术前管理对肾移植围术期并发症的影响分析

Influence of Preoperative Management On Perioperative Complications of Renal Transplantation

目的探讨改善肾移植围术期状况的管理模式,尤其是术前管理在肾移植中的意义。方法选取2017年8月至2020年12月于昆明市第一人民医院行肾移植手术患者127例,按照是否参与肾移植术前管理分为两组:观察组和对照组,观察组采用肾移植术前管理模式干预;对照组无特殊干预,遵循目前经验模式。通过临床资料分析,探讨肾移植术前管理在肾移植中发挥的作用。结果按照两组各自的管理模式,观察组术前尿素氮(blood urea nitrogen,BUN)、B型利钠肽(B-typenatriuretic peptide,BNP)明显低于对照组,差异有统计学意义(P<0.05);两组间的血浆白蛋白(plasma albumin,Alb)水平差异有统计学意义(P<0.05);观察组术后移植肾功能延迟恢复(delayed graft function,DGF)发生率和围术期感染率明显低于对照组,在术后7 d内血清肌酐(serum creatinine,SCr)水平、移植术后肾功能恢复所需时间明显优于对照组,差异有统计学意义(P<0.05);观察组的住院时长及总体医疗费用明显低于对照组,差异有统计学意义(P<0.05)。结论术前管理模式下的肾移植术后DGF发生率下降,围术期感染率降低,住院时间缩短,总费用降低,对改善肾移植的预后、节约医疗成本意义重大。

Objective To investigate the system management mode to improve the perioperative condition of renal transplantation,especially the significance of preoperative management in kidney transplantation.Methods A total of 127 patients underwent renal transplantation in Calmette Hospital&the First People’s Hospital of Kunming between August 2017 to December 2020.Enrolled patients were divided into two groups(Group of Calmette Hospital and Referral group of other hospitals),which according to whether they participated in preoperative management of renal transplantation in our hospital.The patients in the group of Calmette Hospital was treated and intervened with the system management mode of Calmette Hospital&the First People’s Hospital of Kunming,while the other hospital referral group had no special intervention and the current empirical mode of following.To explore the role of system preoperative management mode in renal transplantation through the analysis of clinical data.Results Two groups according to the difference of management mode,the levels of the BUN for preoperative,BNP in observation group were significantly lower than those in control group(P<0.05);Albumin level was significant differences in two groups(P<0.05);The incidence rate of DGF and perioperative infection rate in observation group were markedly lower than those in control group(P<0.05).Those of SCr within 7 days after surgery in observation group were significantly lower than in control group,and the recovery of recipient renal function after renal transplantation markedly shorten in observation group(P<0.05).The length of postoperative stay and total medical costs were markedly higher in control group than those in observation group(P<0.05).Conclusions The use of the system preoperative management mode of Calmette Hospital can significantly reduce the incidence rate of DGF and postoperative infection rate,shorten the hospital stay and total medical costs reduction;which is of great significance to improve the prognosis of kidney transplantation and save medical costs.