老年尿毒症患者肾移植的围手术期处理(附23例报告)

Perioperative Management of Renal Transplantation in the Aged Uremic Patients(Report of 23 Cases)

目的:探讨老年患者肾移植围手术期的处理原则及治疗方案,以提高手术成功率。方法:对23例施行肾移植手术的老年尿毒症患者进行临床分析:术前详细检查,排除手术禁忌证;严格组织配型,采取恰当的手术方式;术后严密观察病情变化;采用合适的免疫抑制治疗方案。结果:23例患者手术全部成功。术后发生肺部感染5例,其中1例并发呼吸衰竭、心功能衰竭抢救无效死亡,1例再次肾移植患者出现移植肾功能延迟恢复(DGF)并出现急性排斥反应、心功能衰竭、肺部感染,经抢救无效死亡;心力衰竭1例,脑出血1例,急性排斥反应3例次,消化道出血1例,CsA、FK506浓度中毒各1例,经治疗后,患者均顺利度过围手术期。结论:应严格掌握适应证,良好的组织配型、高质量的供体、完备的术前准备、个体化的手术方式及免疫抑制治疗方案、防治并发症是手术成功的重要保证。

Objective：Investigate the perioperative management of renal transplantation in the aged uremic patients to improve the success rate of surgery. Methods：23 aged recipients received cadaveric renal allograft . The perioperative management of the patients were retrospectively analyzed. All the patients performed detailed examination before the surgery to rule out surgery contraindication. Keep the strict tissue matching, and take the appropriate surgical approach. Take close observation of changes in the condition after the surgery, and take the appropriate immunosuppressive therapy. Results： All the operations were carry out very well. Lung infection occurred in 5 cases, one of them died of respire failure and heart failure, but the others are recovered after treated. One case died of delayed graft function （DGF）, lung infection, heart failure. Heart failure occurred in 1, cerebral vascular accident occurred in 1, 3 cases of them acute rejection occured , one case of CsA, FKS06 toxicty, After treatment, all these 6 patients are cured. Conclusions： Renal transplantation is effective to end-stage renal disease in aged. Stricted tissue matching, good quantities of allografts, appropriate technique of operations, suitable immunosuppressants and prevention complications can improve successful rate.