Objective To investigate the efficacy and safety of blood purification therapy in the treatment of diuretic resistance in patients with nephrotic edema.Methods 40 cases of primary nephrotic syndrome with diuretic resistance in our hospital were randomly divided into hemodialysis (HD) group and continuous blood purification (CVVH) group and each group were 20 cases.All the patients were given basic treatment (lipid modulation,anticoagulation and glucocorticoid) and the observation time was 4 weeks.The changes of biochemical indexes (24 h urine protein,plasma albumin,serum urea nitrogen and serum creatinine) were observed before and after treatment in two groups.In addition,the complications of four groups were recorded.Results After blood purification treatment,urinary volume of two groups were significantly increased,the quantity of 24 h urinary protein and serum albumin were significantly improved,levels of serum urea nitrogen and serum creatinine were significantly decreased.The differences were statistically significant (P ＜ 0.05 or P ＜ 0.01).Compared with HD group,the urine volume increased more obviously in CVYH group after 2 weeks' treatment (P ＜ 0.05).The same time,24 h urinary protein was reduced and plasma albumin was improved more significantly (P ＜ 0.05),levcls of serum urea nitrogen and serum creatinine were not differ between the two groups (P ＞ 0.05).There was no difference in urine volume and renal function between the two groups (P ＞ 0.05) after 4 weeks' treatment.24 h urinary protein was significantly decreased and serum albumin was significantly higher than HD group (P ＜ 0.05).There were no serious complications in the two groups.Conclusion Blood purification in the treatment of diuretic resistance in patients with nephrotic edema is safe and effective.Continuous blood purification treatment can effectively alleviate nephrotic edema with diuretic resistance,promote the recovcry of renal function and improve the prognosis of kidney disease.

Purpose To explore the application of contrast-enhanced ultrasound in evaluating the local muscle microcirculation before and after acupuncture at Zusanli point in normal people.Materials and Methods A total of 72 healthy volunteers who visited the Department of Ultrasound,the Second Affiliated Hospital of Fujian Medical University from September 2018 to May 2020 were prospectively collected,all subjects performed ultrasound contrast before acupuncture,acupuncture with strongest deqi,and two hours after acupuncture to observe the blood flow perfusion of the microvessels in the tibialis anterior muscle.The pre-selected areas of interest the small arteries,muscle tissues and venules in the middle were analyzed to obtain the time-intensity curve and contrast transit time(CTTs)perfusion parameters.Needle sensation was evaluated using objective scoring criteria for acupuncture combined with moxibustion recipients.Gastrin,plasma gastrin,cholecystokinin,and secretin were measured in all subjects before acupuncture,when acupuncture had the strongest deqi,and two hours after acupuncture.Results ①CTTs of arterial-muscle,muscle-venous and arterial-venous of the tibialis anterior muscle at acupuncture with strongest deqi were significantly shorter than those at before acupuncture and two hours after acupuncture(all P<0.001),and there was no significant difference in CTTs before and after acupuncture and moxibustion(P>0.05);②when acupuncture deqi was strongest,serum gastrin,plasma prokinetics,cholecystokinin,and secretin were significantly increased compared with those before acupuncture and two hours after acupuncture,with statistically significant difference(all P<0.001),while there was no significant difference in these parameters between before acupuncture and two hours after acupuncture(P>0.05);③when acupuncture had the strongest deqi,there were positive correlations between gastrin,plasma prokinetic hormone,cholecystokinin,and secretin values and CTTs of arterial-muscle,muscle-venous,and arterial-venous(r=0.360-0.702,P<0.001).Conclusion Acupuncture of the Zusanli,when it gains the strongest deqi,can cause changes in the microcirculation around the skeletal muscle,leading to a significant shortening of CTTs,and also promotes the secretory function of the gastrointestinal tract.