目的 探讨持续负压吸引在微通道经皮肾镜取石术治疗鹿角形肾结石的临床效果。方法 选取2016年1月—2017年12月在我院确诊鹿角形肾结石并行经皮肾镜取石术治疗的病例138例;根据通道大小、有无负压吸引装置分为观察组和对照组,其中观察组66例,采用20F微通道联合持续负压吸引,对照组72例,采用22F标准通道,无负压吸引。比较两组的术中生命体征变化、肾盂内压力以及术后发热的发生率。结果 观察组在术中血压和心率等生命体征变化、肾盂内压力以及术后发热的发生率均低于对照组,差异有统计学意义(P<0.05)。结论 微通道联合负压吸引行经皮肾镜取石术治疗鹿角形肾结石可以有效降低肾盂内压力,有效维持生命体征的稳定,减少术后发热的发生率,提高手术安全性。

Objective To explore the clinical effect of percutaneous nephrolithotomy for treatment of staghorn kidney stonesusingmicro-channel combined with vacuum suction. Methods A total of 138 patientsofstaghorn kidney stones with PCNL in our hospital from January 2016 to December 2017 were included and divided into experimental group and control group according to the size of the channel and the vacuum suction device. Y-type minimally invasive dilatation drainage kit of 20F micro-channelandvacuum suctionwere used in experimental group within 66 patients.A standard channel (22F diameter) without vacuum suction was used in control group within 72 patients. The changes in vital signs, intrapelvic pressureand incidence of postoperative fever were compared between experimental and control groups. Results The vital signs variety of blood pressure and heart rate, intrapelvic pressure and incidence of postoperative fever in experimental group were lower than those in control group(P<0.05). Conclusion Micro-channel combined with vacuum suctioninpercutaneous nephrolithotomy for treatment of staghorn kidney stones could effectively maintenance of stable vital signs, reduce intrapelvic pressure and the incidence ofpostoperative fever, and improve the safety of surgery.

目的 通过观察隔姜灸神厥穴并同时口服黄芪汤治疗脓毒症急性肾损伤患者的效果分析,初步探讨该方法能否改善患者的APACHEⅡ评分,入住重症监护病房的时间有没有缩短,14天内死亡率有否差异。方法 以2014年1月—2015年8月于我院确诊的脓毒症急性肾损伤患者为研究对象,观察常规治疗(对照组)及常规治疗基础上给予隔姜灸神厥穴同时口服黄芪汤治疗(治疗组)对脓毒症急性肾损伤患者危重情况的影响。结果 治疗组患者的危重指标(APACHEⅡ评分)明显改善,患者治疗5天后组间比较差异有统计学意义(P<0.05);两组患者入住重症监护病房的时间比较,患者治疗第四周χ²=4.5241,P=0.0334,差异有统计学意义(P<0.05);14天死亡率差异无统计学意义(P>0.05)。结论 隔姜灸神厥穴同时口服黄芪汤治疗能有效改善脓毒症急性肾损伤患者的APACHEⅡ评分,入住重症监护病房的时间减少。

目的 分析复方丹参注射液对轻度子痫前期患者肾功能与妊娠结局的影响。方法 对照组:在1000 mL浓度为5%的葡萄糖注射液中加入60 mL浓度为25%的硫酸镁,每天静滴1次,以连续静滴5 d为一个疗程;观察组:在250 ml浓度为5%的葡萄糖注射液中加入20 mL复方丹参注射液行静脉滴注治疗,每天静滴1次,以连续静滴5 d为一个疗程。结果 观察组的总有效率为96.88%,对照组为78.13%,观察组高于对照组,两组存在差异(P<0.05)。结论 为了有效改善轻度子痫前期患者的妊娠结局及预后,建议在临床中推广使用复方丹参注射液。

Objective The Objective of the investigation was to study how compound danshen injection(CDI)affected the kidney function and pregnant outcomes of patients diagnosed as mild preeclampsia. Methods Samples are randomly divided into two groups:observation group,in which patients were treated with magnesium sulfate,and control group,in which patients were treated with Danshen injection. Results In control group the treatment showed valid effect in 78.13% of the patients,and in observation group the ratio was 96.88%, which was remarkably higher. Conclusion To improve the pregnant outcomes and prognosis of mild preeclampsia,compound danshen injection should be recommended during the clinical practice.

目的 探讨肾移植术后患者膀胱痉挛发生现状及影响因素。方法 选取广州医科大学附属第一医院2022年12月—2024年4月收治的80例肾移植患者为研究对象,记录术后膀胱痉挛发生情况,将15例术后发生膀胱痉挛的患者纳入膀胱痉挛组,其余65例患者纳入非膀胱痉挛组。对比两组一般人口学资料,术前临床资料、术中及术后情况。以合并膀胱痉挛作为因变量纳入Logistics回归模型分析肾移植术后膀胱痉挛发生的影响因素。结果 80例肾移植患者在术后共有15例患者发生膀胱痉挛,占比为18.76%。膀胱痉挛组与非膀胱痉挛组的性别、年龄、体质指数、文化程度、付费方式、家庭收入比较差异无统计学意义（P>0.05）;两组原发疾病、合并基础疾病、透析方式比较差异无统计学意义（P>0.05）,两组患者术前透析时间及术前贫血情况比较差异有统计学意义（P<0.05）;两组手术时间、术中出血量、术后尿管留置时间、术后尿潴留、术后视觉模拟量表评分、C反应蛋白、肿瘤坏死因子-α、白细胞介素-6、碱性磷酸酶、谷草转氨酶、肌酐、尿素氮、胱抑素C比较差异无统计学意义（P>0.05）,两组使用尿管材质、术后7 d平均尿量比较差异有统计学意义（P<0.05）;根据Logistics回归分析结果显示,术前透析时间（95%CI：1.327~9.846,OR：3.614,P=0.012）、术前贫血（95%CI：0.995~1.000,OR：0.997,P=0.045）、尿管材质（95%CI：1.498~3 199.687,OR：69.239,P=0.030）及术后7 d平均尿量（95%CI：1.058~334.543,OR：18.813,P=0.046）为肾移植术后膀胱痉挛发生的独立影响因素（P<0.05）。结论 肾移植患者术前透析时间较长、术前贫血、应用尿管材质较硬、术后尿量少均可增加术后膀胱痉挛发生风险,因此需针对膀胱痉挛高风险患者增加护理评估,监测患者术后尿量,尽量选择软质尿管,预防肾移植术后膀胱痉挛的发生。

Objective To explore the current situation and influencing factors of bladder spasms in patients after kidney transplantation. Methods Selecting 80 kidney transplant patients admitted to the First Affiliated Hospital of Guangzhou Medical University from December 2022 to April 2024 as the research subjects, the occurrence of postoperative bladder spasm was recorded. Fifteen patients who experienced bladder spasm after surgery were included in the bladder spasm group, and the remaining 65 patients were included in the non bladder spasm group. The general demographic data,preoperative clinical data, intraoperative and postoperative conditions between two groups were compared. Incorporating bladder spasm as the dependent variable into the Logistics regression model to analyze the influencing factors of bladder spasm after kidney transplantation. Results A total of 15 out of 80 kidney transplant patients experienced bladder spasms after surgery, accounting for 18. 76%. By comparing general demographic data between the bladder spasm group and the non bladder spasm group, it was found that there were no significant differences in gender, age, Body Mass Index, education level, payment methods, and household income（P>0. 05）. There was no significant differences in primary disease, combined basic disease, and dialysis method between the two groups（P>0. 05）,while there were significant differences in preoperative dialysis time and preoperative anemia between the two groups（P<0. 05）. Surgical time, intraoperative blood loss,postoperative urinary retention, postoperative visual analog scale score, C reactive protein, tumor necrosis factor-α, interleukin-6, alkaline phosphatase, transaminase, creatinine, urea nitrogen, cystatin C were not different between the two groups（P>0. 05）. The difference in the mean urine volume after seven days and urinary catheter material were significant（P<0. 05）. According to the results of the Logistic regression analysis,preoperative dialysis duration（95%CI：1. 327-9. 846,OR：3. 614, P=0. 012）, preoperative anemia（95%CI：0. 995-1. 000,OR：0. 997, P=0. 045）, catheter material（95%CI：1. 498-3 199. 687,OR：69. 239, P=0. 030）, and mean urine output at seven days postoperatively（95%CI：1. 058-334. 543,OR：18. 813, P=0. 046）were identified as independent influencing factors for the occurrence of bladder spasms after kidney transplantation（P<0. 05）. Conclusions Renal transplant patients have a longer preoperative dialysis time, and the use of harder urinary catheter materials and lower postoperative urine output can increase the risk of postoperative bladder spasms. Therefore, it is necessary to increase nursing evaluation for high-risk patients with bladder spasms mentioned above, monitor postoperative urine output, and choose soft urinary catheters as much as possible to prevent the occurrence of bladder spasms after kidney transplantation.

       目的   血清同型半胱氨酸（Hcy）水平与慢性肾脏病（CKD）的进展相关，但中年人群的非线性关联研究较少，本研究旨在寻找慢性肾脏病危险因素。方法   本研究基于NHANES 1996—2006年数据，纳入5 361例45~65岁参与者，以估算肾小球滤过率（eGFR）＜60 mL/（min·1.73 m² ）和尿白蛋白/肌酐比值（uACR）≥30 mg/g评估肾功能下降。结果   通过逻辑回归及平滑曲线拟合分析发现，Hcy每升高1 µmol/L，eGFR降低的风险增加8%（OR=1.08，95%CI：1.06~1.10），uACR升高的风险增加2%（OR=1.02，95%CI：1.00~1.04）。非线性分析显示，Hcy对eGFR的阈值效应拐点为13.4 µmol/L（拐点左侧OR=1.59，95%CI：1.49~1.70；右侧无显著关联）。亚组分析表明，性别、高血压、糖尿病等协变量无交互作用，然而，在敏感性分析中，糖尿病患者中Hcy与eGFR降低的关联更强（交互P=0.015 8）。结论   本研究提示，控制Hcy水平或可延缓美国中年人群（尤其是糖尿病患者）的肾功能衰退。

        Objective   Elevated serum homocysteine（Hcy）levels are linked to chronic kidney disease（CKD）progression，yet the nonlinear relationship in middle-aged populations remains underexplored．Methods  This  study analyzed data from 5 361 participants aged 45–65 years in the NHANES 1996–2006 cohort．Renal dysfunction was defined as an estimated glomerular filtration rate（eGFR）＜60 mL/min/1.73 m²  and urinary albumin-to-creatinine ratio（uACR）≥30 mg/g．Results  Logistic regression and smoothed curve fitting revealed that each 1 µmol/L increase in Hcy elevated the risk of reduced eGFR by 8%（OR=1.08，95% CI：1.06–1.10）and uACR by 2%（OR=1.02，95% CI：1.00–1.04）．A nonlinear threshold effect was identified at 13.4 µmol/L，with a stronger association below this threshold（OR=1.59，95% CI：1.49–1.70）and no significant effect above it．Subgroup analyses showed no interactions with gender or hypertension，but a stronger Hcy-eGFR association was observed in diabetics（interaction P=0.0158）．Conclusions  These findings suggest that controlling Hcy levels may mitigate renal decline，particularly in diabetic populations，warranting further causal investigations．