肾移植受者围术期危急值的临床分析  

Clinical analysis of perioperative critical values in renal transplant recipients

作　　者：欧志宇 钟羽琦 陈飞雪 邓文锋[2] 曾文利[2] 苗芸[2] 徐健[2] 夏仁飞[2] Ou Zhiyu;Zhong Yuqi;Chen Feixue;Deng Wenfeng;Zeng Wenli;Miao Yun;Xu Jian;Xia Renfei(Southern Hospital,the First Clinical Medical College,Southern Medical University,Guangzhou 510515,Guangdong,China;Department of Organ Transplantation,Southern Hospital,Guangzhou 510515,Guangdong,China)

机构地区：[1]南方医科大学南方医院,南方医科大学第一临床医学院,广东广州510515 [2]南方医科大学南方医院器官移植科,广东广州510515

出　　处：《实用器官移植电子杂志》2021年第5期359-363,共5页Practical Journal of Organ Transplantation(Electronic Version)

基　　金：国家自然科学基金(82070770);广东省自然科学基金(2020A1515010674);广州市科技计划项目(201803010109);南方医院院长基金(2018B009,2018C003);大学生创新创业训练计划项目(202012121046,X202012121239)。

摘　　要：目的分析并总结肾移植受者围术期常见危急值的项目、特点及其原因。方法收集2018年1月至2020年11月出现危急值的283例次围术期肾移植受者的性别、年龄、原发病、移植时间、危急值项目、并发症和相应处理,以及移植术后免疫抑制剂血药浓度等资料并进行分析。结果肾移植受者术前最常见的危急值是血清肌酐水平过高,占62.7%(69/110),其次是电解质和酸碱紊乱,占27.3%(30/110);肾移植受者术后以电解质和酸碱紊乱最为常见,占39.9%(69/173),其次为微生物分离与培养阳性和血常规异常,分别占22.0%(38/173)和15.0%(26/173)。术前和术后出现危急值的平均年龄为(39.3±12.5)岁和(45.4±11.6)岁(P<0.001),且男女比例存在明显差异(分别为术前78.2%比21.8%和术后62.4%比37.6%,P<0.05)。结论肾移植受者术前处于肾病终末期,危急值多发生于透析不规律或不充分者,以及未规律复诊的患者,因此,对于等待移植的患者应重视宣教和随访,确保规律透析和定期复查。肾移植受者术后早期出现危急值多因机体内环境改变、多尿或利尿导致电解质紊乱、移植肾功能延迟恢复、急性排斥反应以及药物的相互作用所致。因此,对于术后患者管理要加强监测、及时调整。Objective The aim of this study is to analyze and summarize the markers,characteristics and causes of common critical values in renal transplant recipients during the perioperative period.Methods The data of gender,age,primary disease,transplantation time,critical values,complications and corresponding treatments as well as blood concentrations of immunosuppressive agents after transplantation were collected and analyzed in 283 cases of renal transplant recipients who presented with critical values between January 2018 and November 2020.Results The most common preoperative critical value of renal transplant recipients was high serum creatinine(62.7%,69/110),followed by electrolyte and acid-base disorders(27.3%,30/110).And the most common postoperative critical value of renal transplant recipients was electrolyte and acid-base disorders(39.9%,69/173),followed by microbial isolation or culture positivity(22.0%,38/173)and abnormal blood routine test(15.0%,26/173).The preoperative and postoperative mean age of patients presented with critical values were(39.3±12.5)years old and(45.4±11.6)years old(P<0.001),respectively.And the ratio of male to female were statistically significant(78.2%vs 21.8%preoperatively and 62.4%vs 37.6%postoperatively,P<0.05).Conclusion Renal transplant recipients are in the end stage of renal disease before transplantation,and critical values mostly occur in patients with irregular or inadequate dialysis,as well as in those with irregular follow-up.Therefore,attention should be paid to education and follow-up for the patients waiting for transplantation,to ensure regular dialysis and visits.The early emergence of critical values in renal transplant recipients is mainly due to the changes of internal environment,electrolyte imbalance caused by polyuria or diuresis,delayed graft function,acute rejection and drug interaction.Therefore,it is necessary to strengthen monitoring and timely adjustment for postoperative patients.

关 键 词：肾移植 危急值 围术期 

分 类 号：R699.2[医药卫生—泌尿科学]