急性肾损伤肾脏替代治疗模式的临床决策

急性肾损伤是指病程3个月内的,包括血、尿、组织学及影像学检查所见的肾脏结构与功能异常。目前,急性肾损伤肾脏替代治疗的模式尚无明确定论。常用的模式有间断性血液透析、持续性肾脏替代治疗、杂合式肾脏替代治疗、腹膜透析。临床上应根据患者的年龄、病因、病情危重程度、所在医院的条件和经济状况等选择合适的治疗模式。     

论人体肾脏捐献中的合理补偿原则

无偿捐献作为当前获取肾脏的伦理原则,是最没有争议、最理想的,但是依靠单纯的无偿捐献所获器官远远不能满足医疗的需求。合理补偿原则既可以有效增加供体数量,又不违背伦理学原则,而且更具有道德上的广泛性和现实的可行性。相信合理补偿原则的实施将会大大促进我国器官移植事业的发展。     

我国人体器官移植的社会支持系统研究

供体来源不足严重制约了我国器官移植事业的发展。有鉴于此,建立一个非技术的人体器官移植的社会支持系统对促进我国器官移植事业的发展将具有重要意义。通过对该系统各组成部分如法律法规系统、组织管理系统、宣传教育系统、补偿系统的研究,旨在对我国器官移植事业的发展有所裨益。     

Lipo PGE1在肾移植中的应用

为了探讨前列腺素E1的脂微球载体靶向制剂（Lipo PGE1）对肾移植术后移植肾功能恢复和血流动力学的影响,80例肾移植受者在术后被随机分成两组：PGE1组和对照组。PGE1组从手术当天起至术后第14天每天给予静脉注射Lipo PGE1 20μg。比较两组术后尿量、血肌酐、彩色多普勒超声下移植肾收缩期最大血流速度（PSV）和血流阻力指数（RI）以及两组肾功能恢复延迟（DGF）的发生率。应用Lipo PGE1的患者术后尿量明显高于对照组（P〈0．05）,而血肌酐、PSV、RI和肾功能恢复延迟发生率则明显低于对照组（P〈0．05）。因此,前列腺素E1有利于肾移植术后移植肾功能的恢复,对肾移植术后早期肾动脉血流动力学有促进作用。     

单纯性肾囊肿外科手术适应证的选择

单纯性肾囊肿是临床常见的肾脏疾病之一,临床常采用去顶减压术治疗,但外科治疗的适应证目前尚不统一。除症状性肾囊肿及由囊肿引起尿路梗阻外,对于高血压病合并肾囊肿者,如囊肿直径大于5cm,考虑囊肿有可能对高血压产生影响,因此,有必要采取外科治疗措施;但如果不合并高血压,是否一定需要治疗有待进一步探讨。肾囊肿对肾功能影响目前尚无定论,对于小于60岁的肾囊肿患者其肾功能下降可能与肾脏原发病变有关,应积极查找病因并密切随访。对于肾囊肿Bosniak分型为Ⅰ、Ⅱ、ⅡF型的患者,可以不需要手术治疗,密切随访;对于Ⅲ、Ⅳ型患者,应进行外科手术治疗。     

农村与城镇终末期肾病患者临床状况比较分析

时比分析农村与城镇终末期肾病患者的临床状况,旨在了解新农合政策带给农村终末期肾病患者的益处及今后还需完善和努力之处.对广西壮族自治区人民医院血液净化治疗中心2007年新增的238例终末期肾病患者按农村与城镇进行分组对比分析.96例农村患者,88例选择血液透析,8例放弃治疗;142例城镇患者,23例选择腹膜透析,108例血液透析,11例放弃.无论是城镇还是农村患者慢性肾炎为主要的原发病、都存在透析过晚、并发症发生率高、急诊透析率高的现象.与城镇组相比,农村组患者平均年龄、肾痛知晓率、残余肾功能、血红蛋白、二氧化碳结合力、尿素清除指数低于城镇组(P<0.05);梗阻性肾病发病率、并发症发生率、急诊透析率、死亡率、失访率高于城镇组(P<0.05).新农合的实施使农村终末期肾病患者获得了治疗的机会,针对农村患者肾病知晓率低、临床状况差的特点,需加强农村慢性肾病的防治工作.     

绩效反馈研究的回顾与展望

绩效反馈是组织中鼓励先进、鞭策落后、激发员工潜能的很重要的管理手段。该概要回顾了有关反馈的研究,分析了反馈研究的发展趋势,认为不同反馈来源中上级反馈的影响越来越重要;表扬还是批评的信息对员工的影响值得进一步探讨;反馈接受者本人的特点对反馈效果的影响研究应更加深入。     

The impact of defibrillator discharges on psychological functioning of implantable cardioverter defibrillator recipients

A lag exists with respect to our understanding of the psychological demands and rehabilitation needs of individuals who have undergone implantable cardioverter defibrillator (ICD) implantation. The ICD is designed to transmit an electric shock to the heart to treat a potentially life-threatening arrhythmia. This study specifically examined the impact of defibrillator discharges on the psychological functioning of ICD recipients. A questionnaire was self-administered to 33 individuals who have been living with the ICD for at least 6 months. Results revealed that levels of anger and depression were significantly higher in those subjects who reported a lower discharge rate, while sense of well-being was significantly higher in those subjects who reported a greater discharge rate. Possible explanations for our findings were proposed as well as implications for clinical intervention were discussed.     

Training public-speaking behavior: an experimental analysis and social validation

The effect of an instructional package on public-speaking behaviors was analyzed in two experiments. The instructional package was designed to teach public-speaking trainees to look at the audience, make gestures, and perform a number of speaking behaviors. The results of Experiment I, with a university student serving as the trainee, showed that the percentage of each category of public-speaking target behavior increased only after the instructional package was introduced for that category. The results of Experiment 2, with three low-income paraprofessional staff members of a neighborhood service center serving as trainees, showed that the percentage of target behaviors increased after the instructional package was introduced for the respective trainee. Audience ratings of public-speaking performance were correlated with direct observations of target responses. All trainees showed marked improvements in audience ratings from pretraining to posttraining. This study demonstrated an effective procedure for training public-speaking behaviors.     

肾血管病的经皮介入治疗：争议与共识

由于近十年来经皮介入治疗技术的巨大进展,肾血管病（renovascular disease,RVD）患者中接受经皮肾动脉成形治疗的数量迅速增加,已作为纠正严重肾动脉狭窄的首选措施逐步被接受。但目前对粥样硬化性肾动脉狭窄尚无公认的最优治疗,选择经皮介入重建肾动脉血流还是单纯药物保守治疗在学术界尚有争议。现系统评述目前临床...