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標題: 影響小動物急性腎衰竭之預後指標與犬隻使用中央靜脈導管相關感染之評估
Prognostic Indicators Affecting the Outcome of Acute Renal Failure in Small Animals and Evaluation of Related Infection by Using Central Venous Catheter in Dogs
作者: 林凱威
Lin, Kai-Wei
關鍵字: acute renal failure
出版社: 獸醫學系暨研究所
引用: 劉佳遠。犬貓腎衰竭短期預後相關因子之研究。國立台灣大學獸醫學研究所臨床組碩士論文。台北,中華民國,2005。 蔡函儒、劉佳遠、楊淑芳、楊姮稜。血液透析於犬隻腎衰竭治療之評估。台灣獸醫誌29:353-358,2003。 蔡阿芳。肝素及Ticlopidine於犬血液透析之抗凝研究。國立台灣大學獸醫學研究所臨床組碩士論文。台北,中華民國,1996。 Adin CA, Cowgill LD. Treatment and outcome of dogs with leptospirosis: 36 cases (1990-1998). Am Vet Med Assoc 216: 371-375, 2000. Adin CA, Gregory CR, Adin DB, Cowgill LD, Kyles AE. Evaluation of three peripheral arteriovenous fistulas for hemodialysis access in dogs. Vet Surg 31: 405-411, 2002. Adin CA, Gregory CR, Kyles AE, Cowgill L. Diagnostic predictors of complications and survival after renal transplantation in cats. Vet Surg 30: 515-521, 2001. Adin CA. Canine renal transplantation: the next steps. Vet Surg 35: 103-104, 2006. Allon M. Dialysis catheter-related bacteremia: treatment and prophylaxis. Am J Kidney Dis 44: 779-791, 2004. Barber PJ, Elliott J. Feline chronic renal failure: Calcium homeostasis in 80 cases diagnosed between 1992 and 1995. J Small Anim Pract 39: 108-116, 1998. Beal MW, Hughes D. Vascular access: theory and techniques in the small animal emergency patient. Clin Tech Small Anim Pract 15: 101-109, 2000. Beckel NF, Toole TE, Rozanski EA, Labato MA. Peritoneal dialysis in the management of acute renal failure in 5 dogs with leptospirosis. J Vet Emerg Crit Care 15: 201-205, 2005. Behrend EN, Grauer GF, Mani I, Groman RP, Salman MD, Greco DS. Hospital-acquired acute renal failure in dogs: 29 cases (1983-1992). J Am Vet Med Assoc 208: 537-541, 1996. Bernieh B, Al Hakim M, Boobes Y, Siemkovics E, El Jack H. Outcome and predictive factors of acute renal failure in the intensive care unit. Transplant Proc 36: 1784-1787, 2004. Betjes MG, van Agteren M. Prevention of dialysis catheter-related sepsis with a citrate-taurolidine-containing lock solution. Nephrol Dial Transplant 19: 1546-1551, 2004. Block GA, Hulbert-Shearin TE, Levin NW, Port FK. Association of serum phosphorus and calcium × phosphate product with mortality risk in chronic hemodialysis patient: a national study. Am J Kidney Dis 31: 607-617, 1998. Blot F, Nitenberg G, Brun-Buisson C. New tools in diagnosing catheter-related infections. Support Care Cancer 8: 287-292, 2000. Blot F, Nitenberg G, Chachaty E, Raynard B, Germann N, Antoun S, Laplanche A, Brun-Buisson C, Tancrede C. Diagnosis of catheter-related bacteraemia: a prospective comparison of the time to positivity of hub-blood versus peripheral-blood cultures. Lancet 354: 1071-1077, 1999. Bodry AR, Michell AR. An epidemiologic study of blood pressure in domestic dogs. J Small Anim Pract 37: 116-125, 1996. Bouza E, Burillo A, Munoz P. Catheter-related infections: diagnosis and intravascular treatment. Clin Microbiol Infect 8: 265-274, 2002. Brezis M, Rosen S, Epstein FH. Acute renal failure. In: Brenner BM, Rector FC, eds. The kidney, 4th ed. W.B. Saunder Co., Philadelphia, USA, 993, 1991. Brun-Buisson C, Abrouk E, Legran P, Huet Y, Larabi S, Rapin M. Diagnosis of central venous catheter-related sepsis. Critical level of quantitative tip cultures. Arch Intern Med: 873-877, 1987. Bunchman TE, McBryde KD, Mottes TE, Gardner JJ, Maxvold NJ, Brophy PD. Pediatric acute renal failure: outcome by modality and disease. Pediatr Nephrol 16: 1067-1071, 2001. Camacho AT, Guitian EJ, Pallas E, Gestal JJ, Olmeda AS, Goethert HK, Telford SR 3rd, Spielman A. Azotemia and mortality among Babesia microti-like infected dogs. J Vet Intern Med 18: 141-146, 2004. Capdevila JA. Catheter-related infection: an update on diagnosis, treatment, and prevention. Int J Infect Dis 2: 230-236, 1998. Carrer S, Bocchi A, Bortolotti M, Braga N, Gilli G, Candini M, Tartari S. Effect of different sterile barrier precautions and central venous catheter dressing on the skin colonization around the insertion site. Minerva Anestesiol 71: 197-206, 2005. Chetboul V, Lefebvre HP, Pinhas C, Clerc B, Boussouf M, Pouchelon JL. Spontaneous feline hypertension: clinical and echocardiographic abnormalities, and survival rate. J Vet Intern Med: 89-95, 2003. Chew DJ, DiBartola SP, Crisp MS. Peritoneal dialysis. In: DiBartola SP, ed. Fluid therapy in small animal practice, 2th ed. W.B. Saunder Co., Philadelphia, USA, 1615-1633, 2000. Cleri DJ, Corrado ML, Seligman SJ. Quantitative culture of intravenous catheters and other intravascular inserts. J Infect Dis 141: 781-786, 1980. Cook AK, Cowgill LD. Clinical and pathological features of protein-losing glomerular disease in dogs: A review of 137 cases (1985-1992). J Am Anim Hosp Assoc 32: 131-322, 1996. Coolman BR, Marretta SM, Kakoma I, Wallig MA, Coolman SL, Paul AJ. Cutaneous antimicrobial preparation prior to intravenous catheterization in healthy dogs: clinical, microbiological, and histopathological evaluation. Can Vet J 39: 757-763, 1998. Cowgill LD, Elliott DA. Acute renal failure. In: Ettinger SJ, Feldman EC, eds. Textbook of veterinary internal medicine, 5th ed. W.B. Saunder Co., Philadelphia, USA, 1615-1633, 2000. Cowgill LD, Elliott DA. Hemodialysis. In: DiBartola SP, ed. Fluid therapy in small animal practice, 2th ed. W.B. Saunder Co., Philadelphia, USA, 1615-1633, 2000. Cowgill LD, Langston CE. Role of hemodialysis in the management of dogs and cats with renal failure. Vet Clin North Am Small Anim Pract 26: 1347-1378, 1996. Crisp MS, Chew DJ, DiBartola SP, Birchard SJ. Peritoneal dialysis in dogs and cats: 27 cases (1976-1987). J Am Vet Med Assoc 195: 1262-1266, 1989. Crump JA, Collignon PJ. Intravascular catheter-associated infections. Eur J Clin Microbiol Infect Dis 19: 1-8, 2000. Danny WS, Willam HM, Griffin CE. Bacterial skin disease. In: Danny WS, Willam HM, Griffin CE, eds. Muller & Kirk''s small animal dermatology, 6th ed. W.B. Saunder Co., Philadelphia, USA, 274-288, 2001. Davenport A, Jones SR, Goel S, Astley JP, Hartog M. Differentiation of acute from chronic renal impairment by detection of carbamylated haemoglobin. Lancet 341: 1614-1617, 1993. Devriese LA, Vancanneyt M, Baele M, Vaneechoutte M, De Graef E, Snauwaert C, Cleenwerck I, Dawyndt P, Swings J, Decostere A, Haesebrouck F. Staphylococcus pseudintermedius sp. nov., a coagulase-positive species from animals. Int J Syst Evol Microbiol 55: 1569-1573, 2005. DiBartola SP, Rutgers HC, Zack PM, Tarr MJ. Clinicopathologic findings associated with chronic renal disease in cats: 74 cases (1973-1984). J Am Vet Med Assoc 190: 1196-1202, 1987. DiBartola SP. Clinical approach and laboratory evaluation of renal disease. In: Ettinger SJ, Feldman EC, eds. Textbook of veterinary internal medicine, 5th ed. W.B. Saunder Co., Philadelphia, USA, 1600-1614, 2000. Dogra GK, Herson H, Hutchison B, Irish AB. Prevention of tunneled hemodialysis catheter-related infections using catheter-restricted filling with gentamicin and citrate: a randomized controlled study. J Am Soc Nephrol 13: 2133-2139, 2002. Elliott DA, Marks SL, Cowgill LD, Kass PH, Rogers QR. Effect of hemodialysis on plasma amino acid concentrations in healthy dogs. Am J Vet Res 61: 869-873, 2000. Elliott DA. Hemodialysis. Clin Tech Small Anim Pract 15: 136-148, 2000. Elliott J, Barber PJ. Feline chronic renal failure: clinical findings in 80 cases diagnosed between 1992 and 1995. J Small Anim Pract 39: 78-85, 1998. Elwood S, Whatling C. Grape toxicity in dogs. Vet Rec 158: 492, 2006. Eubig PA, Brady MS, Gwaltney-Brant SM, Khan SA, Mazzaferro EM, Morrow CM. Acute renal failure in dogs after the ingestion of grapes or raisins: a retrospective evaluation of 43 dogs (1992-2002). J Vet Intern Med 19: 663-674, 2005. Finco DR, Duncan JR. Evaluation of blood urea nitrogen and serum creatinine concentrations as indicators of renal dysfunction: a study of 111 cases and review of related literature. J Am Vet Med Assoc 168: 593-601, 1976. Fischer JR, Pantaleo V, Francey T, Cowgill LD. Veterinary hemodialysis: advances in management and technology. Vet Clin North Am Small Anim Pract 34: 935-967, 2004. Fischer JR, Pantaleo V, Francry T, Cowgill LD. Clinical and clinicopathologic features of cats with acute ureteral obstruction managed with hemodialysis between 1993 and 2004: a review of 50 cats. J Vet Intern Med 18: 418, 2004. (abstract) Forrester SD, Brandt KS. The diagnostic approach to the patient with acute renal failure. Vet Med 89: 212-218, 1994. Forrester SD, Jacobson JD, Fallin EA. Taking measures to prevent acute renal failure. Vet Med 89: 231-236, 1994. Forrester SD, Little SE. The etiopathogenesis of acute renal failure. Vet Med 89: 204-211, 1994. Forrester SD, McMillan NS, Ward DL. Retrospective evaluation of acute renal failure in dogs. J Vet Intern Med 16: 354, 2002. (abstract) Francey T, Cowgill LD. Use of hemodialyisis in the treatment of acute renal failure in the dog: 124 cases (1990-2001). J Vet Intern Med 16: 354, 2002. (abstract) Francey T. Acute leptospirosis in dogs from Western Swirtzerland (2002-2005), in preparation. Frank LA, Kania SA, Hnilica KA, Wilkes RP, Bemis DA. Isolation of Staphylococcus schleiferi from dogs with pyoderma. J Am Vet Med Assoc 222: 451-454, 2003. Gerber B, Glaus TM, Unterer S, Reusch CE. Evaluation of parameters for the differentiation of acute from chronic renal failure in the dog. Schweiz Arch Tierheilkd 146: 365-373, 2004. (abstract) Goldstein RE, Lin RC, Langston CE, Scrivani PV, Erb HN, Barr SC. Influence of infecting serogroup on clinical features of leptospirosis in dogs. J Vet Intern Med 20: 489-494, 2006. Grauer GF, Greco DS, Behrend EN, Mani I, Fettman MJ, Allen TA. Estimation of quantitative enzymuria in dogs with gentamicin-induced nephrotoxicosis using urine enzyme/creatinine ratios from spot urine samples. J Vet Intern Med 9: 324-327, 1995. Grauer GF. Early detection of renal damage and disease in dogs and cats. Vet Clin North Am Small Anim Pract 35: 581-596, 2005. Grauer GF. Fluid therapy in acute and chronic renal failure. Vet Clin North Am Small Anim Pract 28: 609-622, 1998. Grauer GF. Prevention of acute renal failure. Vet Clin North Am Small Anim Pract 26: 1447-1459, 1996. Greco DS, Turnwald GH, Adams R, Gossett KA, Kearney M, Casey H. Urinary gamma-glutamyl transpeptidase activity in dogs with gentamicin-induced nephrotoxicity. Am J Vet Res 46: 2332-2335, 1985. Gregory CR, Kyles AE, Bernsteen L, Mehl M. Results of clinical renal transplantation in 15 dogs using triple drug immunosuppressive therapy. Vet Surg 35: 105-112, 2006. Gwaltney-Brant S, Holding JK, Donaldson CW, Eubig PA, Khan SA. Renal failure associated with ingestion of grapes or raisins in dogs. J Am Vet Med Assoc 218: 1555-1556, 2001. Hadley RM, Richardson JA, Gwaltney-Brant SM. A retrospective study of daylily toxicosis in cats. Vet Hum Toxicol 45: 38-39, 2003. Hardie EM, Page RL, Williams PL, Fischer WD. Effect of time of cisplatin administration on its toxicity and pharmacokinetics in dogs. Am J Vet Res 52: 1821-1825, 1991. Harvey RG., Lloyd DH. The Distribution of Bacteria (Other than Staphylococci and Propionibacterium acnes) on the Hair, at the Skin Surface and Within the Hair Follicles of Dogs. Vet Dermatol 6: 79-84, 1995. Heiene R, Vulliet PR, Williams RL, Cowgill LD. Use of capillary electrophoresis to quantitate carbamylated hemoglobin concentrations in dogs with renal failure. Am J Vet Res: 1302-1306, 2001. Hoekstra KA, Paulton RJ. Clinical prevalence and antimicrobial susceptibility of Staphylococcus aureus and Staph. intermedius in dogs. J Appl Microbiol 93: 406-413, 2002. Jacob F, Polzin D, Osborne H. Association of initial proteinuria with morbidity and morality on dogs with spontaneous chronic renal failure. J Vet Inter Med 18: 417, 2004. (abstract) Jacob F, Polzin DJ, Osborne CA, Neaton JD, Kirk CA, Allen TA, Swanson LL. Evaluation of the association between initial proteinuria and morbidity rate or death in dogs with naturally occurring chronic renal failure. J Am Vet Med Assoc 226: 393-400, 2005. Johnson JA. Nosocomial infection. Vet Clin North Am Small Anim Pract 32: 1101-1126, 2002. Kinirons B, Mimoz O, Lafendi L, Naas T, Meunier J, Nordmann P. Chlorhexidine versus povidone iodine in preventing colonization of continuous epidural catheters in children: a randomized, controlled trial. Anesthesiology 94: 239-244, 2001. Kite P, Dobbins BM, Wilcox MH, McMahon MJ. Rapid diagnosis of central-venous-catheter-related bloodstream infection without catheter removal. Lancet 354: 1504-1507, 1999. Krogh HF, Kristensen S. A study of skin diseases in dogs and cats. Nord Vet Med 28: 459, 1976. Kuwahara Y, Ohba Y, Kitoh K, Kuwahara N, Kitagawa H. Association of laboratory data and death within one month in cats with chronic renal failure. J Small Anim Pract 47: 446-450, 2006. Labato MA. Peritoneal dialysis in emergency and critical care medicine. Clin Tech Small Anim Pract 15: 126-135, 2000. Labato MA. Strategies for management of acute renal failure. Vet Clin North Am Small Anim Pract 31: 1265-1687, 2001. Lane IF, Grauer GF. Management of acute renal failure. Vet Med 89: 219-230, 1994. Langgartner J, Linde HJ, Lehn N, Reng M, Scholmerich J, Gluck T. Combined skin disinfection with chlorhexidine/propanol and aqueous povidone-iodine reduces bacterial colonisation of central venous catheters. Intensive Care Med 30: 1081-1088, 2004. Langston CE, Cowgill LD, Spano JA. Application and outcome of hemodialysis in cats: a review of 29 cases. J Vet Intern Med 11: 348-355, 1997. Langston CE. Acute renal failure caused by lily ingestion in six cats. J Am Vet Med Assoc 220: 49-52, 2002. Lees GE. Early diagnosis of renal disease and renal failure. Vet Clin North Am Small Anim Pract 34: 867-885, 2004. Lilenbaum W, Esteves AL, Souza GN. Prevalence and antimicrobial susceptibility of staphylococci isolated from saliva of clinically normal cats. Lett Appl Microbiol 28: 448-452, 1999. Lilenbaum W, Nunes EL, Azeredo MA. Prevalence and antimicrobial susceptibility of staphylococci isolated from the skin surface of clinically normal cats. Lett Appl Microbiol 27: 224-228, 1998. Lilenbaum W, Veras M, Blum E, Souza GN. Antimicrobial susceptibility of staphylococci isolated from otitis externa in dogs. Lett Appl Microbiol 31: 42-45, 2000. Linares J, Sitges-Serra A, Garau J, Perez JL, Martin R. Pathogenesis of catheter sepsis: a prospective study with quantitative and semiquantitative cultures of catheter hub and segments. J Clin Microbial 21: 357-360, 1985. Littman MP. Spontaneous systemic hypertension in 24 cats. J Vet Intern Med: 79-86, 1994. Lulich J, Osborne C, O’brien T. Feline renal failure: Questions, answers, questions. Compend Contin Educ Pract Vet 14: 127-152, 1992. Lund EM, Armstrong PJ, Kirk CA, Kolar LM, Klausner JS. Health status and population characteristics of dogs and cats examined at private veterinary practices in the United States. J Am Vet Med Assoc 214: 1336-1341, 1999. Mahajan S, Tiwari S, Bhowmik D, Agarwal SK, Tiwari SC, Dash SC. Factors affecting the outcome of acute renal failure among the elderly population in India: a hospital based study. Int Urol Nephrol 38: 391-396, 2006. Maki DG, Weise CE, SeraBn HW. A semiquantitative culture method for identifying intravenous catheter-related infection. N Engl J Med 296: 1305-1309, 1977. Marsh-Ng ML, Burney DP, Garcia J. Surveillance of infections associated with intravenous catheters in dogs and cats in an intensive care unit. J Am Anim Hosp Assoc 43: 13-20, 2007. Mashita T, Yasuda J, Iijima M, Takiguchi M, Yamazaki T, Hashimoto A. Short-term hemodialysis treatment in dogs and cats with total uretic obstruction. Jpn. J Vet Rec 45: 59-65, 1997. May ER, Hnilica KA, Frank LA, Jones RD, Bemis DA. Isolation of Staphylococcus schleiferi from healthy dogs and dogs with otitis, pyoderma, or both. J Am Vet Med Assoc 227: 928-931, 2005. Minkus G, RC, Horauf A. Evaluation of renal biopsies in cats and dogs-histipathology in comparison with clinicl data. J Small Anim Pract 35: 465-472, 1994. Monroe WE, Davenport DJ, Saunders GK. Twenty-four hour urinary protein loss in healthy cats and the urinary protein-creatinine ratio as an estimate. Am J Vet Res 50: 1906-1909, 1989. Morris DO, Rook KA, Shofer FS, Rankin SC. Screening of Staphylococcus aureus, Staphylococcus intermedius, and Staphylococcus schleiferi isolates obtained from small companion animals for antimicrobial resistance: a retrospective review of 749 isolates (2003-04). Vet Dermatol 17: 332-337, 2006. Morrow CM, Valli VE, Volmer PA, Eubig PA. Canine renal pathology associated with grape or raisin ingestion: 10 cases. J Vet Diagn Invest 17: 223-231, 2005. Nagase N, Sasaki A, Yamashita K, Shimizu A, Wakita Y, Kitai S, Kawano J. Isolation and species distribution of staphylococci from animal and human skin. J Vet Med Sci 64: 245-250, 2002. Nyland TG, Mattoon JS, Herrgesell EJ, Wisner ER. Urinary tract. In: Nyland TG, Mattoon JS, eds. Small animal diagnostic ultrasound, 2nd ed. W.B. Saunder Co., Philadelphia,USA, 162, 2002. Oliver MJ, Callery SM, Thorpe KE, Schwab SJ, Churchill DN. Risk of bacteremia from temporary hemodialysis catheters by site of insertion and duration of use: a prospective study. Kidney Int 58: 2543-2545, 2000. Pantaleo V, Francey T, Fischer JR, Cowgill LD. Application of hemodialysis for the management of acute uremia in cats: 119 cases (1993-2003). J Vet Intern Med 18: 418, 2004. (abstract) Paragioudaki M, Stamouli V, Kolonisiou F. Intravenous catheter infections associated with bacteraemia: a 2-year study in a university hospital. Clin Microbiol Infect 10: 431-435, 2004. Patel A, Lloyd DH, Lamport AI. Antimicrobial resistance of feline staphylococci in south-eastern England. Vet Dermatol 10: 257-261, 1999. Peters RM, Goldstein RE, Erb HN, Njaa BL. Histopathologic features of canine uremic gastropathy: a retrospective study. J Vet Intern Med 19: 315-320, 2005. Petti CA. Detection and identification of microorganisms by gene amplification and sequencing. Clin Infect Dis 44: 1108-1114, 2007. Polzin DJ, Osborne CA, Jacob F, Ross S. Chronic renal failure. In: Ettinger SJ, Feldman EC, eds. Textbook of veterinary internal medicine, 5th ed. W.B. Saunder Co., Philadelphia, USA, 1615-1633, 2000. Polzin DJ, Osborne CA, O’Brien TD. Diseases of the kidneys and ureters. In: Ettinger SJ, ed. Textbook of veterinary internal medicine, 3th ed. W.B. Saunder Co., Philadelphia, USA, 1963-2046, 1989. Poole CV, Carlton D, Bimbo L, Allon M. Treatment of catheter-related bacteraemia with an antibiotic lock protocol: effect of bacterial pathogen. Nephrol Dial Transplant 19: 1237-1244, 2004. Rivers BJ, Johnston GR. Diagnostic imaging strategies in small animal nephrology. Vet Clin North Am Small Anim Pract 26: 1505-1517, 1996. Rumbeiha WK, Francis JA, Fitzgerald SD, Nair MG, Holan K, Bugyei KA, Simmons H. A comprehensive study of Easter lily poisoning in cats. J Vet Diagn Invest 16: 527-541, 2004. Saad TF. Bacteremia associated with tunneled, cuffed hemodialysis catheters. Am J Kidney Dis 34: 1114-1124, 1999. Safdar N, Maki DG. The pathogenesis of catheter-related bloodstream infection with noncuffed short-term central venous catheters. Intensive Care Med 30: 62-67, 2004. Saxena AK, Panhotra BR. The impact of catheter-restricted filling with cefotaxime and heparin on the lifespan of temporary hemodialysis catheters: a case controlled study. J Nephrol 18: 755-763, 2005. Stepanovic S, Dimitrijevic V, Vukovic D, Dakic I, Savic B, Svabic-Vlahovic M. Staphylococcus sciuri as a part of skin, nasal and oral flora in healthy dogs. Vet Microbiol 82: 177-185, 2001. Stokes JE, Forrester SD. New and unusual causes of acute renal failure in dogs and cats. Vet Clin North Am Small Anim Pract 34: 909-922, 2004. Stone EA, Littman MP, Robertson JL, Bovee KC. Renal dysfunction in dogs with pyometra. J Am Vet Med Assoc 193: 457-464, 1988. Syme HM, Elliott K. Relation of survival time and urinary protein excretion in cats with renal failure and/or hypertension. J Vet Inter Med 17: 405, 2003. (abstract) Syme HM, Markwell PJ, Pfeiffer D, Elliott J. Survival of cats with naturally occurring chronic renal failure is related to severity of proteinuria. J Vet Intern Med 20: 528-535, 2006. Vaden SL, Gookin J, Trogdon M, Langston CE, Levine J, Cowgill LD. Use of carbamylated hemoglobin concentration to differentiate acute from chronic renal failure in dogs. Am J Vet Res 58: 1193-1196, 1997. Vaden SL, Levine J, Breitschwerdt EB. A retrospective case-control of acute renal failure in 99 dogs. J Vet Intern Med 11: 58-64, 1997. Whittemore JC, Webb CB. Beyond fluid therapy: treating acute renal failure. Comp Cont Ed Pract Vet 27: 288-297, 2005. Worwag S, Langston C. Retrospective, acute renal failure in cats: 25 cases (1997-2002). J Vet Intern Med 16: 387, 2004. (abstract) Yuasa S, Takahashi N, Shoji T, Uchida K, Kiyomoto H, Hashimoto M, Fujioka H, Fujita Y, Hitomi H, Matsuo H. A simple and early prognostic index for acute renal failure patients requiring renal replacement therapy. Artif Organs 22: 273-278, 1998.
摘要: 腎衰竭為動物臨床上常見疾病之一。當有腎衰竭發生時,即表示有75%以上的腎元失去正常生理功能,進而導致代謝廢物的累積,液體、電解質與酸鹼的不平衡。雖然急性腎衰竭導致的腎臟損傷是可逆性的,但急性腎衰竭在不同治療方式下(如傳統輸液療法、腹膜透析與血液透析療法),仍有30-83%的致死率。另一方面,中央途徑的血管通路(如中央靜脈導管)可用以輸液治療與多次採血,但由於導管相關感染(catheter-related infection)的情形,往往限制這類導管的使用並導致血管通路的喪失。本研究的實驗目的主要分為兩部分,第一部份為收集急性腎衰竭動物的基本資料、出現臨床症狀、伴隨疾病與臨床病理學、尿液學和血液氣體分析的結果,調查影響急性腎衰竭犬貓的相關預後因子。於2000年一月至2006年十二月間,共有1,339個犬隻病例與241個貓隻病例因腎衰竭就診於中興大學獸醫獸醫教學醫院。腎衰竭之年盛行率與致死率在犬隻分別為4-10%與49-59%,在貓隻則為2-10%與33-62%。在判定為急性腎衰竭的動物中(501為犬隻、69為貓隻),犬貓整體致死率分別為81.2%與65.2%。調查結果顯示在犬隻若住院天數 ≦ 5天、就診時體溫 ≦ 37.4℃、氮血症較嚴重(BUN > 100.0 mg/dL、creatinine > 6.0 mg/dL)、血中磷離子(> 10.0 mg/dL)與鈣磷乘積(> 60.0 mg2/dL2)較高和出現蛋白尿(> 25.0 mg/dL)者,會有較高的致死率,然而在貓隻,僅發現住院天數(≦ 4天)與就診時體溫 ≦ 37.6℃者,會影響貓隻的存活率。本研究另一部份為將中央靜脈導管放置於8隻健康犬隻之頸靜脈內,進行6天的實驗期,期間由導管周圍皮膚、導管中心內外圍、導管於皮下與尖端的部分進行採樣,並採集血液進行微生物培養,評估中央靜脈導管相關感染的情形。結果顯示並無發現任何導管相關感染的現象。不過在導管放置後第三天與第六天,由導管周圍皮膚與導管中心外圍所分離到的菌株中,以革蘭氏陽性菌佔多數,特別是Bacillus sp.( 37.5% )、Staphylococcus epidermidis ( 25.0% )與Micrococcus luteus ( 25.0% ),且這些菌株對多數抗生素皆具敏感性,以penicillin、cefazolin、chloramphenicol與enrofloxacin等抗生素敏感性較佳。由本研究可知,在患有急性腎衰竭的犬隻,若就診時呈現較嚴重的氮血症與電解質不平衡時,會有較差的預後。另外,中央靜脈導管未來可安全應用於腎衰竭的動物上,作為長期輸液與採血途徑,並進行中央靜脈壓的監控。
Renal failure is one of the most common diseases in practice and contributes to retention of metabolic toxins and derangement of electrolyte balance. Although renal damage resulting from acute renal failure (ARF) is reversible, the mortality rates of ARF following different treatments were determined between 30-83%. Vascular access of central line such as central venous catheter (CVC) allows for reliable fluid therapy, the key in treating ARF and frequent blood sampling. However, catheter-related infection significantly limits the use of catheters and causes vascular access loss. The purpose of this study was to access the prognostic indicators associated with ARF for small animals in central Taiwan. In addition, we evaluated the catheter-related infection induced by using CVC in dogs. A total of 1,339 dogs and 241 cats with renal failure were admitted to Veterinary Medicine Teaching Hospital of NCHU from January 2000 to December 2006. The yearly prevalence of renal failure in dogs and cats was 5-10% and 2-10%, respectively. Among 501 dogs and 69 cats with ARF, the mortality rates were 81.2% and 65.2%, respectively. The clinical parameters such as hospitalized day (≦ 5 day), body temperature (≦ 37.4℃), the magnitude of azotemia (BUN > 100.0 mg/dL, creatinine > 6.0 mg/dL), the concentrations of serum phosphorus(> 10.0 mg/dL) and calcium × phosphorus product (> 60.0 mg2/dL2), and severity of proteinuria(> 25.0 mg/dL) at initial presentation were identified to be associated with high mortality in dogs, while in cats, only hospitalized day (≦ 4 day) and body temperature (≦ 37.6℃) at initial presentation were identified to be associated with mortality. The application of CVC was performed to eight health adult dogs in a period of 6-day-experment. Skin of insertion site and external surface of catheter hub were cultured for bacteria. Blood cultures were obtained through the distal part of catheter before catheter removal. The results of the culture indicated that gram-positive bacteria were mostly isolated from skin of insertion site and external surface of catheter hub on the 3rd and 6th day after CVC insertion, especially for Bacillus sp. (37.5%), Staphylococcus epidermidis (25.0%), and Micrococcus luteus (25.0%), which were susceptible to penicillin, cefazolin, chloramphenicol and enrofloxacin. In conclusions, canine ARF with severe azotemia and electrolytes disorders is significantly associated with poor outcome. The application of CVC in small animals with renal failure would be safe for a long-term fluid therapy and central venous pressure monitoring in the future.
其他識別: U0005-1107200715040300
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