目的 觀察三種不同血液凈化方式[血液透析（HD）、血液透析濾過（HDF）、血液透析+血液灌流（HD+HP）]對維持性血液透析患者高磷血癥清除效果。 方法 選擇2009年2月－2011年2月行維持性血液透析的48例高磷血癥患者為研究對象，所有患者在低鈣透析（1.25 mmol/L）的基礎，隨機分為HD組、HDF組、HD+HP組，每組16例，分別在治療時及治療后4周、8周檢查鈣、磷、鈣磷乘積和全段甲狀旁腺激素，并觀察其變化。 結果 在治療4周、8周后，HDF組、HD+HP組磷較前均顯著下降（P值均＜0.05），兩組同時點相比較差異無統計學意義（P＞0.05）；HD組較前血磷無明顯變化（P＞0.05）。 結論 HDF、HP清除維持性血液透析患者高磷有顯著的效果，而HD效果則不佳。
【摘要】 目的 探討切開復位肱骨近端內固定鎖定系統(proximal humeral internal locking system，PHILOS)治療老年肱骨近端骨折的療效。 方法 2008年5月-2009年5月，對22例60歲以上肱骨近端新鮮移位骨折按Neer分型，二部分2例，三部分16例，四部分4例；采用肩前方入路切開復位PHILOS治療。 結果 22例患者獲12～18個月隨訪，平均14.6個月，采用Constant-Murley評分，優8例，良10例，可3例，差1例，優良率81.4%。 結論 切開復位PHILOS治療老年肱骨近端骨折療效肯定。【Abstract】 Objective To discuss the clinical effect of open reduction and internal fixation with the proximal humeral internal locking system (PHILOS) plate in treating elder patients with proximal humeral fracture. Methods From May 2008 to May 2009, we classified 22 cases of fresh displaced proximal humeral fracture according to the Neer classification. All patients were older than 60 years. There were two cases of two-part fracture, 16 cases of three-part fracture and four cases of four-part fracture. The open reduction and internal fixation with PHILOS plate was performed with the anterior deltopectoral approach. Results The 22 patients were followed up for 12 to 18 months with a mean period of 14.6 months. According to Constant-Murley Shoulder Score measurement, eight cases were graded as excellent, 10 good, three fair, and one poor with a excellent and good rate of 81.4%. Conclusion The open reduction and internal fixation with Philos plate is effective in treating elder patients with proximal humeral fracture.
ObjectiveTo explore the risk factors for central venous catheter (CVC)-related infections and its Countermeasures, as CVC is an important vascular access for blood purification and is widely used in clinical applications, but catheter-related infection is one of the common severe complications. MethodsWe retrospectively analyzed the clinical data of 725 patients with complicated infections of indwelling center venous double lumen catheter treated between January 2009 and December 2012. ResultsAmong all 725 cases, 15 had catheter-related infection. There were one case of subcutaneous tunnel infection (staphylococcus aureus by the secretion culture, negative for blood culture), and 14 cases of positive blood culture including 9 staphylococcus aureus cases, 3 escherichia coli cases, 1 colorless bacillus case and 1 stenotrophomonas maltophilia case. Eight cases were cured by antibiotic therapy while antibiotics were invalid in the other 7 cases resulting in tube withdrawing. ConclusionThe central venous catheter-related infections are related to medical service ability, catheter indwelling position, indwelling time, hemodialysis adequacy, patients' general condition and personal hygiene. Taking relative measures in view of each factor is the key to prevent infections.
ObjectiveTo analyze the clinical manifestations and pathological patterns of renal diseases requiring percutaneous renopuncture, evaluate the clinical significance of renal biopsy and the value of clinical pathway for renal biopsy. MethodsWe retrospectively summarized and analyzed the clinical and pathological data, and the clinical pathway implementation of 224 patients who underwent renal biopsy between October 2009 and September 2014. ResultsIn the 224 patients, there were 62 cases of IgA nephropathy (27.68%), 50 cases of minimal change nephropathy (22.32%), 28 cases of lupus nephritis (12.5%), 26 cases of membrane nephropathy (11.6%), 26 cases of mesangial proliferative glomerulonephritis (11.6%), 6 cases of purpura nephritis (2.68%), 4 cases of focal segmental glomerular sclerosis (1.79%), 4 cases of hepatitis B virus-associated membrane nephropathy (1.79%), 4 cases of nodular diabetic glomerulosclerosis (1.79%), 4 cases of acute tubulointerstitial nephropathy (1.79%), 2 cases of hypertensive renal damage (0.89%), 2 cases of membrano-proliferative glomerulonephritis (0.89%), 1 case of lipoprotein kidney disease (0.45%), and 1 case of fibrillary glomerulopathy (0.45%). A total of 220 specimens in the 224 cases were qualified, accounting for 98.21%. Diagnosis of 70 patients in the qualified 220 cases were re-corrected according to their renal pathology reports, accounting for 31.81%. In the 224 cases, there were 16 cases of gross hematuria (7.14%) and 24 of peri-renal hematoma (10.71%) after renal biopsy. Patients who met the requirement of clinical pathway were divided into clinical pathway group and control group randomly. Average hospitalization time of the clinical pathway group was (7.6±1.2) days, and the average cost was (5 860±237) yuan, both lower than the control group [(11.8±2.3) days, (7 658±360) yuan)]. The difference was statistically significant. ConclusionsIgA nephropathy is the most common pathological type of primary glomerular diseases, and minimal change nephropathy the second. Lupus nephritis, membranous nephropathy, mesangial proliferative glomerulonephritis are still the most common types of glomerular diseases. Lupus nephritis becomes the first secondary glomerular disease. Ultrasound guided percutaneous renal biopsy is safe and has high success rate and high clinical application value. The implementation of clinical pathway can shorten the average length of hospital stay and reduce the average hospital cost.