初次单侧全膝关节表面置换者肾功能的变化  

Changes of renal function of patients with first unilateral total knee arthroplasty

作　　者：张鹏[1] 刘军[2] 段圆慧[2] 龙刚[3] 

机构地区：[1]天津医科大学研究生院,天津市300070 [2]天津市人民医院关节外科,天津市300121 [3]天津市人民医院肾脏病科,天津市300121

出　　处：《中国组织工程研究》2013年第17期3065-3072,共8页Chinese Journal of Tissue Engineering Research

摘　　要：背景:全膝关节表面置换中植入假体系统、围手术期血流动力学的改变、药物等均可能对患者肾功能产生影响。目的:动态观察膝关节表面置换术围手术期相关处理对患者肾功能的影响。方法:纳入膝关节表面置换患者42例,检测患者置换前后血清肌酐、胱抑素C及尿微量白蛋白水平,比较置换前后患者肾功能。结果与结论:42例患者全膝关节表面置换均成功,在置换后1个月内未发生少尿、无尿、大量蛋白尿、肾衰竭等严重的肾脏并发症。围手术期血清肌酐水平未发生明显变化;胱抑素C水平在置换后1周内无明显变化,而在置换后1个月,较置换前下降;尿微量白蛋白水平在置换后1d上升,自置换后3d开始呈下降趋势,置换后7d、1个月尿微量白蛋白水平均较置换前降低。结果说明,全膝关节表面置换对患者肾功能仅产生了轻度的一过性损伤,并且置换后1个月患者肾功能平均水平得到改善。对初次行单侧膝关节表面置换患者,围手术期积极恰当的临床处理,不致对肾功能产生严重损伤。BACKGROUND：Implanting prosthesis system during operation, perioperative haemodynamics changes and drugs may affect the renal function of patients receiving total knee arthroplasty. OBJECTIVE：To dynamical y assess the effect of relative treatment on the renal function in the perioperative period of total knee arthroplasty. METHODS：Forty-two patients with total knee arthroplasty were included. The serum creatinine, cystatin C and microalbuminuria levels before and after total knee arthroplasty were detected, and then renal function before and after replacement were compared. RESULTS AND CONCLUSION：Al of the total knee arthroplasty operations were successful in 42 patients, and no oliguria, anuria, amount urinary protein and renal failure or other serious kidney complications were observed within 1 month after total knee arthroplasty. There was no change in serum creatinine level, so was cystatin C in 1 week after total knee arthroplasty, but the cystatin C level was decreased significantly at 1 month after the operation. The microalbuminuria concentration was increased at 1 day after total knee arthroplasty, and began to descent on day 3, and the microalbuminuria concentration at 7 days and 1 month after total knee arthroplasty was decreased when compared with that before operation. Total knee arthroplasty only caused mild damage to patients’ renal function, while the average level of renal function was improved at 1 month later. To the patients who receive the unilateral total knee arthroplasty for the first time, active appropriate clinical treatment may al eviate the kidney damage.

关 键 词：骨关节植入物 人工假体 全膝关节表面置换 膝关节置换 假体 肌酐 胱抑素C 肾功能 尿微量白蛋白 肾衰 血流动力学 肾 

分 类 号：R318[医药卫生—生物医学工程]