05). Therefore, the reduction of ARF was mainly attributed to the reduction in RIFLE-F stage. Conclusion　By using the latest RIFLE criteria to classify ARF, it illustrates that our perioperative interventions have effectively decreased ARF, limited ARF in its early and reversible stage, and prevented advancing.

Experimental Research of Renal Aquaporin-3 Expression in Obstructive Jaundice

ObjectiveTo explore the value of Aquaporin-3 (AQP-3) on the detection of early renal function damage by investigating the expressions of renal AQP-3 mRNA and protein of rats with obstructive jaundice (OJ). MethodsForty mature male Wistar rats were divided into two groups randomly: experimental group (n=20) in which the model of OJ rats was established, and control group (n=20, sham operation group). The levels of serum total bilirubin (TBIL), direct bilirubin (DBIL), creatinine (Cr)， and blood urea nitrogen (BUN) were detected by fullautomatic biochemical analyzer on 7 d and 14 d after operation. The expressions of renal AQP-3 mRNA and protein of rats were detected by RT-PCR and Western blotting, respectively. ResultsThe levels of serum TBIL and DBIL were significantly higher on 14 d than those on 7 d after operation in experimental group (P=0.000), which were significantly higher than those at corresponding time point in control group (P=0.000), while the difference within control group was not significant (P=0.154). Thus, the OJ models of rats were established successfully. The difference of serum Cr levels of rats between inter-and intragroup were not significant (Pgt;0.05). Serum BUN level on 14 d after operation in experimental group was significantly higher than those on 7 d after operation in experimental group and on 14 d after operation in control group (P=0.001), although serum Cr levels were not different between 7 d and 14 d after operation in control group (P=0.288). The expressions of AQP-3 protein of rats on 7 d and 14 d after operation in experimental group were significantly lower than those at corresponding time point in control group (P=0.033, P=0.000), meanwhile on 14 d after operation in experimental group was significantly lower than those on 7 d after operation in experimental group (P=0.000). The expressions of AQP-3 mRNA of rats on 7 d and 14 d after operation in experimental group were significantly higher than those at corresponding time point in control group (P=0.000), but the difference at different time point in two groups was not significant (P=0.139, P=0.059). ConclusionsThe changes of renal AQP-3 protein and mRNA expressions are prior to the changes of serum Cr and BUN levels of rats suffered from OJ complicated renal function damage, which are promised to improve the early diagnosis rate of renal function damage in rats with OJ.