48例肾移植患儿围手术期的液体管理

Perioperative fluid management during pediatric kidney transplantation

目的探讨肾移植患儿围手术期液体管理的方法和效果。方法对48例行肾移植术的患儿,术前做好心功能和治疗依从性评估,根据儿童的循环特点,制订围手术期的输液方案,保持电解质平衡,减少因输液导致的各种并发症。结果本组48例患儿中有29例术后第1 d发生不同程度的电解质紊乱,经处理后在术后第2 d得到改善。出现少尿5例,移植肾功能延迟恢复3例,贫血9例,经控制输液量,改善肾脏微循环后,患儿移植肾功能恢复正常。结论制订合理的输液计划,保持电解质平衡,做好多尿、少尿和无尿期及移植肾功能延迟恢复患儿的液体管理对降低围手术期并发症发生,保证患儿顺利渡过围手术期具有重要的意义。

Objective To explore the strategies and effectiveness of perioperative fluid administration during pediatric kidney transplantation.Methods In our study,we evaluated the heart function and compliance of pediatric patients preoperatively,and then formulated perioperative fluid management strategy according to children’s circulation feature.The electrolytic balance was kept and complications were prevented.Results Twenty-nine out of all 48 children experienced electrolyte disturbance to different extents on day 1 postoperatively,which improved on day 2 after prompt management.There were five cases of oliguria,three cases of delayed graft function（DGF）,one case of heart failure and multiple organ failure respectively.Conclusion Such nursing strategies like formulation of reasonable fluid infusion plan according to the physiological features of pediatric recipients,keeping the electrolytic balance and careful management of fluid at polyuria,oliguria and anuria,care critical for the children to live through the perioperative periods.