Risk factors for pulmonary hypertension in patients receiving maintenance peritoneal dialysis

We investigated the risk factors for pulmonary hypertension (PH) in patients receiving maintenance peritoneal dialysis (MPD). A group of 180 end-stage renal disease patients (124 men and 56 women; mean age: 56.43±8.36) were enrolled in our study, which was conducted between January 2009 and June 2014. All of the patients received MPD treatment in the Dialysis Center of the Second Affiliated Hospital of Soochow University. Clinical data, laboratory indices, and echocardiographic data from these patients were collected, and follow-ups were scheduled bi-monthly. The incidence and relevant risk factors of PH were analyzed. The differences in measurement data were compared by t-test and enumeration data were compared with the χ2 test. Among the 180 patients receiving MPD, 60 were diagnosed with PH. The remaining 120 were regarded as the non-PH group. Significant differences were observed in the clinical data, laboratory indices, and echocardiographic data between the PH and non-PH patients (all P<0.05). Furthermore, hypertensive nephropathy patients on MPD showed a significantly higher incidence of PH compared with non-hypertensive nephropathy patients (P<0.05). Logistic regression analysis showed that the proportion of internal arteriovenous fistula, C-reactive protein levels, and ejection fraction were the highest risk factors for PH in patients receiving MPD. Our study shows that there is a high incidence of PH in patients receiving MPD and hypertensive nephropathy patients have an increased susceptibility to PH.

Effects of perioperative rehabilitation for patients with self-forearm internal arteriovenous fistula / 中国实用护理杂志

Objective To evaluate the effects of perioperative rehabilitation for patients with self-forearm internal arteriovenous fistula.Methods Divided 124 patients with end-stage renal disease into the functional training group (65 cases,A group)and the control group(59 cases,B group) randomly,and then compared certain related indexes between the two groups.Results In the A group,the artery diametcr was obvious widen before functional training without operation,and the vein diameter was obvious widen before functional training without operation too,P ＜ 0.05.After operation,the A group Anastomotic unobstructed was obviously better than B group in one-stage,P ＜ 0.05.A group with thrombosis cases significantly less postoperative than B group,P ＜ 0.05.A group with edema of hands was significantly shorter than B group,P ＜ 0.01.Postoperative fistula time to maturity in the A group was (43.76 ± 2.21) days,which was significantly shorter than that of in the B group,(49.69 ± 5.85) days,P ＜ 0.01.Conclusion Systematic strengthening of perioperative functional exercises can significantly improve preoperative vascular conditions,improve the success rate of operation,reduce risk of thrombosis cases,shorten the time of hand edema and the time of fistula in mature.

Effect of different puncture distances in internal arteriovenous fistula on dialysis adequacy in maintenance hemodialysis patient / 现代临床护理

Objective To investigate the effect of different puncture methods on dialysis adequacy in maintenance hemodialysis patients. Methods One hundred and twenty patients receiving maintenance hemodialysis were divided into the observation group and the control group according to the sequence of receiving the hemodialysis with 60 cases in each group. Patients in the observation group were treated with increasing distance arteriovenous fistula of more than 10 cm , while patients in the control group received normal dialysis care without changing the way of puncture. The difference of dialysis adequacy before and after intervention were compared between the two groups. Result The dialysis adequacy after intervention in the observation group was improved significantly compared with the control group (P<0.05). Conclusion The dialysis adequacy in patients with maintenance dialysis can be improved by increasing the puncture distance of internal arteriovenous fistula.

Detection of blood flow in the brachial artery and dialysis flow after standard internal fistula operation by ultrasound:an association study / 中华超声影像学杂志

Objective To explore the value of detection of blood flow in the brachial artery after forearm standard internal fistula (wrist radial artery-cephalic vein)operation by color Doppler ultrasound in the assessment of internal fistula function.Methods The data of the blood flow in the brachial artery after forearm standard internal fistula operation detected by color Doppler ultrasound in 103 patients were retrospectively studied.In detecting the blood flow in the brachial artery,350 ml/min and 500 ml/min were used as demarcation points and the patients were divided into dysfunction,uncertainty and good function group.In internal fistula dysfunction,dialysis flow <200 ml/min was taken as the golden criterion.ROC curve was constructed and analyzed.Results In using Doppler ultrasound to detect the blood flow in the brachial artery and to diagnose the standard internal fistula dysfunction,the area under ROC curve was 0.949 (P <0.001)and 95% of confidence interval was (0.909,0.989).The best diagnostic demarcation point was 470 ml/min.In using the blood flow 350 ml/min and 500 ml/min in the brachial artery as demarcation points and dividing the patients into dysfunction,uncertainty and good function group,the area under the ROC curve was 0.916 (P <0.001 )and 95% of confidence interval was (0.857,0.975 ).Conclusions The accuracy of using Doppler ultrasound to detect the blood flow in the brachial artery and to diagnose the standard internal fistula dysfunction is higher.Using 350 ml/min and 500 ml/min as demarcation points,the grouping method is of higher clinical applied value.

Issues related to vascular access in pediatric blood purification / 中华实用儿科临床杂志

This article makes a summary on the vascular access issues related to pediatric blood purification and progress,especially in view of the characteristics,principles of selection,maintenance and development direction of various vascular access in application of children patients.