Objective To summarize the experience of open heart operation on neonates with critical and complex congenital heart diseases and evaluate the methods of perioperative management. Methods From May 2001 to January 2003, 12 patients of neonates with congenital heart diseases underwent emergency operation. Their operating ages ranged from 6 to 30 days, the body weights were 2.8 to 4.5 kg. Their diagnoses included D-transposition of the great arteries in 4 cases, ventricular septal defect with atrial septal defect in 5 cases, complete atrioventricular septal defect, obstructed supracardiac total anomalous pulmonary venous drainage and cardiac rhabdomyomas in 1 case respectively. 12 cases were operated under moderate or deep hypothermic cardiopulmonary bypass. Results All cases were observed in ICU for 2-11 days and discharged 7-19 days after operation. The postoperative complications included low cardiac output, mediastinal infection, respiratory distress syndrome, systemic capillary leak syndrome and acute renal failure. All cases were cured and the follow-up (from 6 months to 2 years) showed satisfactory outcome. Conclusion A particular cardiopulmonary bypass and proper perioperative management is very important to ensure the successful outcome. Peritoneal dialysis is an effective and safe method for treating acute renal failure after cardiac operation in neonates.
ObjectiveTo investigate the status of roxadustat in patients undergoing maintenance peritoneal dialysis and analyze the factors affecting drug compliance. MethodsPatients with renal anemia undergoing maintenance peritoneal dialysis in West China Hospital of Sichuan University from July 2020 to March 2021 were selected. All patients took roxadustat orally. According to the medication compliance, the patients were divided into good compliance group and poor compliance group. The general information questionnaire and Morisky Medication Adherence Scale-8 (MMAS-8) were used to investigate and analyze the included patients, and their clinical examination indexes were collected. ResultsA total of 100 patients were included, Including 39 cases (39%) in the good compliance group and 61 cases (61%) in the poor compliance group. The average score of medication compliance of roxadustat was 5.19±1.72. Logistic regression analysis showed that drug cognition [odds ratio (OR)=0.099, 95% confidence interval (CI) (0.027, 0.365), P=0.001], medication troubles/complex protocol [OR=5.330, 95%CI (1.567, 18.132), P=0.007], and adverse drug reactions [OR=5.453, 95%CI (1.619, 18.368), P=0.006] were factors affecting patient compliance. Hemoglobin in the good compliance group was lower than that in the poor compliance group (Z=?2.259, P=0.024); there was no significant difference in other clinical examination indexes (P>0.05). ConclusionsThe overall compliance of oral roxadustat in maintenance peritoneal dialysis patients is poor, and the corresponding follow-up management system should be improved. Nurses should provide comprehensive and systematic medication guidance to patients, encourage them to fully understand the clinical manifestations, treatment schemes and prognosis of renal anemia, clarify the time, dose, possible adverse reactions and mitigation methods of roxadustat, etc., and help them to treat the disease with correct cognition and attitude, so as to improve their drug compliance.
目的 探討持續性非臥床腹膜透析（CAPD）患者低鉀血癥的發生及臨床特點。 方法 選取2002年12月－2011年12月采取持續非臥床腹膜透析治療的47例尿毒癥患者，就其透析過程中低鉀血癥發生情況進行總結分析。 結果 低鉀血癥31例（66%）；低鉀血癥組與非低鉀血癥組比較，低鉀血癥組血尿素氮、肌酐、血鈉、血氯、血鈣及白蛋白明顯降低（P＜0.05）；兩組年齡、性別、糖尿病腎病所占的比例及透析齡差異均無統計學意義（P＞0.05）。血鉀水平隨白蛋白濃度、血氯及血鈣的提高而下降（OR=0.756， 0.772，0.022，P＜0.05）。 結論 密切聯系、定期隨診觀察CAPD患者，提高患者就診依從性，及時發現與糾正低鉀血癥，有助于提高CAPD患者的生活質量與長期存活率。
Objective To summarize our experience of cardiovascular surgery for patients dependent on dialysis, and evaluate its safety and efficacy.?Methods?Clinical data of 10 consecutive patients dependent on maintenance dialysis underwent cardiovascular operations between Dec. 2004 and April 2011 in Peking Union Medical College Hospital were analyzed retrospectively. There were 6 male and 4 female patients, aged between 23 to 71 （57.6±13.2） years. They were put on dialysis 3-98 （25.2±30.6） months prior to operation due to diabetic nephropathy in 6 patients, chronic glomerulitis in 3 patients and systemic lupus erythemus in 1 patient, and 8 were dependent on hemodialysis and 2 on peritoneal dialysis. Five patients underwent coronary artery bypass grafting, one underwent Bentall procedure，two underwent aortic valve replacement, one underwent mitral valve replacement, and one underwent superior vena cava thrombectomy and patch repair. Patients underwent dialysis on the day before elective operation, followed by continuous ultra-filtration during cardiopulmonary bypass, and then bedside heparin-free continuous veno-venous hyperfiltration-dialysis started 5-32 hours after the operation. Conventional peritoneal dialysis or hemodialysis was resumed 4-7 days after operation.?Results?All operations were successfully completed. Cardiopulmonary bypass time was （125.8±33.5）minutes, aortic clamp time was（77.2±25.5） minutes. One in-hospital death occurred due to septic shock after deep chest wound infection. One patient underwent re-exploration due to pericardial temponade to achieve hemostasis. Three patients experienced atrial fibrillation and were all converted to sinus rhythm by amiodarone. Nine patients recovered to discharge and were followed-up for 8-76 months. Two late deaths occurred due to intracranial hemorrhage and liver carcinoma respectively. Seven survived patients were all in New York Heart Association grade II functional class, and none of them experience major advertent cardiac events related to grafts or prosthetic valve. One patient switched to hemodialysis 14 months after discharge due to peritonitis.Conclusion?Cardiovascular surgery can be practiced in patients dependent on maintenance hemodialysis or peritoneal dialysis with appropriate peri-operative management, so that symptoms can be relieved and quality of life improved.
ObjectiveTo investigate the influence of evidence-based nursing intervention on the treatment effect and quality of life in patients with peritoneal dialysis. MethodSixty-four patients who underwent peritoneal dialysis between January 2013 and December 2014 in our hospital were randomly divided into control group (n=32) and intervention group (n=32) . The control group received routine nursing and the intervention group received evidencebased nursing intervention. Urea clearance index (KT/V), serum albumin and hemoglobin levels were detected for both groups of patients before and after nursing intervention. Generic Quality of Life Inventory (GQOLI)-74 scale was used to assess patients' quality of life. ResultsAfter nursing intervention, KT/V, serum albumin and hemoglobin levels in the intervention group were significantly higher than those in the control group (P<0.05) . The scores of such items as physical function, psychological function, social function and overall evaluation in the GQOLI-74 scale in the intervention group were significantly higher than those in the control group (P<0.05) . ConclusionsEvidence-based nursing intervention can effectively improve the treatment effect and quality of life in patients with peritoneal dialysis, which is worthy of clinical popularization and application.
Objective To investigate the risk factors of high peritoneal transport characteristics in patients with end-stage renal disease undergoing initial continuous ambulatory peritoneal dialysis. Method The clinical data of continuous ambulatory peritoneal dialysis patients who underwent initial peritoneal dialysis and catheterization in the Department of Nephrology, West China Hospital of Sichuan University from January 2011 to December 2017 and completed the peritoneal equilibration test were collected retrospectively. According to the ratio of dialysate to plasma ratio for creatinine at 4 hour [D/Pcr (4h)] in the standard peritoneal equilibration test, the patients were divided into 4 groups (low transport, low average transport, high average transport and high transport). Spearman correlation analysis was used to analyze the related factors of D/Pcr (4h). The risk factors of high peritoneal transport characteristics were analyzed by ordered multi classification logistic regression. Results A total of 647 patients were included. The average age of the patients was (45.85±14.03) years, and the average D/Pcr (4h) was 0.67±0.12. Among them, there were 89 cases (13.76%) in the high transport group, 280 cases (43.28%) in the high average transport group, 234 cases (36.17%) in the low average transport group and 44 cases (6.80%) in the low transport group. Diabetic patients with D/Pcr (4h) were higher than those without diabetes mellitus (0.72±0.12 vs. 0.66±0.12; t=?4.005, P<0.001). Correlation analysis showed that age and 24-h urine volume were positively correlated with D/Pcr (4h); serum albumin, triglyceride, potassium, calcium, magnesium, phosphorus, hemoglobin, serum uric acid and creatinine were negatively correlated with D/Pcr (4h); body surface area (BSA), high sensitivity C-reactive protein, ferritin, cholesterol, sodium, intact parathyroid hormone and estimated giomerular filtration rate had no correlation with D/Pcr (4h). Regression analysis showed that serum albumin [odds ratio (OR)=0.842, 95% confidence interval (CI) (0.809, 0.877), P<0.001], serum uric acid [OR=0.996, 95%CI (0.994, 0.998), P<0.001], magnesium [OR=0.389, 95%CI (0.156, 0.965), P=0.042], BSA [OR=3.916, 95%CI (1.121, 13.680), P=0.032] were correlated with the incidence of peritoneal high transport characteristics. Conclusion Low serum albumin, high BSA, low magnesium and low serum uric acid were independent risk factors for high transport characteristics in initial PD patients.
ObjectiveTo explore the practice effect of the combination management of tertiary hospital and community hospital for home peritoneal dialysis patients. MethodsA total of 50 patients of end-stage renal disease from December 2012 to May 2013 were involved in this study, including 26 males, and 24 females with the average age of 47.1±13.9. The patients were randomly divided into hospital group (30 patients) and combination group (20 patients). For the patients in the hospital group, the specialists take care of them with regular outpatient service and follow-up; for the patients in the combination group, they were taken care by doctors from both tertiary hospital and community hospital, while the community general practitioners were trained by the tertiary hospital regularly with peritoneal dialysis basic treatment and standardization management and communication. All the patients were managed for 9 months. ResultsAt the end of the observation,the dialysis adequacy success rate, hemoglobin, blood potassium, phosphorus, calcium, albumin, CO2CP, blood pressure success rate, the incidence of peritonitis, and average monthly medical treatment expense between the two groups were not statistically different (P>0.05); the difference in cost of transportation was statistically significant (P<0.05). ConclusionThe standardization manage of combination of tertiary hospital and community for patients with home peritoneal dialysis may reduces the patients' expense in transportation, and improve the community general practitioners' level of basic knowledge and indication of peritoneal dialysis.
ObjectiveTo explore and discuss the effects of lanthanum carbonate on serum calcium and phosphorus of continuous ambulatory peritoneal dialysis (CAPD) patients with chronic renal failure receiving calcitriol pulse therapy due to secondary hyperparathyroidism (SHPT). MethodsCAPD patients caused by SHPT in peritoneal dialysis centre of the Qingdao Municipal Hospital of Eastern Hospital from March to June, 2013 were selected and randomly divided into two groups (lanthanum carbonate group and calcium carbonate group). The lanthanum carbonate group were treated with oral lanthanum carbonate and calcitriol pulse therapy, while the calcium carbonate group were treated with calcium carbonate and calcitriol. Change of levels of serum calcium, phosphorus and iPTH were observed and statistic analysis was conducted using SPSS 17.0. ResultsA total of 40 CAPD patients were included, 20 cases in each group. After 12-week treatment, levels of serium phosphate (t=5.095, P=0.000) and iPTH (t=1.225, P=0.000) in the lanthanum carbonate group were significantly lower than those before treatment. The levels of serum calcium (t=1.127, P=0.001) and phosphate (t=2.035, P=0.000) in the lanthanum carbonate group were significantly lower than those in the calcium carbonate group (P < 0.05). ConclusionLanthanum carbonate serves as a useful approach to improve hypercalcemia and the hyperphosphatemia in CAPD patients receiving calcitriol pulse therapy due to SHPT.